Inspection on 01/04/08 for Lyngate Care Home

This inspection was carried out on 1st April 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Lyngate Care Home 24/11/08

Lyngate Care Home 22/07/08

Lyngate Care Home 17/10/07

Lyngate Care Home 24/05/06

Lyngate Care Home 13/12/05

Lyngate Care Home 23/05/05

Lyngate Care Home 14/12/04

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Lyngate Care Home 236 Wigan Road Bolton Lancashire BL3 5QE Lead Inspector Judith Stanley and Avril Frankl (Pharmacy Inspector) Unannounced Inspection 1 and 2 April 2008 09:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lyngate Care Home DS0000059303.V361272.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lyngate Care Home DS0000059303.V361272.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lyngate Care Home Address 236 Wigan Road Bolton Lancashire BL3 5QE 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) 01204 62150 01204 657441 Lyngate Health Care Limited Mrs Ann Marie Else Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places Lyngate Care Home DS0000059303.V361272.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The Home is registered for a maximum of 41 service-users to include: Up to 41 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. 17th October 2007 Date of last inspection Brief Description of the Service: Lyngate care home provides care and accommodation for up to 41 older people. The home is situated approximately 1 mile from Bolton town centre. There are bus routes, shops, a bank, and other community facilities close by. The home is on three floors and it has 29 single bedrooms and 6 doubles. Twenty-four of the rooms are en-suite. There are four lounge/dining rooms and an activities lounge. Three of the lounges have kitchenettes where residents and visitors can make drinks. There is a garden at the front of the home and a car park at the back. The home is fitted with suitable adaptations and equipment such as a passenger lift, assisted baths and showers, portable hoists, and grab rails. In addition to care staff, the home employs an activities co-ordinator, cooks, kitchen assistants, domestic staff, and a maintenance worker. A brochure describing the home’s services is available and the provider gives other information about the home to new and prospective residents and their families verbally and they are also offered a copy of the home’s Service User Guide (Residents Information Guide). The current weekly charge for accommodation and services range from £349.93 to £355.08 with additional charges being made for hairdressing, chiropody, extra toiletries, newspapers, holidays and trips out. Lyngate Care Home DS0000059303.V361272.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means that people who use the service experience poor quality outcomes. This inspection which included a site visit that the service did not know was going to take place was conducted over two dates, by the lead inspector and the pharmacy inspector. On day one, an inspector was at the home from 09:15 until 11:15. On day two the inspectors were at the home from 09:15 until 15:45. One of the inspectors spent time looking at the records the home holds on residents (care plans) and other information the home needs to keep to ensure the home is being properly run. The pharmacist inspector checked the medication and recording for some residents. On day two, one inspector looked around the home and spoke with residents and staff. Prior to the inspection the home was sent an Annual Quality Assurance Assessment form (AQAA). This is completed by the manager and the information tells the inspector how the home meets the National Minimum Standards (NMS), what has improved since the last inspection and what improvements the home plans to make in the future. To find out more information about the home comment cards were sent to residents, staff, relatives, and to other people who visit the home. Ten residents and 6 staff returned comment cards; there has been no response from relatives or other visitors. One resident said, “Staff are very kind and helpful. It’s a lovely clean home”. Another said, “Sometimes I have to wait a long time for attention and I definitely think the meals could be improved”. Information taken from a staff survey said, “ We need more care staff, this would make a less stressed atmosphere. The appointment of an administrator would give the manager more time to deal with the actual running of the home”. Following this inspection the home was left three immediate requirements. An immediate requirement is where the inspector has concerns about practice with in the home. The manager must inform the CSCI with in 48 hours of how these requirements will be addressed. The immediate requirements were relating to medication and included: • We found that the handwritten Medication Administration Record Sheets were not always accurate and that some residents have not been given the correct doses of medicines because of the inaccuracies. Lyngate Care Home DS0000059303.V361272.R01.S.doc Version 5.2 Page 6 • • Medication could not be accounted for or audited due to poor, incomplete or a lack of records. Co-dydramol for one particular resident could not be fully accounted for. We found that medication was not audited to ensure it was administered properly What the service does well: What has improved since the last inspection? The pre admission assessment contains more detail that informs staff of the individual needs of the residents. Training for staff has improved, including training in dementia, medication and protection of vulnerable adults. There was evidence of on going maintenance work within the home. The fire officer requirements from the last inspection had been addressed. The lighting had