This inspection was carried out on 14th October 2009.
CQC found this care home to be providing an Adequate service.
The inspector found there to be outstanding requirements from the previous inspection
report. These are things the inspector asked to be changed, but found they had not done.
The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.
Random inspection report
Care homes for older people
Name: Address: Lyndon Hall Nursing Home Malvern Close West Bromwich West Midlands B71 1PP one star adequate service 23/06/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Karen Thompson Date: 1 4 1 0 2 0 0 9 Information about the care home
Name of care home: Address: Lyndon Hall Nursing Home Malvern Close West Bromwich West Midlands B71 1PP 01215005777 01215005551 lyndonhall@schealthcare.co.uk www.schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Southern Cross Healthcare Services Ltd care home 80 Number of places (if applicable): Under 65 Over 65 0 40 dementia old age, not falling within any other category Conditions of registration: 40 0 The maximum number of service users who can be accommodated is: 80 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 40, Old age, not falling within any other category (OP) 40 Date of last inspection Brief description of the care home Lyndon Hall Nursing Home is a purpose built three-storey building. The Home is set in attractive grounds surrounded by mature trees. There is car parking facilities available. Entrance to the home is through a secure door that leads into a small reception area. Accommodation is provided on the ground and first floor with a staff room and meeting
Care Homes for Older People Page 2 of 12 2 3 0 6 2 0 0 9 Brief description of the care home room on the second floor. The home is divided into four 20 bedded units, namely Poppy, Rose, Sunflower and Bluebell. Poppy unit and Sunflower are registered for the care of persons with Dementia and are situated on the first floor. Rose and Bluebell are situated on the ground floor and are registered to accommodate people who are elderly and frail. Each unit has a large lounge and separate dining room for communal use. There is also a quiet lounge situated on Bluebell. There are seventy-eight bedrooms in total, sixty-six single rooms with en-suite facilities and two double bedrooms both also having en-suite facilities available on Sunflower and Rose units, and ten single rooms without en-suite facilities, five on Poppy and five on Bluebell. Assisted baths are available on each unit. A shaft lift is available to provide access to all floors. Care Homes for Older People Page 3 of 12 What we found:
The reason for this inspection was to monitor complaince with statutory requirements issued following the key inspection in June 2009 and to look at concerns raised about meeting nutritional needs of people living in the home. Three inspectors visited the home on 14 October 2009, one of these was the specialist pharmacy inspector. We only visited two of the four units at the home Sunflower and Poppy and our finding are based on our visit to these units only. The outcome is as follows: The pharmacy inspector found that medication was stored in locked treatment rooms. The temperatures of the rooms were recorded daily and were within the correct storage temperature for medication. We saw that the medication refrigerator was locked and a daily record of the temperatures was within the correct storage temperature. This means that medication was stored securely and within the recommended temperature ranges. We looked at the current records for the receipt and administration of medication for people living in the home and found that overall the medication records were well recorded. The majority of the medication administration record (MAR) charts were documented by the care staff either with a signature for administration or a code was documented with a reason why medication was not given. The receipt of medication was documented onto the MAR charts. Balances of medication were carried forward from an old MAR chart to a new MAR chart. The date of opening of any boxed or bottles of medication was recorded. This means that medication checks could be done to ensure medicine had been given to people who live in the service. We did see one example where the check was not accurate because the MAR chart records were unclear. We informed the manager of this particular example in order to ensure the health and well being of people who live in the home are safeguarded . We saw that some people were prescribed medicine which was to be given on a when required or as needed basis. For example, one person was prescribed medication for agitation. There was no guidance for staff to follow to ensure that the medication was given according to a behaviour management plan. It was not clear what calming measures were used and under what specific circumstances the medication would be required to be given to the person. We checked the medication and healthcare records for the person. There was no record of the medication documented in the healthcare records. We saw that the medication had been recorded as given on two separate occasions but there was no recorded evidence why it had been given. We spoke to the nurse in charge who informed us that the nurses would use their discretion but agreed this was not documented. This means that a medication for behaviour control had been administered but there was no written documentation available to explain why it had been administered to ensure the safety of the person. We found information that suggested that one person was being given their medication in food or drink without their knowledge. This is covert administration of medication. We saw a written record in the care plan that stated that the family and GP were aware of this. A letter was seen from the GP which indicated that the medication could be administered with food or drink but was not specific that the medication was being given without the persons consent. We saw a document for the administration of covert medication in the persons care plan which suggested that the medication was being
