Inspection on 14/02/08 for Lynfords

This inspection was carried out on 14th February 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 no outstanding requirements from the previous inspection report, but made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lynfords 06/02/09

Lynfords 05/01/07

Lynfords 18/01/06

Lynfords 23/08/05

Lynfords 24/01/05

Lynfords 09/09/04

Similar services:

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Lyncol House

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

CARE HOME ADULTS 18-65 Lynfords 3a Nursery Close Hailsham East Sussex BN27 2PX Lead Inspector Lois Tozer Key Unannounced Inspection 14th February 2008 09:55 Lynfords DS0000047635.V357920.R01.S.doc Version 5.2 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 Lynfords DS0000047635.V357920.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 Adults 18-65. 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. Lynfords DS0000047635.V357920.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lynfords Address 3a Nursery Close Hailsham East Sussex BN27 2PX 01323 440843 EX22 01323 449555 nursery@regard.co.uk 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) The Regard Partnership Ltd vacant post Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Lynfords DS0000047635.V357920.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is six (6). Service users must be aged between eighteen (18) and sixty-five (65) years on admission. Service users with a learning disability only to be accommodated. Date of last inspection 5th January 2007 Brief Description of the Service: Lynfords is a purpose built bungalow, situated in a quiet residential area of Hailsham. The home shares the same site and manager as The Marshes, another home owned by the same organisation. Resident accommodation provides six single bedrooms, a large communal lounge and a kitchen/diner. The two bathrooms are fitted with the necessary adaptations. The grounds are secure and provide a well-maintained garden and ample parking. The home is registered to accommodate six adults aged between 18-65 on admission, whom are affected by learning disabilities. The Registered Providers of the service are The Regard Partnership. This organisation owns a large number of homes across England and Wales. Information received from the Manager details that the current baseline fees starts at £1340:00 per week, with additional 1-1 support charged at £10.61 per hour. More detailed information about the services provided at Lynfords can be found in the home’s Statement of Purpose and Service User Guide - copies of these documents can be obtained directly from The Regard Partnership. Latest CSCI inspection reports are on available on request from the home. Lynfords DS0000047635.V357920.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key site visit took place on 14th February 2008 between 09:55 am and 4:15 pm. The manager, people who live at the home and staff assisted with the process. The manager had only been in post for four days at the time of this visit. The inspector who carried out the site visit was made welcome. We received an AQAA (Annual Quality Assurance Assessment) before the inspection. This had been completed by a staff member who was acting as deputy in the absence of an allocated manager. Six people live at the home. Two staff comment cards were returned on the day, and we gave out a variety of resident and relative / care manager cards for distribution. We spoke briefly to four residents who were able to give various degrees of feedback. One person showed us her personal plan, and said that this was something she and staff were working on. The manager and, for some time, a resident, showed us around their home. The manager pointed out where changes are planned, where maintenance was needed and where improvements had taken place. The inspection process consisted of information collected before, during and in the few days after the visit to the home. Some of the information seen was assessment and care plans, medication records, duty rota, health support plans, training information and staff records, including recruitment and fire risk assessments. The overall star rating for this home is ‘One Star’, which means the home is providing an adequate service. The home will be required to produce an improvement plan detailing how the service will implement change, and who will be responsible. This will be requested after the home has seen and agreed the facts contained in this report. What the service does well: The home is set in pleasant grounds that are safe and well maintained. The home is in good condition and there is good maintenance support, which means that things do not remain broken or out of order for long. There is a newly appointed manager There is a broad range of training given to the staff team and all of the full time staff have achieved an NVQ qualification. Lynfords DS0000047635.V357920.R01.S.doc Version 5.2 Page 6 Although there has been a POVA (protection of vulnerable adults) alert raised recently, highlighting some areas for improvement, it is good that staff felt able to come forward and make their concerns known. It is reassuring that the organisation took the right course of action and is conducting a joint investigation with the local social services department. There are fun days out and residents enjoy leisure activities. People have key workers. The staff are friendly and some have known the people living at the home for a long time. What has improved since the last inspection? What they could do