been improved in the lower ground floor lounge. Monthly written reports of the registered provider visits were available for inspection. Extra staff is now on duty in the morning and afternoon. Lyngate Care Home DS0000059303.V361272.R01.S.doc Version 5.2 Page 7 An administrator has been appointed, however appropriate vetting checks need to be returned before commencing work. What they could do better: There should be an up to date photograph of all residents living at the home. The daily progress notes need to be improved to properly inform staff of how each resident has been during the day and at night. The food served must reflect what is written on the menus or any changes should be indicated. The system for people accessing and leaving the building needs to be improved as a lot of staff time is wasted on opening the door. The home would benefit from a system of printed MAR (drug sheets) charts from the pharmacy. This will help to make sure that there is less chance of errors being made and to ensure that medicines are administered as prescribed. Whatever system is decided on the records kept must be accurate and medicines given properly. Under new recent legislation the home must have an official controlled drugs cupboard for the safe storage of controlled drugs. Cigarettes must not be stored in the drugs trolley. The bathrooms require attention, one bath and a toilet cistern was seen bound up with silver tape. There was evidence of communal toiletries seen in the bathrooms and the inspector removed a razor from one bathroom. There was a residents prescribed cream in one bathroom (this was not recorded on the MAR sheet) and the prescribed shampoo for another resident who had died some time ago dated 04/06/07. Information and files relating to the residents and staff must be kept in a secure location. Lyngate Care Home DS0000059303.V361272.R01.S.doc Version 5.2 Page 8 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. Lyngate Care Home DS0000059303.V361272.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lyngate Care Home DS0000059303.V361272.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 4 were assessed. Quality in this outcome area is good. A pre admission assessment is carried out to ensure the home can meet the needs of the individual. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We chose three residents files to examine and work with throughout this inspection, these files are referred to as care plans. There was evidence in all three-care plans of a pre admission assessment that is carried out prior to admission. The assessment ensures that the resident’s health; personal care and social needs could be met. Assessments are carried out at the most convenient place for the prospective resident, either at their own home, hospital or place of stay. The assessment covers the resident’s well being, areas of risk, personal care, communication, oral care, allergies etc. Lyngate Care Home DS0000059303.V361272.R01.S.doc Version 5.2 Page 11 It is important that as much information as possible is gathered at the pre admission stage to ensure that the individuals care needs can be met and the information provides the base line for the drawing up of the care plan. We asked to see the written contracts/ statement of terms and conditions of stay for the three residents files we were looking at. There was only one contract available for inspection. The owner of the home said that one contract was with the resident’s solicitor. This needs to be followed up and a copy available kept on file. All residents must have a written contract regardless of how their care is purchased. Information provided by the owner shows that staff have undertaken training in caring for people with a dementia related illness, the manager confirmed that some staff needed updates in relation to dementia training. Lyngate Care Home DS0000059303.V361272.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is poor. Medication practices were poor and had the potential to place residents’ health at risk. This judgement has been made using available evidence including a visit to this service EVIDENCE: We continued to use the same three care plans. The information contained in the care plans gave staff details about the care each resident required. This included what the residents can do for themselves and what they required assistance with. There is information regarding eating and drinking, bathing, mobility, continence, risks of falls, communication and records of weight, pressure care and mental and physical assessments etc. There was evidence that showed that outside agencies are contacted as required such as the resident’s doctor, the district nurse, the chiropodist and optician. Lyngate Care Home DS0000059303.V361272.R01.S.doc Version 5.2 Page 13 There is little information on the resident’s background, for example where they were born, family life and experiences, hobbies and interests and places they where they spent good times. This not only tells staff some background details about the person they are caring for but can be the subject of many discussions. Currently the care plans are kept in a filing cabinet in a main thoroughfare where residents, staff and visitors to the home are constantly wandering through. This is confidential information and the filing cabinet should be locked at all times when staff are not accessing or working on care plans. The recording in the daily progress notes must be improved. There appears to be a standard one-line entry recorded by staff, for example, ‘slept well’. On checking the progress notes of one resident, the information recorded on the 13 March 2008 says, “ Slept well, c/o (complaining of) pain, hips, shoulders and back”. There was no additional information for example