Care Homes for Older People Page 4 of 12 given without their knowledge. We saw that the MAR chart had no information documented about how the persons medication should be given in food or drink. We spoke to the nurse in charge who was unable to give any further information because the medication was given by the night staff. The information we found was not clear and we were unable to determine how the person was being given their medication. This means that the health and well being of people living at the home were not safeguarded. We spoke to staff about the care they provided for people living in the home. Care planning records do not match the care being provided to people living the home. Staff spoken to demonstrate they had an individual approach to providing care. This was not being recorded in the care records. For example, one person who chose to sleep part of the night in an armchair in the lounge did not have this mentioned in their care plan. Staff also demonstrated they were knowledgable about individual needs such as behaviour that challenges. They were able to give times and dates of instances which had occurred in relation to behaviour that challenges but these were not being recorded in the care records. This means there is no overview to establish whether the are any patterns and trends for behaviour. Staff told us they had no training in managing behaviour that challenges. The home was unable to supply us with its internal training matrix to demonstrate what training staff had recieved. The home has introduced a new handover sheet system to ensure that carers knowledge is formally recorded and passed onto the trained nursing staff. We found one example where care staff had passed on concerns about the physical health of someone living in the home the day before our visit but had not felt listened to and bought it to our attention. We felt these concerns should have been listened to and acted upon. Once bought to the attention of management team the appropriate action was taken. This demonstrates that despite communication systems being in place these are not leading to action to protect and promote the well being of people living in the home. Nutritional care is another example of poor communication systems within the home. Staff weigh people living in the home on a regular basis. Approximately one third of people living on the Sunflower unit are underweight. Staff told us they complete a food chart for all people living on the unit. Supplements have been prescribed and are offered to people if staff feel they should have one, for example if they miss a meal. The kitchen staff have introduced a comments book to get feed back on the food they are producing. The kitchen staff were only aware of one person being underweight and needing extra calories in the form of grated cheese. Extra calories in the form of butter and cream we were told was added to food as standard. The home has a night snack box system. The night snack box system should provide food for people living in the home when the main kitchen is closed. Care staff spoken to were not aware of the availability of the night snack box system. The contents of the night snack box which is kept in the kitchenette area of the home consisted of fish paste, cornbeef, marmalade and spaghetti. The kitchenette areas where the night snack box was kept had no utensils for preparing or serving food for example, plate, knife and fork. There was also no tea or coffee available in this kitchenette or mugs or cups to make drinks outside kitchen hours. Kitchen staff informed us that the dishwasher, spray rinser, hot water dispenser, food mixer and hot food trolleys were now working or had been replaced. Other improvements we were told of during this inspection included the bathrooms. We were told they are all now in working order and ready for people to access. Care Homes for Older People Page 5 of 12 What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 12 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 8 12 Care planning and record 07/08/2009 keeping for behaviour that challenges must be based on a thorough assessment of needs and show how care is to be delivered. Care plans must be accessible to staff delivering the care and be a reflectin of the care being given. Care plans must be reviewed at the point where a persons needs change or routinely and staff must be aware of these changes. This will ensure that people living at the home have their needs meet and their rights protected and promoted 2 9 13 Medication must not be 14/08/2009 covertly administered unless a multi disciplinary decision has been obtained and is in agreement with this. This will ensure that the rights and risks are promoted and protected for the person concerned. Care Homes for Older People Page 7 of 12 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 7 12 Systems must reviewed and monitored for the provision of food outside main kitchen times. To ensure that people living at the home have their nutritional needs meet. 30/11/2009 2 7 17 Care plans must be based on 30/11/2009 a though assessment of needs and show how care is to be delivered. Care plans must be accessible to the staff delivering the care being given. Care plans must be reviewed and amended at the point where a persons needs changes or routinely and staff must be aware of these changes. To ensure that people living in the home are provided with care that meets their needs. 3 9 13 The service must make 30/11/2009 arrangements to ensure that care plans include detailed information and instructions
