Inspection on 30/01/09 for Lyndon Rest Home

This inspection was carried out on 30th January 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lyndon Rest Home 14/02/07

Lyndon Rest Home 20/07/05

Lyndon Rest Home 15/03/05

Lyndon Rest Home 14/04/04

Lyndon Rest Home 29/03/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Lyndon Rest Home 79 Bury Road Tottington Bury Lancs BL8 3EU     The quality rating for this care home is:   two star good service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sarah Tomlinson     Date: 3 0 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Lyndon Rest Home 79 Bury Road Tottington Bury Lancs BL8 3EU 01204885124 F/P01204885124 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Mary Galvin Name of registered manager (if applicable) Mrs Mary Galvin Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The home is registered for a maximum of 16 service users, to include: Up to 16 service users in the category of OP (Older People). The service should employ a suitably qualified and experienced manager, who is registered with the Commission for Social Care Inspection. Date of last inspection Brief description of the care home Lyndon is a private care home, owned and managed by Mrs Mary Galvin. The home is registered with us (the commission) to provide care for up to 16 older people. It is on two floors, with eleven bedrooms - six singles and five shared bedrooms (doubles). All bedrooms have wash hand basins (there are no ensuites). There is no passenger lift, rather there are two stair/chair lifts. The home has two lounges, a conservatory and a dining room. Toilets are provided on both floors and there is an assisted bathroom on the first floor. There is a small garden area with seating that can be reached from the Care Homes for Older People Page 4 of 30 care home 16 Over 65 16 0 Brief description of the care home conservatory. The home is on main road, in a residential area about one mile from Tottington town centre. There is a bus stop to the front and a private car park at the rear. The current fees (at 1/2009) are 369.00 pounds per week (toiletries, hairdressing and dry cleaning are not included). A copy of our latest inspection report is available from the homes office. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Our visit, which the home was not told about beforehand, lasted 9 hours. We talked with six residents, two visitors and with staff (four carers, the cook and the owner/manager). We spent time watching how staff cared for residents. We also looked around all communal areas, some bedrooms and at some paperwork. Before our inspection we sent surveys to people who visit and work in the home. Five relatives and nine staff returned them. Their views are included in this report. We have also used information from an Annual Quality Assurance Assessment form (AQAA). The home has to complete this each year, telling us what they do well and what they would like to do better. Care Homes for Older People Page 6 of 30 We last inspected this service on 14th February 2007. What the care home does well: What has improved since the last inspection? What they could do better: With regard to record keeping - clearer records would better show the social activities provided for each resident; and minor changes to medicine administration records and the keeping of staff photographs would help keep residents safe. Recording discussions and decisions about the sharing of bedrooms would show how residents and family were fully involved. To make sure staff have up to date skills and knowledge, they all need training at least once a year in fire safety and in moving residents. At least one member of staff per shift also needs to know what to do if a resident chokes. Clearer training records would help make sure this training was being done. To make sure staff get the support and guidance they need, the induction for new staff should be developed, whilst existing staff should have more regular formal supervision. Care Homes for Older People Page 8 of 30 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 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information provided by the home about its fees was now clearer, helping a person decide if Lyndon was the right place for them. Information about their needs was properly received by the home, ensuring these could be met before admission. Evidence: We looked at the brochure (Service Users Guide) given to prospective residents and their families, telling them about Lyndon. As we requested at our last inspection, this brochure and the homes contract had both been updated - with clearer information about the cost of living in the home. In response to feedback from a relative, Mrs Galvin also confirmed improvements in the homes invoicing system, with families receiving clearer details of the period covered. Three new residents had moved in since our last inspection. Good practice was noted, as one person had been given the opportunity to visit the home and stay for a meal to Care Homes for Older People Page 11 of 30 Evidence: help them decide about moving in. The family of another person had looked around the home before their relative had moved in. The family of a new resident confirmed they had received a brochure and a contract from the home. We discussed how our last report was made available to visitors. Due to one resident moving paperwork, a copy was kept in the office. We advised a brief, large print notice could be displayed next to our registration certificates in the hallway, telling visitors where a copy was kept and inviting them to read it. We looked at the pre-admission records of two of the new residents (one funded by Social Services, the other self funded). Good practice was noted, as their care and support needs had been confirmed before they had moved in - with assessment details received from Social Services for the former and a brief, formal assessment completed by Mrs Galvin during a visit to the latter resident. One person was receiving day care during our inspection. This was the first person to do so at the home for a number of years. Mrs Galvin was aware of the need to monitor the impact a person staying for day care might have upon residents. (Intermediate care is not provided by the home. Consequently standard 6 does not apply and was not assessed). Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents received good, personalised care. Minor improvements in some record keeping would strenghten this further. Evidence: We spent time watching how staff spoke to and cared for residents. Staff on duty were warm, considerate, patient and respectful (e.g. crouching down to make eye contact when talking with residents who were seated and being discreet when taking residents to the toilet). One resident spoke highly of the staff, saying they were very kind...very thoughtful. Another resident said they felt well looked after...very lucky to be here...all staff lovely, you only have to ask and theyll do anything for you. A third resident said they were very satisfied with the home. We also received positive feedback from relatives about the care provided. One said they were always made welcome and kept informed of their residents welfare and they cant fault the home ... [and were] extremely satisfied. Care Homes for Older People Page 13 of 30 Evidence: The care staff we spoke with had a good understanding of the help and support residents needed and how they liked this to be given. Care records generally supported this. Although all care staff worked with all residents, the home also had a personal worker system, whereby each staff member was allocated a resident, with additional minor practical responsibilities (e.g. managing their clothes). We advised this could be developed further, with the personal worker also helping their resident to bathe or shower (taking into account residents preferences and shift patterns). Although the staff group was small, it would ensure this intimate task was not shared across the staff team, further promoting residents dignity and privacy. Five of the homes eleven bedrooms were shared rooms (double occupancy). All these rooms had curtains or a screen provided to ensure privacy when intimate personal care was being given. We advised the current practical arrangements for hairdressing needed to change. To respect the privacy of residents individual bedrooms, one (occupied) bedroom should stop being used for all residents. As there was no hairdressing room, residents hair should be done in their own individual bedrooms or in a communal room (e.g. bathroom). We looked at three residents files in detail. These were satisfactory and were being regularly reviewed. As requested at our last inspection, these were now being signed and dated by staff on completion (with residents or their familys involvement where possible). All had personalised care plans. We advised daily care notes could be improved to better reflect care plans and the actual care staff gave (e.g. one residents care plan said they should be helped to do daily exercises, but their daily care notes did not mention if staff supported them to do these, only stating instead all cares given). We found risk issues were being thought about and acted upon. At our last inspection, we found some risk assessments were not up to date. New risk documents had now been introduced (with assessments for diet, moving and handling, and pressure area care). These were generally being reviewed and updated appropriately. Although one residents nutrition assessment had not been updated after major weight loss (although action had been taken to investigate the loss). We again advised links needed to be maintained between all relevant care forms. Good practice was noted, as residents health was actively promoted and maintained. At our last inspection, relatives of a new resident had been very pleased with the Care Homes for Older People Page 14 of 30 Evidence: health screening received after they had moved in. This was again noted at this inspection. Relatives of new resident said although their resident had been very poorly before admission, she had since put on weight, was now able to walk without a zimmer frame, had been seen by chiropody and an optician and had received new glasses. Brief records confirmed residents received regular health care check ups. Health care services (e.g. GP, district nurse, psychiatrist) were promptly contacted with any concerns (e.g. weight loss). These records could be improved to better reflect the excellent health care being given, with clearer details recorded of the reason for a check up or visit, the outcome and any follow up action. We discussed changes to the care received by one resident, who was now being cared for in their first floor bedroom. We advised their care records were updated to show this and their Social Services reviewing officer was informed. We looked at a sample of medication records and medicines. Medicines were stored safely. A medicine trolley was used and this was kept in a lockable cupboard when not in use. There was separate secure storage for controlled drugs. Records were generally in good order, with an audit trail showing medicines entering the home, being administered to residents and any unused medicines returned to the pharmacist. There was one minor discrepancy in the Controlled Medicines record book and several handwritten entries on medicine administration records (MARs) had not been countersigned (to reduce the risk of error). Good practice was noted, as to aid identification photographs of residents were in place. We discussed the administration of prescribed creams or ointments (or prescribed supplement drinks). We advised the person administering the cream should be the person signing the MAR. A separate MAR can be used for this purpose (and kept with the cream). Creams can be kept in a residents room, as long as safe and secure storage is available. Staff who administer such cream must have been trained to do so and understand what it is for. Residents care plans should include details of any prescribed cream and what it is for, with entries made in daily care notes when it is used. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents enjoyed a choice of good food and a mix of social activities. To strengthen this area, evidence of the latter needs to be better shown. Evidence: The home did not employ an activities co-ordinator, rather care staff organised and carried out social activities, usually in the afternoon. There was no set timetable, with staff usually chosing an activity from the guide displayed in the hallway. This listed a range of activities, including bingo, hand massage and reminiscence. The latter two activities had been introduced following our request at the last inspection for more activities for less able residents. Good practice was noted, as there was a new weekly arts and crafts group, run by a visiting activity worker. Further good practice was noted, as a choir and a musical entertainer both continued to visit monthly. The hairdresser visited twice a week. We discussed the benefits of continuing to develop ordinary, everyday activities for residents, e.g. folding small items of linen, stockings, socks etc. each day with residents in the lounge; residents helping dust ornaments; and if able and willing, Care Homes for Older People Page 16 of 30 Evidence: helping make their own beds. Reminiscene memorabilia, photographs and particularly objects could also be placed around the home for residents to look at and touch (rather than being brought out for formal reminiscence sessions). Whilst one residents relatives said they usually saw social activities taking place when they visited (which was three times a week), we had difficulty confirming what activities individual residents partipated in, as this was not usually recorded. With regard to more confused residents, we advised the personal worker role could also include developing a life history for their resident. These would provide information about a residents life, including family members, jobs and hobbies (which in turn could help shape one to one and group social activities). Visitors felt they were made very welcome. Good practice was noted (as found at our last inspection), as relatives of a new resident again confirmed they had been encouraged and supported to personalise their residents room (with furniture as well as pictures and ornaments). With regard to residents being helped to make choices, we discussed various routines in the home. Whilst most residents had a bath in the morning, one resident was now supported to bathe in the evening (at their request). Another resident was able to have their tea time meal later in order to watch a favourite television programme. We also discussed how staff helped residents to get up in the morning. When we arrived at 7.15am, eight residents were already up and a further resident was being helped to get up. A night carer said they were not instructed or expected to wake residents and get them up. Rather those residents who woke early (5.30am onwards), who because of their confusion were at risk of falling, were helped to dress and get up. Day staff said apart from a few residents who liked to sleep longer, most residents were always up when they came on duty at 8am. Two residents seemed unclear they had a choice about getting up in the morning. One resident also felt things were sometimes abit rushed in the mornings. We advised Mrs Galvin to monitor the morning routine and ensure individual preferences about what time residents liked to get up and go to bed (and any other night time routines and help needed) were clearly documented in their care file (e.g. in a separate night time care plan ). With regard to the sharing of bedrooms, we advised the decision making process involved with the resident and/or their family was clearly shown in care files, with ongoing review (including when a shared place became vacant, the discussion with the remaining resident and/or their family about any future decision to share again). With regard to decision making and where a person may wish to die, we discussed Care Homes for Older People Page 17 of 30 Evidence: funding for end of life care, giving details of recent national guidance and how this could support a resident to remain at Lyndon (rather than being transfered elsewhere to receive nursing care). Regarding food choices, whilst likes and dislikes were well known by staff, residents were also asked on a daily basis what they would like to eat. Although the home provided a single choice menu, records showed frequent examples of alternatives being provided. Good practice was also noted, as there was a choice of two vegetables with the main lunchtime meal. We joined residents for lunch. Most ate in the dining room, although due to recent changes, four residents now remained in the smaller lounge to eat. Good practice was noted, as there was new dining furniture, including chairs with glide rails. Tables looked attractive, with tablecloths, flower arrangements, cups, saucers and napkins. There was a calm and relaxed atmosphere, with residents given plenty of time to enjoy their food. One resident said the food was good and you got a choice, another that it was excellent and that they were putting on weight. We advised a daily menu was reintroduced, to serve as a memory prompt for more able residents and to also provide information and a conversation piece for visiting relatives. Staff provided assistance discreetly and patiently. Residents dignity was promoted as food was cut up away from the dining room. We advised some small stools were provided to enable staff to sit beside any resident who needed help (rather than having to stand over them). We also discussed introducing regular food based social activities with residents (e.g. sandwich making). Special dietary needs were catered for, with low sugar and pureed meals provided. Good practice was noted, as pureed foods were now being served separately, maintaining taste, texture and appearance. With regard to meeting nutritional needs, full fat milk was also now being used in dishes. Fresh fruit was served. We advised this could be developed further with soft cut fruit offered on a daily basis at morning or afternoon drink times. To further support the above good practices, we showed a copy of Water for Healthy Ageing, a best practice toolkit by Water UK for care homes to avoid dehydration. We also discussed recent national advice from the National Patient Safety Agency to all care facilities (including care homes), to ensure staff have the skills to deliver effective first aid, in particular the management of choking. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements for protecting residents from abuse or harm and for taking concerns seriously were in place. Evidence: Information about how to make a complaint was in the homes brochure and also displayed in the homes entrance. This notice had been updated with our new contact details and was also now in a larger font size, making it easier to read. Surveys from relatives confirmed they knew how to complain. No complaints had been received by the home and none had been received by us. Mrs Galvin was aware of the need to keep a full record of any complaint made. We discussed the benefits of also recording more informal issues (to show how all concerns were taken seriously and acted on). No safeguarding alerts had been made concerning the home. Abuse awareness training had previously been completed by existing staff and recently done by the new staff member. We discussed the forthcoming introduction of the Deprivation of Liberty safeguards. Mrs Galvin was aware of the changes but needed to find out more about her new specific legal role and responsibilities as a Registered Manager. We also discussed the general issue of capacity and how care staff can record the different ways they facilitate everyday decision making for residents (e.g. chosing what to Care Homes for Older People Page 19 of 30 Evidence: wear). Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Lyndon provided residents with a very clean, comfortable, safe and homely place to live. Evidence: Lyndon was bright and welcoming, with the use of wallpaper and general layout making it feel homely and comfortable. The building continued to be well maintained both inside and out. The two lounges and dining room had been redecorated since our last inspection. Good practice was noted, as new specialist dining furniture had been provided, including chairs with glide rails and hand rails. We again advised the fluorescent tube lights in both lounges and dining room were replaced with lighting that was bright but more domestic in character. Thermostatic mixer valves were not fitted, although all hot water outlets were checked each month, with written records kept. With regard to adaptations and equipment, there were grab rails in corridors, bathrooms and toilets. Raised toilet seats and an assisted bath were also provided. One resident had been supplied with an electric rise and fall bed. There was ramp access via the conservatory at the side of the home. There was no passenger lift, although there were two stair/chair lifts. Care Homes for Older People Page 21 of 30 Evidence: Some bedrooms had yale locks fitted. Ideally these should be replaced with more suitable locks (e.g. operated with a thumb turn from the inside and key from the outside). If the yale locks remained in place, the deadlock facility should be removed (to prevent residents locking themselves in and staff being unable to gain access). The home was very clean and tidy and smelt fresh. This was confirmed by one regular visitor who said Lyndon always smells clean. There was liquid soap and paper towels for staff to use in toilets and bathrooms, but not in all bedrooms. To support good hand hygiene practices, these should be available for staff in all residents bedrooms. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were protected by improvements in recruitment practices and benefited from good staffing levels and a small, stable staff team. Gaps in training put this at risk. Evidence: Residents continued to benefit from a very stable, consistent and experienced staff team - only one new staff member had started since our last inspection. Staffing levels were good with a minimum of three staff on duty during the day and two at night. With regard to communication, although Mrs Galvin worked in the home on a daily basis, we advised brief paid handovers should be introduced for senior staff when she was not on duty. With regard to NVQ training, good practice was noted, with 70 percent of the care staff team having attained at least an NVQ level 2 care award. Other staff were being supported to undertake external qualifications, with a cook and the two domestics also completing NVQ awards. We looked at the recruitment of the new staff member. A written reference had been requested from the previous care employer but only a verbal reference (with written details kept) had been provided. In this situation, we advised Mrs Galvin should state Care Homes for Older People Page 23 of 30 Evidence: in her written request to the previous employer that if they did not reply she would assume there were no issues that would prevent the applicants re-employment in a care setting. Proof of identity had been kept, although there was no photograph. To allow identification and the protection of residents, recent photographs of all staff should be kept. At the last inspection we had been concerned the proper criminal record checks had not been in place before staff started. At this inspection we found these checks were in good order. We advised previous Crminal Record Bureau disclosures should now be destroyed. However, the disclosures reference number and date of issue should be recorded on each staff members file. A disclosure of a new staff member must be kept until we have seen it. Consequently, the disclosures of any staff starting after this inspection must be kept until we next visit. We looked at the training completed by the new starter. At our last inspection we had been concerned that whilst previous new starters had completed an informal introduction, there had been no structured induction, with any records kept. At this inspection, Mrs Galvin had completed a brief induction checklist with the new starter. To ensure a new starter (particularly a person new to care) received adequate guidance and support, we advised the induction needed to be developed further (e.g. covering more practice based issues - practical ways to maintain a residents dignity, confidentiality, infection control, health and safety). We again advised using or adapting units from the Common Induction Standards by Skills for Care to help with the induction process. The new starter had not yet completed any formal courses apart from safeguarding. We advised moving and handling, fire safety and food