was any pain relief given to this resident and what did staff do to help this resident in pain. Another entry for the same resident on the 18 March 2008 states, ‘slept well, dressing and undressing in the night’. It would appear that this resident did not sleep well and had a disturbed night. The progress notes must be a running record of events and provide staff with detailed information at the change over of shifts. During the inspection the pharmacist inspector looked at how well medicines were handled to make sure that residents were being given their medicines properly. Since the last inspection staff that looked after medicines had done medication training, however some of this training was not relevant because of the record keeping systems in use. The system of record keeping was old fashioned; however if the records had been kept accurately then this system could show if medicines were administered properly and that medication could be accounted for. Records regarding medicines were poorly kept, for instance when medication was received into the home it was not always properly recorded so it was difficult to track or to check if medicines had been given properly. Staff did not make any records regarding medicines, which were no longer needed, so it was not possible to tell if these medicines had been disposed of safely. The medicines administration records were handwritten and a number of errors had been made when they were “written up”. When errors had been made staff were not always sure of the current doses of medication. Due to these errors one resident was given half the dose of one of her medicines and a third Lyngate Care Home DS0000059303.V361272.R01.S.doc Version 5.2 Page 14 of the dose of another of her medicines. If residents are not given medication as prescribed their health could be put at risk. Most medicines were stored properly, however some medicines were not stored securely and arrangements need to be made to store controlled drugs in a cupboard, which meets new legislation. We also saw that cigarettes were stored in the drug trolley, only medicines should be stored in drug storage areas. Medicines were found in communal areas of the home belonging to residents who no longer lived in the home. These medicines should have been disposed of safely and in a timely way so that the risk of medicines being mishandled is reduced. We also had serious concerns that not all residents were being given their medicines as prescribed. One resident had not been given the correct dose of medicines because of poor record keeping. Another resident had been prescribed a medicine to be given four times daily, however it had only been given three times a day for a number of weeks. It was also seen that newly admitted residents were not always given all their medicines on the day they came to live in the home. When medication is not given as prescribed residents’ health could be at risk. Giving medicines to all the residents took a long time and there was not always enough time between drug rounds to leave a safe time between doses, this was a concern at the last inspection and continues to potentially put the health of residents at risk. We noted that staff recognised that some people like to look after some or all of their own medicines and these residents were supported to do so safely. It was worrying that some medicines could not be accounted for. For example some strong painkillers had recently been received for a resident however staff could not find them and could offer no explanation as to where they were. It was also a concern that there was no system or auditing or checking that medicines could be accounted for or were being administered as prescribed. At the end of the inspection an immediate requirement notice was issued to the home to make sure some issues of concern identified were addressed urgently to ensure the safety of residents health. The inspector heard staff speaking with residents in a polite and respectful manner and it was evident that good relationships between staff and residents had been formed. It was observed that several of the chairs in the upstairs lounge had small kylies (squares that soak up urine) on them. This tends to highlight that a Lyngate Care Home DS0000059303.V361272.R01.S.doc Version 5.2 Page 15 resident has a continence problem. To maintain residents dignity these should be removed and alternative arrangements put into place. The manager would be able to get advice from the continence nurse as how best to deal with this issue. Lyngate Care Home DS0000059303.V361272.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 14 and 15 Quality in this outcome area is good. The home offers a range of activities to suit the expectations and capabilities of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The homes hobby therapist plans a wide range of activities including trips out to different places. Residents spoken with said that they were looking forward to a trip to the local garden centre where they have their lunch and look around. On the day of the inspection several residents were taking part in a quiz. One resident said she did a lot of knitting and enjoyed word searches and puzzles. Other activities include reminiscence, arts and crafts, bingo, gentle exercise, visits from entertainers etc. Visitors are welcome to visit the home at any time; there are no restrictions as to when people can visit. Residents can meet with their visitors in any of the lounges or in the privacy of their own rooms. The inspector spoke with two Lyngate Care Home DS0000059303.V361272.R01.S.doc Version 5.2 Page 17 visitors and both expressed their satisfaction of the care provided to their relatives, they had no worries or concerns. There have been no comment cards