Inspection on 28/06/07 for Lyndhurst Residential Home

This inspection was carried out on 28th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Lyndhurst Residential Home 15/12/08

Lyndhurst Residential Home 26/06/08

Lyndhurst Residential Home 19/06/06

Lyndhurst Residential Home 07/12/05

Lyndhurst Residential Home 30/08/05

Lyndhurst Residential Home 07/10/04

Lyndhurst Residential Home 27/08/04

Lyndhurst Residential Home 18/12/03

Lyndhurst Residential Home 24/06/03

Lyndhurst Residential Home 23/08/02

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Lyndhurst Residential Home Lyndhurst Road Goring On Thames Reading RG8 9BL Lead Inspector Robert Dawes Unannounced Inspection 28th June 2007 10:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lyndhurst Residential Home DS0000013107.V342967.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lyndhurst Residential Home DS0000013107.V342967.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lyndhurst Residential Home Address Lyndhurst Road Goring On Thames Reading RG8 9BL Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01491 873397 Lyndhurst (Goring) Limited Kathleen Hayman Care Home 23 Category(ies) of Dementia - over 65 years of age (3), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (1), Old age, not falling within any other category (23) Lyndhurst Residential Home DS0000013107.V342967.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The total number of persons that may be accommodated at any one time must not exceed 23. 19th June 2006 Date of last inspection Brief Description of the Service: Lyndhurst Residential Home is a residential home registered for 23 older persons who require personal care and accommodation. The home is privately owned and is set in the village of Goring. The accommodation is provided in a Victorian style house. The house has been altered and adapted for its purpose. Many rooms are large and bright with views of the countryside and the village green. The village offers shops, pubs and cafes with transport links to Reading and Oxford. Staff are provided in adequate numbers to enable care to be provided in a relaxed manner, taking account of service users’ privacy and dignity. Fees range from £500 per week to £650 per week. Lyndhurst Residential Home DS0000013107.V342967.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced site visit, which took place during the day on the 28th June 2007. The Annual Quality Assurance Assessment and one resident’s survey were returned to the inspector before the site visit. These, together with the site visit, were the main sources of information for the key inspection. During the site visit the inspector interviewed the manager, cook and two carers; discussed the quality of care with four residents; toured the premises; looked at records; case tracked; and observed the interaction between clients and staff. Four of the seven outcome groups were scored as good, two as adequate and one as poor. Four requirements and four recommendations were made. What the service does well: What has improved since the last inspection? Chairs have been replaced for all the residents in both lounges. A new drugs trolley been purchased. More garden furniture been purchased. Decoration has taken place inside and outside of the home. Staffing numbers have increased. Lyndhurst Residential Home DS0000013107.V342967.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Lyndhurst Residential Home DS0000013107.V342967.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lyndhurst Residential Home DS0000013107.V342967.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Number 3. People who use the service experience good quality outcomes in this area. No client moves into the home without having had his/her needs assessed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Records showed that the health and social care needs of prospective clients are assessed prior to their admission. Appropriate admission procedures are in place. Lyndhurst Residential Home DS0000013107.V342967.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Numbers 7, 8, 9 and 10. People who use the service experience good quality outcomes in this area. All residents have individual care plans which are regularly reviewed. The care plans contained the required information and records but the quality of background information and information about residents’ diverse leisure and social activities and cultural interests should be improved. The residents’ physical and emotional health needs are well met; they are protected by the home’s medication procedures; and are treated with respect and dignity. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All residents’ files seen had care plans which had been reviewed every month. In addition, residents placed by social services’ departments had been reviewed annually. Information about residents’ interests and hobbies and background information was not sufficiently detailed to ensure residents were offered activities and leisure pursuits that suited their preferences and capabilities. A key worker system operates in the home. Lyndhurst Residential Home DS0000013107.V342967.R01.S.doc Version 5.2 Page 10 All the files contained appropriate health records of appointments and charts to monitor weight, nutrition, pressure sores and personal care tasks such as baths, cleaning teeth and washing hair. They showed the clients’ physical health and personal care are being well monitored, responded to appropriately and any problems are being promptly addressed. Clients looked clean and presentable. In response to the question in the resident’s survey, ‘do you receive the medical support you need?’ the resident replied, ‘yes’. Residents said their health is well looked after by the staff. None of the clients self-administer their medication. There are no controlled drugs on the premises. The medication administration records were in order. There are five trained staff plus the manager to cover all the shifts. The manager said medication was always administered by a trained member of staff. Appropriate medication policies and procedures are in place. A pharmacist visits the home regularly to inspect the storage, administration, recording and disposal of the medication. The pharmacist last visited in March 2007 and made no recommendations. Residents said ‘staff were nice’, ‘ we are treated as individuals’, staff are very good and respectful’, ‘don’t rush you with personal care’, ‘respond to call bells straight away’, and ‘ help you settle into the home’. A relative commented in the resident’s survey, ‘I couldn’t wish for a better home for my mum to be in, the staff always treat every one with patience, gentleness and above all genuine love’. Lyndhurst Residential Home DS0000013107.V342967.