better: The last inspection took place 13 months ago, and the home was rated ‘Good’. This visit has gathered evidence that the rating has decreased, with an overall rating of 1 star, adequate. Some areas of practice are assessed to be poor. The home has not had a manager in post since September 2007. A manager has recently been appointed, and has been working in the home for 4 days at the time of this visit. There are several things that require an improvement. People need to know that when they choose to live at Lynfords, they will be listened to and supported to make choices for themselves. At the moment, some decisions people have made have been ignored. This means that the plans for daily activities have not involved the individuals and are not be to their liking. When they have objected to doing things the planned way, their plans have not been reviewed to make it better for them. This has made some people angry and made relationships between people difficult. People are not involved in the daily running of the home, so are not supported to be as independent as they could be. We saw people having to wait for staff to make hot drinks and sandwiches, rather than the people who wanted them be helped to make them for themselves. Because people are not helped to have a say in a way that is right for them (there are no strong communication tools or systems being used), lifestyles Lynfords DS0000047635.V357920.R01.S.doc Version 5.2 Page 7 and life choices may not be what people want. An example is that people are assumed to be heterosexual because they have severe learning disabilities. Sexual pictures have been put up for a person to look at, which is good practice, however its not clear if these images reflect the gender preference of the person concerned. Personal support is not based on what a person wants, as they have had little say in it. Where people have made their feelings clear about when they want and don’t want, they have been ignored. Some people need a medicine review and the contents of health support plans needs to be revised so that all of the right information is available. The staff carry out medication management. Some of the ways of working need improvement, such as being clear on the policy of removing medicine from the home and having clear stock control for ‘as required’ medicines. There has been a POVA (protection of vulnerable adults) alert one week before the site visit. This has raised some issues that mean the complaints system may not be easy for residents to use. The quality assurance system needs to be reviewed to make sure it looks at the experience of the residents. It relies on questionnaires, which most of the residents cannot complete. Many of these issues identified in the summary and the requirements made at the end of the report have already been identified by the organisation. 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. Lynfords DS0000047635.V357920.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lynfords DS0000047635.V357920.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use the service experience adequate quality outcomes in this area. People choosing to live at the home will have their needs and aspirations assessed, but may not always be central to the process. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live at the home have had full needs assessments, which have taken place before they moved in. It is not clear how involved each individual or people who know them well were, but these have gone on to form the basis of their support plan. There is a system of reviewing needs on at least an annual basis. The two examples seen showed no evidence of involvement or consultation from the person it concerned. The acting manager made clear that prospective residents would have ‘person – centred’ support to choose if the home was for them, and that the trial period would be important, especially for those who had communication difficulties. In both files there was a service users guide and statement of terms and conditions. These had been signed by or on behalf of the person. Support towards a more independent lifestyle was part of the contract, but in both cases, putting this into practice was not happening as well as it could, which is evidenced in the Lifestyles section. Lynfords DS0000047635.V357920.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 People who use the service experience poor quality outcomes in this area. Routines in the home are task led and this means decision-making and skills development opportunities are not planned and so happen infrequently. People who live here do not have a leading say in what goes on and how their home is run. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person has a care and support plan. It has been written from the initial assessment and looks at supporting personal care in some detail. There were ‘pen portraits’ in the two files seen, which are designed to give the reader a good idea about the person they will support, their personality and how they wish to be treated. They were found to be very brief and not very descriptive, and had not built up a profile of the person over their lifetime. One person showed us their ‘person centred plan’, which they were pleased to have. It said what this person wanted out of their life, but these wishes had not been Lynfords DS0000047635.V357920.R01.S.doc Version 5.2 Page 11 put into practice until the last few days. The detail about daily support was informative and would give staff a good idea on how to offer care, but it is uncertain