Page 8 of 12 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action for staff in respect of the administration and management of medication, including the reasons to give medicines on as and when required basis. To ensure and promote the safety and wellbeing of people receiving medication in the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 7 An audit of dependency scoring be carried out to ensure these are an accurate reflection of dependency. (Recommendation made at June 2009 key inspection not assessed at this inspection visit) The identified frequency in the care plans of receiving a bath or shower should be made available to people living in the home and the frequency tailored to their wishes. (Recommendation made at June 2009 key inspection not assessed at this inspection visit) Trained staff working at the home should re-familirise themselves with the Nursing and Midwifery Council Record Keeping document to promote and protect the health and well being of people living in the home. (Recommendation made at June 2009 key inspection not assessed at this inspection visit) Recording of behaviour that challenges should be organised to ensure that all information is available and does not hinder the retrieval of information which could be of benefit to people receiving care at home. (Recommendation made at June 2009 key inspection not assessed at this inspection visit) The home must consider the arrangements for supervising
Page 9 of 12 2 7 3 7 4 8 5 10 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations people with behaviour that challenges and staff awareness for ensuring privacy and dignity is maintained for all persons living at the home. (Recommendation made at June 2009 key inspection not assessed at this inspection visit) 6 12 Activities should be reviewed and based on indiviudal needs. Following this review an action plan should be drawn up and findings implemented. (Recommendation made at June 2009 key inspection not assessed at this inspection visit) The televisions provided in the communal areas of the home should meet the needs of all persons recognising the impact of visual impairment in old age. (Recommendation made at June 2009 key inspection not assessed at this inspection visit) Menus should be reviewed with people living at the home. (Recommendation made at June 2009 key inspection not assessed at this inspection visit) Food should be cooked to required standard so that it is edible. (Recommendation made at June 2009 key inspection not assessed at this inspection visit) Management of complaints should be reviewed so that they are dealt with appropriately and sensitively and do not reoccur. (Recommendation made at June 2009 key inspection not assessed at this inspection visit). The home should ensure that staff are trained on a regular basis in safeguarding procedures to ensure that all peoples are protected. (Recommendation made at June 2009 key inspection not assessed at this inspection visit) It is recommended that the home obtain a copy of the Department of Health Guidance Mental Capacity Act 2005 core training set published July 2007 and staff are provided with training so that staff are aware of their role and responsibility and peoples rights are protected. (Recommendation made at June 2009 key inspection not assessed at this inspection visit) The refurbishment and replacement programme should have timescales for completion to ensure things do not slip. (Recommendation made at June 2009 key inspection not assessed at this inspection visit)
Page 10 of 12 7 12 8 15 9 15 10 16 11 18 12 18 13 19 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 14 26 The third washing machine should be in working order to ensure peoples clothes are laundered in a timely manner. (Recommendation made at June 2009 key inspection not assessed at this inspection visit) Staffing levels should be reviewed in the home so that people living in the home receive care in an appropriate manner. (Recommendation made at June 2009 key inspection not assessed at this inspection visit) Shortfalls identified in training needs such as fire, food hygiene, safeguarding, infection control, mental capacity, nutrition and specialist topics must be addressed in the appropriate learning style so that this training embeds. This will ensure that knowledge and practice mirror and meets the needs of people living in the home. (Recommendation made at June 2009 key inspection not assessed at this inspection visit) The management team should review the systems of support for staff to ensure the workforce can perform appropriately. The management team needs to capture the commitment of those staff who show an excellent level of committment by ensuring these members of staff are supported and have the skills and competences to deliver care that meets peoples needs. (Recommendation made at June 2009 key inspection not assessed at this inspection visit) Issues identified in the quality assurance systems should be swiftly addressed and monitored on a regular basis to ensure and develop more positive outcomes for people. (Recommendation made at June 2009 key inspection not assessed at this inspection visit) 15 27 16 30 17 32 18 33 Care Homes for Older People Page 11 of 12 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 12 of 12 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