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Numbers 12, 13, 14 and 15. People who use the service experience adequate quality outcomes in this area. The residents’ routines of daily living are flexible and varied to suit their expectations, diverse needs and preferences; friends and relatives can visit at any reasonable time; and are offered a healthy diet and enjoy their meals. Leisure and recreational activities are offered to residents but the range and number must be improved to offer more choice and cater for the needs of residents who suffer from dementia. Residents are helped to exercise choice and control over their lives except for those who smoke. Staff hold their cigarettes and matches without risk assessments being undertaken and agreements signed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents said, ‘they can get up and go to bed when they like’, ‘choose what activities to take part in’, ‘could do with one or two outings’, ‘can go to your room or in the garden’, ‘no one plays the piano’, ‘there is no exercise lady’ and ‘there is no mobile library’. Lyndhurst Residential Home DS0000013107.V342967.R01.S.doc Version 5.2 Page 12 In response to the question in the resident’s survey, ‘are there activities arranged by the home that you can take part in?’ the resident replied, ‘sometimes’. Residents are offered activities such as gardening (flower beds have been raised to assist residents), painting, cooking, giant snakes and ladders, giant dominos and helping to lay the tables for meals. An overhead projector has been purchased to project images onto walls and ceilings for when residents are bed bound. Three residents attend a day centre in the community once a week. A local group sing for the residents every week, a Church of England service is held in the home once a month and a local Catholic priest brings communion to residents every fortnight. If residents requested to attend a local church service they would be taken. The home maintains a daily record of activities in the home which showed a wide range of activities has not been offered to residents on a daily basis in recent months. This was an issue raised at the June 2006 inspection. Staff said activities for residents have suffered while the home has been building up the staffing numbers again. Staff were observed talking to residents and one member of staff was playing a spelling game with a resident. The home is trying to recruit a person to provide gentle exercise sessions for the residents. Residents said relatives can visit at any time. Residents can bring personal possessions with them. No record of residents’ personal possessions was seen in files. Residents have access to personal records. One resident who smokes said staff keep her lighter and cigarettes but she would prefer to look after them herself. The manager said it had been discussed at a review with relatives but no risk assessment or agreement had been produced. The resident said she is not restricted in any other way. Residents said, ‘if you don’t like a meal they will give you something else’, ‘the meals are good’, ‘staff bring round hot and cold drinks’ and ‘there is plenty of choice’. In response to the question in the resident’s survey, ‘do you like the meals at the home?’ the resident replied, ‘always’. Lyndhurst Residential Home DS0000013107.V342967.R01.S.doc Version 5.2 Page 13 Residents are offered hot and cold choices for breakfast; a choice at lunch, including a variety of puddings; and hot and cold snacks for supper. The cook operates a five week menu. A varied, wholesome and nutricious diet for the clients using as much fresh produce as possible is provided. Menus are discussed individually. The cook is aware of every individuals likes and dislikes. A glass of sherry is often offerd before lunch and evening meals. Dietary and cultural needs are catered for. Lyndhurst Residential Home DS0000013107.V342967.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Numbers 16 and 18. People who use the service experience good quality outcomes in this area. People who use the service feel their views are listened to and acted on; and are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is an appropriate complaints procedure in place. No complaints to the Commission or the home have been made since the last inspection. In response to the question in the resident’s survey, ‘do you know how to make a complaint?’ and ‘do you know who to speak to if you are not happy?’ The resident replied ‘yes’. In the homes’ residents survey all the residents said staff were approachable and they new how to make a complaint. The majority of staff, through in house training or studying for a NVQ in care, have received training in safeguarding older people. Lyndhurst Residential Home DS0000013107.V342967.R01.S.doc Version 5.2 Page 15 Staff were clear about how to respond to protection issues. No allegations of abuse have been made to the Commission since the last inspection. Safeguarding older peoples’ policies and procedures are in place. Lyndhurst Residential Home DS0000013107.V342967.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Numbers 19 and 26. People who use the service experience good quality outcomes in this area. The home is comfortable, safe, well decorated and well maintained. Residents have all the technical aids and equipment to lead as full and independent lives as possible. The home is clean and hygienic. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is situated in a pleasant location and is spacious, comfortable, safe, well decorated and well maintained. The pleasant garden is accessible to all the residents. On the day of the site visit the home was clean and free of offensive odours. In response to the question in the residents’ survey, ‘is the home fresh and clean?’ the resident replied ‘always’. Residents said ‘the home is warm and comfortable’. Lyndhurst Residential Home DS0000013107.V342967.