how accurate, or in line with people’s wishes this information actually is. One particular plan recognised a persons wishes about how they would like to live their day, but this had been actively planned against. This meant, for example, that they were expected to get up at a time staff felt was right and do activities. Because they did not wish to comply with this, small sanctions, such as limited access to hot drinks had been put in place. As a consequence of bad planning, more risky situations had occurred, resulting in risk assessed behaviour management plans that were written in a derogatory way, for example ‘will display verbally ‘defiant’ behaviour’. This had been recognised by the management team following a disclosure by a staff member, and work is taking place with social services and within the organisation right now to put this right. Daily records were not reflecting the experience of the resident, but were describing, in one example, that although activities were planned, the day was often limited to watching DVD’s. The AQAA told us that there had been work carried out with the communication specialists in the last year, and there was some evidence that picture symbols were being used. We could not find any communication profiles, and we observed staff offering closed choices verbally, for example ’You want sandwiches? Ham or turkey?’ then proceeding to make the sandwich for the person without waiting for the choice. We were concerned that as the resident was being spoken to without first getting eye contact and engagement that they probably had no idea that the question was directed at them. Other risk assessments were confused, for example, an assessment discussed the potential for loss of communication skills, but did not make clear what the person’s current skills were. There was no communication profile in place, and particular behaviours demonstrated by the individual were seen as ‘challenging’ without exploring what the meaning could have been for them. This had resulted in psychiatry referral and an increase in medication. We observed a heavy desk placed in front of another person, which had drawing materials and puzzles on it. We found that this person needed to use a walking aid, and when we tried to push the desk away from sitting position, found it very difficult. The manager was not certain if this desk acted as a Lynfords DS0000047635.V357920.R01.S.doc Version 5.2 Page 12 restriction (unwittingly), and agreed to make sure that using this, and access to the walking aid, was reassessed. Lynfords DS0000047635.V357920.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 People who use the service experience adequate quality outcomes in this area. Lifestyle support is not personalised and is task led. All residents need more opportunity and support to have individual lifestyle choices that have been made by them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person has a schedule of daily activities. Two examples were seen, and these specified a range of activities, such as shopping, art, college, music, personal care, and outings. There was no evidence that people had chosen the activities and when they took place. Although some records seen mentioned enjoyment, many entries to the daily records did not tell us what people had got out of the activity. The scheduling of activities for all residents was not personalised and was geared to meet the shift patterns and tasks of the home. One person’s schedule had very busy mornings and quite empty evenings. Lynfords DS0000047635.V357920.R01.S.doc Version 5.2 Page 14 This person seldom got up early, and often missed out the activity, or was put under pressure to attend, and this had on occasions resulted in conflict. The other person whose day was tracked seemed to spend long periods watching DVD’s at home. Occasionally records did say if they were offered the planned activity, and if this was taken up, but largely just reported similar patterns of lifestyle from one day to the next. The records showed that the person often went to bed early (around 8pm), and woke up around 5am, but was encouraged to return to bed, and could be quite sleepy in the middle of the day. Review notes did not look at this lifestyle pattern in relation to the medication the person was on, or their medical conditions, but rather focused on promoting sedatives at night so the person slept through the night. This could be a restrictive practice. However, there was clear evidence that people got out and about to have fun at weekends and for special occasions. Lots of pictures displayed around the home showed people enjoying the local community, and two people who lived at the home had been to the supermarket to shop for weekly food. Holidays were arranged with people and took in their interests. Family contact is recorded in the support plan, but it is unclear if people living at the home would be supported to have appropriate personal, sexual relationships, as the AQAA told us that all residents were assumed to be heterosexual. One person had sexy pictures on their ceiling to enjoy, which is of course an excellent idea, but nothing was in place to make sure that they were the preferred gender for the person. We observed life in the home before during and after lunch. We saw that residents were not involved in the daily routines, and had little or no responsibilities. Staff were very kind, but disadvantaged people’s independence as they did not support them to carry out domestic tasks. For example, a later riser asked for a hot drink and was told