hygiene training needed to be arranged. We looked at training completed by existing care staff. Individual records were unclear. We advised these need to be kept up to date and an additional matrix may be helpful (with details of all the staff team). We were concerned all three of the staff we looked at had not received annual refresher training in moving and handling. Two staff had also not received annual fire safety refresher training (although this was due to take place shortly). At our last inspection, we had advised dementia awareness training was provided. This had not taken place. At this inspection we advised enough staff need to have received training in the management of choking to cover all shifts in the home. Mrs Galvin responded promptly to our concerns, informing us shortly after the inspection she had arranged food hygiene and moving and handling courses for March and February respectively. First aid (including the management of choking), infection control, dementia awareness and nutrition training courses had also been booked. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and staff benefited from a well managed home. This would be further strengthened by regular formal supervision of all staff. Evidence: Mrs Galvin owned and managed Lyndon. Mrs Galvin was a qualified nurse and had now completed the Registered Managers Award. Mrs Galvin was very involved in the day to day running of the home, working alongside staff, providing hands on care six days a week. As we found at our last inspection, residents, staff and relatives again spoke very highly of Mrs Galvin. One resident said she was very kind...very thoughtful. Staff described how supportive and involved Mrs Galvin was. Night staff explained how she rang the home every night (even when on leave) to confirm how things were and discuss any issues. Staff were also supported by formal supervision, with new records kept of these meetings. New staff received this supervision regularly, although the frequency for existing, longer term staff was not as often (and needed to be more frequent to ensure they received similar formal support). Communication as a staff Care Homes for Older People Page 25 of 30 Evidence: team took place mainly informally, although a full, formal staff meeting had been held last September. With regard to how the home monitored the quality of its service, as noted, Mrs Galvin was in close day to day contact with residents and their families. In addition, Mrs Galvin sent annual surveys to relatives and carried out informal residents meetings. We saw numerous thank you cards and letters from relatives, praising the care provided by Mrs Galvin and the staff team. Mrs Galvin had requested formal feedback from professionals involved with the home (e.g. district nurses, GPs) but none had been received. Mrs Galvin confirmed no money or valuables were held on residents behalf. As noted earlier in the report, some records could have been in better order (e.g. staff training records). Also, some care records could be completed to evidence and more clearly reflect the good standard of care (e.g. activity records). With regard to safe working practices, accident records were being completed appropriately. We advised introducing a monthly audit of these to help monitor any possible patterns. We received formal confirmation in the AQAA that all safety and maintenance checks were up to date. During the inspection we checked these for the stair lifts, the assisted bath and for fire safety. These were in order apart from fire safety refresher training, which as noted, was out of date - although an external fire safety trainer was due to visit in March 2009 and regular fire drills were being held. (We advised the names of staff who participated in fire drills were recorded in the new style record book (as previously done)). The safety of staff, residents and visitors was promoted with appropriate weekly fire safety checks carried out by Mrs Galvin. To encourage familiarity and confidence in the staff team, we advised as many staff were involved with these routine checks as possible (e.g. a different staff member was asked to assist each week, with their name also recorded in the fire safety log). Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 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, Care Homes 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 29 19 A recent staff photograph must be held in each staff members file. To safeguard residents. 30/04/2009 2 30 23 All staff must receive annual 31/03/2009 fire safety training. To keep residents and staff safe. 3 30 13 All staff must receive annual 31/03/2009 moving and handling training. To keep residents and staff safe. 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 9 To reduce the risk of errors, any handwritten entries on medication administration records should be countersigned. To provide a clear audit trail, the medication administration sheets for prescribed creams, ointments and supplement Care Homes for Older People Page 28 of 30 drinks should be signed by the person administering them. 2 12 To show how each resident is supported to take part in social activities that meet their needs, preferences and capabilities, clearer records should be kept. With regard to the homes double bedrooms, to show how affected residents and their families have been and continue to be fully involved in the decision making process about sharing a room, there should be a clear record of discussions held and decisions made. To prevent harm from choking, there should be enough staff trained in the management of choking so there is always at least one member of staff on duty who can respond appropriately. To enable staff training needs to be monitored and met, clearer, up to date training records should be kept. To ensure new starters receive adequate support and guidance, induction training should be developed. To ensure long standing staff receive support and feedback, they should receive regular, formal supervision. 3 14 4 15 5 6 7 30 30 36 Care Homes for Older People Page 29 of 30 Helpline: 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 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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