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Numbers 27, 28, 29 and 30. People who use the service experience poor quality outcomes in this area. The ratio of staff on duty to the number of residents is very good and residents said they are cared for patiently and without discrimination. Over 50 of the care staff should have achieved a NVQ 2 or above in care within six months. Recruitment procedures could place residents at risk. Only a minority of staff have received the necessary training to equip them with the skills and knowledge to ensure the residents assessed needs are met at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Five care staff are on duty in the mornings; four care staff in the afternoons and evenings; and two care staff at night. In addition the home employs a domestic, cook and a maintenance man. Six care staff have left in the last twelve months. Agency staff have been employed in December 2006 and in May 2007. Staff were observed to be attentive to residents needs. In response to the questions in the resident’s survey, ‘do you receive the care and support you need?’, ‘do the staff listen and act on what you say?’, and are the staff available when you need them?’, the resident replied ‘yes’. Lyndhurst Residential Home DS0000013107.V342967.R01.S.doc Version 5.2 Page 18 38 of the care staff have a NVQ2 or above in care. Three staff who do not have a NVQ are currently studying for the qualification. When they complete their studies 56 of the care staff will be qualified. Three staff who have a NVQ2 are studying for a NVQ3 in care. Records showed staff are starting supervised work in the home without written references, CRB clearance or POVA first checks completed. The manager said that verbal references are obtained before a new member of staff starts work and they do not work alone until the POVA first check has been completed. This practice is not recommended by the CRB and could place residents at risk. A new member of staff must not work in the home until two written references and a POVA first check have been obtained and must not work alone until a CRB check has been returned. The manager can not be certain that the person she obtains a verbal reference from is the person who will be sending the written reference and it is impossible to ensure that a new member of staff is never on his/her own in the home. New staff undertake an induction training programme and all staff have received up to date food hygiene and fire awareness training. However only four care staff have received first aid training; five care staff medication training; two care staff moving and handling training; two care staff health and safety training; and two care staff dementia training. None of the staff have training profiles Lyndhurst Residential Home DS0000013107.V342967.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Numbers 31, 33, 35 and 38. People who use the service experience adequate quality outcomes in this area. The manager is qualified and competent to run the home but must address the requirements made during this inspection. Systems are in place to gain the views of residents and relatives about the standard of care provided in the home. All the necessary health and safety checks take place but because the home operates a poor recruitment practice and insufficient number of staff are trained to administer first aid the residents’ safety and welfare is not properly protected. This judgement has been made using available evidence including a visit to this service. Lyndhurst Residential Home DS0000013107.V342967.R01.S.doc Version 5.2 Page 20 EVIDENCE: The manager, who has been in post just over a year, has completed the Registered Manager’s Award, NVQ 4 in care and has been accepted as a NVQ assessor. She will be applying to become the registered manager for the home. Staff said the manager is supportive, listens to staff’s views and is clear about how the residents should be cared for. A comprehensive residents’ survey is sent to residents and relatives annually but not to professionals who are involved with the residents. A meeting for residents and relatives takes place annually before the surveys are distributed. Regular staff meetings take place. The registered provider visits the home most days and is involved in the dayto-day management of the home. A summary of the surveys returned and an annual development plan are not produced. Regular residents’ meetings do not take place. The home does not look after any service users’ finances or personal money. All health checks and inspection take place as required. The home has an up to date fire risk assessment and monthly health and safety inspections of the home take place. Insufficient number of staff have received first aid training, health and safety training and moving and handling training to ensure the safety of residents at all times. Lyndhurst Residential Home DS0000013107.V342967.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Lyndhurst Residential Home DS0000013107.V342967.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP12 Regulation 16 Requirement Timescale for action 30/09/07 2 OP14 12 3 OP29 19 4 OP30 18 A range of leisure and social activities must be on offer that provides residents with sufficient stimulation and suites their likes and capabilities, i.e. those suffering from dementia. Risk assessments must be 31/07/07 undertaken on residents who smoke to determine whether or not it is safe to allow them to keep their cigarettes and matches. If it is concluded that staff should hold the cigarettes for the resident an agreement to that effect must be signed by the resident/relative and manager. The provider must follow safe 31/07/07 recruitment procedures and ensure a minimum of two written references and a POVA first check is obtained before a new member of staff starts supervised work in the home. The manager must ensure that 31/10/07 all staff are suitably trained to undertake their duties safely and competently and that training profiles for each member of staff are maintained. (This DS0000013107.V342967.R01.S.doc Version 5.2 Lyndhurst Residential Home Page 23 requirement was first made following the 19/06/06 inspection) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations All care plans should have detailed information about the residents’ background and their diverse interests and hobbies in order for the home to provide a range of leisure activities that suit the residents’ preferences and capabilities. A record is kept of personal possessions residents bring into the home. A summary of the residents’ survey is produced and made available for interested parties to read. An annual development plan is produced in order that the progress of key objectives can be monitored. 2 3 4 OP37 OP33 OP33 Lyndhurst Residential Home DS0000013107.V342967.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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