that staff would make it for them soon. It was not clear why the person was not supported to make it for her or himself. A similar situation occurred at lunchtime, when staff provided people with sandwiches, rather than support the making of them. Food shopping had taken place during the visit, and this provided us with a good idea that people had a wide variety of good quality food. There is a 6week rolling menu in place with alternative main courses, and staff said this was built up from people’s preferences. We discussed how much involvement people had each week to agree or change the menu, since 6 weeks was along period of time. Staff said that there was little consultation like this, but they displayed the daily menu in pictures in the dining room. We saw this, and the pictures were large and easy to use, but were displayed up high (around 6’), Lynfords DS0000047635.V357920.R01.S.doc Version 5.2 Page 15 so would be hard for residents to use easily. The AQAA had identified that improvements were needed to increase the amount of participation and interaction for people with the daily routines of the home Lynfords DS0000047635.V357920.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 People who use the service experience adequate quality outcomes in this area. Heath, personal care and medication management support needs to improve so that people can have a say and be fully involved in this aspect of their lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Previous sections have told us that some people are not receiving support in the way they prefer, for example, the person who wishes to rise later in the morning has, until recently, been actively encouraged not to do so. The toilet nearest the communal areas, although unlocked during the visit, had a sign ‘keep locked’. When asked why, staff said that it was sometimes locked, and used to be the staff loo. Bathrooms were accessible, with one specialist Parker bath and a ‘wet room’ style shower. A person had said they did not like either facility, and had objected to using them. The area manager said assessments were underway for the person to maybe use the adjoining registered premises bathroom, which has an ordinary bath. Very recent changes to support have helped a person feel more respected, and less upset about using the facilities. Lynfords DS0000047635.V357920.R01.S.doc Version 5.2 Page 17 This potential long term preference must be reviewed, as going elsewhere for a bath should not be necessary. The AQAA recognised that people need to be more involved in choosing how they are supported and be more independent. Records showed us that healthcare matters are well supported for most people and that people get to see services such as their GP, dentist and optician regularly. Particular behaviours displayed by a person had referral to psychiatry, resulting in an increase of medication, which has had an impact on their ability to remain awake in the day. We were concerned that notes from the psychiatrist did not mention epilepsy; a condition the person was indicated, in the care plan, to have. There was a seizure recording chart, but this had not been completed. Night time incontinence had not been explored to find out what the cause was. Medication is stored and administered centrally. No one has been assessed to see if they can take a role in the management or administration of their medication. Staff told us that they had training by way of a correspondence course in medication administration, and were given competency checks. We looked at the medication administration records (MAR) and found that two staff per item signed them. Staff told us that one signs when the item is got ready for the person, the other signs when it has been given. They were unable to tell us if the policy permitted this, as the MAR is a record of administration, and should be used only for this purpose. Most of the records were in good order, but some codes used did not make sense, and refusals marked ‘R’ had not been recorded as why it was refused. This needs to be recorded so individual preferences can be accommodated. Staff have been ‘secondarily dispensing’ medication into bottles for people when they are away at lunchtime. This is dangerous and not permitted (The Medicines Act 1968). The manager said she would sort this out straight away, telephoning soon afterwards to clarify this had been completed. Some records for safeguarding medicine were missing, such as a stock sheet for ‘as required’ medicines and a bottle of Diazapam from October 2006 was held for no apparent reason. A person had been written up for two ‘as required’ medicines, but staff were unable to find any of these medicines. Two medicines were stored in the home’s unlocked fridge. These were items for occasional use, and the manager must consider if the home should have a separate fridge, especially as one item is for external use, there may be potential for cross-contamination. Eyedrops were also in cold storage after being opened; this practice must be double checked with the pharmacy, as it cannot be pleasant for the person receiving them. Lynfords DS0000047635.V357920.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 People who use the service experience adequate quality outcomes in this area. Resident’s views have not been listened to and acted upon and this has led to their ability to choose being compromised. This has been recognised by a whistle-blower and the organisation is doing something about it. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a pictorial complaints procedure displayed on the notice board in the residents’ dining room. The manager did not know if there had been any complaints raised by residents in the last year, as none were recorded. The AQAA submitted said no complaints had been made. It was clear that where people had tried to make lifestyle choices, they had not been supported. This makes us think that if people had made a complaint within the home, they may not have been taken seriously. A whistle blower had recently raised concerns about some of the care practices of the home. A protection of vulnerable adults (POVA) alert had been raised by the Regard Partnership. A full investigation from the social service team and the organisation is taking place. The organisation has demonstrated that, when faced with such situations, safeguarding residents is taken seriously. Almost all staff have received POVA and some have had ‘Person Centred’ support training, and it is because of this that potential abuse has been Lynfords DS0000047635.V357920.R01.S.doc Version 5.2 Page 19 noticed. The organisation is reviewing all practice in the home as the investigation unfolds, with some work around choices taking place already. The manager told us the process by which people have access to their money. She is unclear if there has been a management audit since the last manager left and if the current process is safe, and told us that she will review this fully. Because of this active approach, no requirements have been made for this outcome area. Lynfords DS0000047635.V357920.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 People who use the service experience good quality outcomes in this area. The home is comfortable and accessible in most areas, but improvements around access to the kitchen may be beneficial. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was in good condition, and was homely. Each person has a single bedroom, which have been decorated individually. Some people have sensory equipment. There are hoists and moving aids to meet all peoples assessed needs, and these have had regular services. The lounge was homely and had puzzles, musical instruments and big games on easel stands available. There is a kitchen / diner, which should mean people get to use the kitchen with support all the time. The manager highlighted that the entry gap into the kitchen was possibly too narrow for a person using a walking aid, certainly would not allow a wheel chair through and that all the work surfaces were standing height. We did not see any resident use the kitchen area for making drinks or snacks during the visit. The manager aims to assess this and see Lynfords DS0000047635.V357920.R01.S.doc Version 5.2 Page 21 how restrictive it is in practice, since the dining tables could easily be used for food preparation too. The managers office is away from the house, so gives privacy and confidentiality for meetings, but hinders management level observations of the homes’ daily running. We were unable to see the laundry as it was locked. The house was clean and seemed hygienic. Lynfords DS0000047635.V357920.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 People who use the service experience adequate quality outcomes in this area. The staff team have the qualifications and have attended a wide variety of training that should assure residents they are in safe hands. Staff are not consistently applying these skills through care planning and delivery. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of the full time staff have an NVQ qualification at level 2 or above. Their individual records show that they have been given a wide range of training opportunities in specialist areas, such as positive behaviour support, autism, conflict management, POVA and person centred planning. It concerns us that with such a range of training and qualifications, that more work around helping residents make choice is not taking place. The staff team have not had a manager for several months, which may contribute to diminished resident involvement. The new manager must make sure that staff are given the support and encouragement to use their training and qualifications fully. The area manager has immediate plans to implement Lynfords DS0000047635.V357920.R01.S.doc Version 5.2 Page 23 training around person centred thinking and developing an ethos that is resident friendly. The recruitment process seen showed us that all necessary police and reference checks were taking place before employment commenced. There was a query over the status of one staff member, which the manager agreed to discuss with the human resources department. Each new staff member carries out the common induction standards with a learning buddy from the existing team. Lynfords DS0000047635.V357920.