returned from relatives offering an opinion of the home, the services or the facilities available. The home tries to maintain links with the local community by residents going out shopping, one lady had been out with her family for a walk, which she said how much she had enjoyed. The home also welcomes visits from the local clergy who visit on a regular basis. The menus were inspected at the last inspection; the cook confirmed these were still the same. There is a choice of breakfast dishes available; including cereals, porridge, toast, and a cooked breakfast is available if requested. Lunch is the main meal of the day and on the day of the inspection the menu was roast pork and gravy or sweet and sour pork accompanied by creamed potatoes and green beans, followed by a dessert of sponge pudding and custard. There had to be a late change to the menu as there was no sweet and sour sauce available. Residents were then offered poached fish. The cook must record the changes to the menu then it is clear which residents have eaten what food. From discussions with staff this is not the first time the cook has not been able to cook what is on the menu due to stock not being available. The meal was well cooked, nicely presented and with good portions offered. One resident did not want the main meal and requested cheese and tomato sandwiches which the cook made for him. In returned comment cards one resident said, “We get the odd poor meal but on the whole the food is good”. Another resident said, “ I definitely think the menus could be improved”. To ensure that the meals are varied, the menus, with the help of the residents and the cook should be reviewed on a regular basis and changed accordingly. During discussion with the residents the inspector asked if residents knew what was for lunch, a comment was made to the inspector that, “ We knew you were here today as they have asked us what we would like to eat. I suppose they even got hats on in the kitchen today for your benefit”. The manager needs to address this and ensure that residents are fully aware of the choices of meals available, and that hygiene procedures in the kitchen are always adhered to. Lyngate Care Home DS0000059303.V361272.R01.S.doc Version 5.2 Page 18 When the inspector asked the manager about displaying the menus, she said, “ I told them to put the menus on the table”. Obviously this had not been done. Staff was seen offering assistance to residents who needed help with their meal. One member of staff sat with a gentleman who needed to be fed, this was done with patience and encouragement and the staff member made conversation with the resident during the course of the meal. Lyngate Care Home DS0000059303.V361272.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 were assessed. Quality in this outcome area is good. Residents and their relatives can have confidence that residents will be protected from abuse and have their rights, including their right to complain, protected by staff training and procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a satisfactory complaints system in place for the recording of any complaints or concerns. There have been no complaints made to the manager of the home since the last inspection and no complaints have been made to the CSCI. Staff have now undertaken training and updates in the protection of vulnerable adults. Information provided on the returned AQAA indicated that there had been no safeguarding referrals made. Lyngate Care Home DS0000059303.V361272.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,24 and 26 were assessed. Quality in this outcome area is adequate. Lyngate is maintained to a satisfactory standard making it homely and comfortable for people to live in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: From a tour of the premises it was evident that improvements had been made. Brighter lighting was now in the downstairs lounge, which residents said was much better. Some chairs and carpets had been replaced. The chairs in the lower ground floor would benefit from being replaced or recovered. The walls in the lower ground floor lounge are waiting to be papered; the residents that use that lounge have picked a paper of their choice. Some of the bedroom furniture is still serviceable but is dated. The manager was informed that in one bedroom the chest of drawers was broken and in need of attention or Lyngate Care Home DS0000059303.V361272.R01.S.doc Version 5.2 Page 21 replacing. Regular checks should be carried out to ensure that the bathrooms and bedrooms are well maintained and any work needed is completed. There are a sufficient number of bathrooms and toilets on all floors. It was discussed with the owner of the home that some of the bathrooms required attention. One bathroom on the first floor had silver sticking tape holding the bath panel in place and the lid on the toilet cistern was also taped up. One toilet on the lower ground floor had a ‘tatty’ ripped notice stuck to the cistern saying, ‘out of order’ neither the manager or the owner were aware of this until the inspector brought it to their attention. Some of the bathrooms were stark and uninviting. It was noted that some of the bathroom floors were stained and looked unsightly. Bathrooms should offer a warm and relaxing environment to enhance residents bathing time, making it a pleasurable experience. The inspector found evidence of communal toiletries include shampoo, block soap, a disposable razor, a residents prescribed cream and prescribed shampoo of a resident who had passed away. These items could be a potential danger to some residents. Several bedrooms were looked at and it was evident that residents had brought with them some of their own personal possessions and mementoes. In the main the home was clean and tidy. Infection control procedures were being adhered to. Staff had the appropriate protective equipment for different tasks. The homes laundry is on the lower ground floor and does not intrude on the residents. The home has a CCTV system covering the outer doors only for added security for residents and staff. Lyngate Care Home DS0000059303.V361272.