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 People who use the service experience adequate quality outcomes in this area. Residents and staff are currently experiencing considerable disruption and change. The new manager aims to settle and coach the staff team as soon as possible so that residents live in a well run home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: When we visited the home, the manager had been in post for 4 days. She is on probation, and does intend to apply for CSCI registration. She has come into the home at a time of considerable disruption and was unable to feel as on-top of the situation as she would have liked. She and the area manager have already identified many of the issues around resident’s opportunities as needing improvement. She aims to review all the procedures in the home and Lynfords DS0000047635.V357920.R01.S.doc Version 5.2 Page 25 make sure that they are in resident’s best interest and applied to each situation sensitively. Although there is a quality assurance system in place, involving visits by the organisations representative, it has failed to pick up on some of the larger issues found during this visit. An example is the derogatory way some care plans have been written and the poor quality of activities and engagement recorded in the daily notes. Although the organisation sends out questionnaires as a quality assessment tool, this may not be capturing the most important information – outcomes to residents. Health and welfare checks have been carried out regularly and have made sure that environmentally people are safe. The fire risk assessment will need to be reviewed by the new manager, as she is now responsible for fire safety. Staff have had a wide range of health and safety training, including food hygiene. We highlighted that defrosting meat at an ambient temperature was poor practice, and reference should be made to the correct way of defrosting meat to avoid bacteria growth. The manager has agreed to address all of the issues highlighted and fed back during the visit. Lynfords DS0000047635.V357920.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 X 1 X LIFESTYLES Standard No Score 11 X 12 1 13 2 14 X 15 2 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 1 2 X 2 X 2 X X 2 X Lynfords DS0000047635.V357920.R01.S.doc Version 5.2 Page 27 No Are there any outstanding requirements from the last inspection? 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 YA6 Regulation 12, 15 Requirement So that every resident has maximum say in how they want their care and support delivered and to make sure it meets their social and health needs, suitable means of consulting, recording and monitoring individual needs and choices must improve. So that people are not restricted unnecessarily, risk assessments must look at the least restrictive alternatives and, where possible, consider wishes, feelings and development opportunities, consulting with the individual. So that people get the most from their lives, they must have consultation around their daily planners, education and occupation. To make sure gender preference is not assumed, staff must be aware of issues of sexuality and create an atmosphere where people could express their preferred sexuality. So people are supported to be DS0000047635.V357920.R01.S.doc Timescale for action 01/05/08 2 YA9 13, 14 24/03/08 3 YA12 16(2)(m) 01/05/08 4 YA15 12(3)(4)(a) (b) 01/05/08 5 Lynfords YA16 12(3), 16 01/05/08 Page 28 Version 5.2 6 YA18 7 YA19 8 9 YA20 YA20 10 YA20 11 YA20 12 YA39 active participants and take responsibilities for development and self-esteem, daily routines must plan to support residents, for example making snacks, doing laundry. 12(3)(4)(a) People need to be actively involved in planning & reviewing their personal care. Personal wishes and feelings must be handled sensitively and with respect. 12(1)(a)(b), Particular healthcare and 13(1)(b) medication issues for an individual must be reviewed and monitored, allowing health professionals to support the person in the best way possible. Information alluding to the known condition of epilepsy needs to be clarified and monitored. 13(2) To protect residents, secondary dispensing of medication must cease. 13(2) For clarity and accuracy, the medication administration records need to be completed in line with the policy and follow the guidance from the Royal Pharmaceutical Society. Staff must be fully aware of such procedures. 13(2) To safeguard residents and staff, a clear, accountable stock control system must be in place for all medicines. 13(2) For the comfort of the individual, eye medication stating ‘Store in a refrigerator, discard within 28 days after opening’ consultation with the pharmacist is necessary to clarify that this needs to remain chilled after opening. 24 So residents get the most from the quality monitoring systems and see their home develop to DS0000047635.V357920.R01.S.doc 01/05/08 13/03/08 14/02/08 13/03/08 13/03/08 20/02/08 01/05/08 Lynfords Version 5.2 Page 29 13 YA42 13(3) meet their changing needs, their views and experiences must be fully integrated into the system. To protect all persons eating at 21/02/08 the home, correct food hygiene procedures must be carried out, for example, avoiding defrosting meat at an ambient temperature over several hours. 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 YA20 Good Practice Recommendations Brought forward from the previous inspection, 05/01/07 Implement a recorded system of obtaining consent from those service users whose medication they hold. Work towards supporting people to take some control over the administration of their medication. To make sure that appropriate permissions have been granted to allow a care workers right to accept work, further information and clarification should be collected in respect of one named staff file. So residents’ benefit from the training staff received, staff should have regular, direct supervision from the manager when carrying out agreed tasks with individuals or groups. 2 YA34 3 YA35 Lynfords DS0000047635.V357920.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. Extracts may not be used or reproduced without the express permission of CSCI Lynfords DS0000047635.V357920.R01.S.doc Version 5.2 Page 31 - 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. 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