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. Quality in this outcome area is adequate. Recruitment procedures were satisfactory, ensuring the protection of residents living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff rotas were available for inspection and showed that sufficient numbers of staff were on duty. On duty, on the day of the inspection was the manager, deputy manager, five carers, hobby therapist, a cook and kitchen assistant, housekeeper, domestic, laundress and the maintenance man. There are three staff on waking night duty throughout the night. There was evidence that mandatory staff training had improved and that staff had undertaken training in moving and handling, food hygiene, fire, first aid at work, protection of vulnerable adults, medication, health and safety, infection control and dementia. Further training had been planned and booked for 14 April 2008. Although there has been an improvement in training, the inspectors had concerns that regardless of the recent training in health and safety and Lyngate Care Home DS0000059303.V361272.R01.S.doc Version 5.2 Page 23 medication that serious errors are still occurring, potential placing residents at risk. The home needs to continue with the training of staff for NVQs. Information provided on the AQAA indicates that the home only has seven staff out of twenty-one staff who are qualified at NVQ level 2 in care or above. The home must have 50 of staff qualified at NVQ level 2. We looked at three staff files and found that all contained the necessary information required including: an application form, two written references, criminal records bureau checks, a health declaration and other forms of identification such as copy of passports, birth or marriage certificates etc. The inspector did not evidence terms and conditions in all files and the manager must ensure that these are available in every staffs files. There was evidence of new staff undertaking an induction programme on commencing work at the home. Lyngate Care Home DS0000059303.V361272.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33, and 38 were assessed. Quality in this outcome area is poor. To ensure the safety and wellbeing of people the manager must make sure that safe systems are in place and are used and monitored. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s manager has a number of years experience in working with and caring for the elderly. The manager is currently working towards the NVQ Level 4 Registered Managers Award and has one unit still to complete. It was evident from the inspector’s observations and through discussions with the staff and residents that the manager knows her residents well and strives Lyngate Care Home DS0000059303.V361272.R01.S.doc Version 5.2 Page 25 continually to meet their needs. Her manner in dealing with the residents appeared to be very kind, patient and understanding. From the inspectors observations the manager is a ‘hands on’ manager and is very comfortable in that role. This is commendable, however some of the tasks that the manager undertakes could easily be carried out by staff, leaving the manager to make sure the home is running properly. For example on the first morning of the inspection the manager spent at the hospital with a resident who was undergoing tests. A carer or another member of staff, if there were no relatives to accompany the resident could have escorted the resident for this appointment. The manager spends a lot of time letting visitors and staff in and out of the home due the systems in place, which would benefit from being reviewed. The manager or the deputy manager needs to carry out regular checks of the environment to make sure everything is in working order and that there are no hazards left about the home. That records (daily progress notes) are properly maintained and have been written in a suitable format that provides correct information about the resident’s well being and that the medication is properly recorded and can be accounted for The manager operates an ‘open door’ policy so that she can be approached at any time by staff or residents or their families, this was observed during the inspection, when residents came to speak with the manager. In the main the records required by regulation were available for inspection. The home has appointed an administrator (awaiting CRB clearance) who should be of great help to the manager. The manager is reminded that some information is confidential and should be securely stored; such as the filing cabinet containing care plans which should be locked or removed from where it is now. The staff appraisal file was also accessible to everyone as it is on a shelf in the main thoroughfare where any member of staff can read what has been discussed between the manager and the member of staff. Systems are in place for self-monitoring within the home. The inspector was shown examples of resident’s satisfaction questionnaires, at the last inspection, which had been returned in 2007. Feedback from residents was positive about the care provided. The manager must hold regular staff and residents meetings. The date of the last staff meeting was recorded on 7 March 2007, the manager thought there had been another meeting since then but there was no evidence that showed this. The owner of the home is now visiting the home on a monthly basis and a written report is completed as required. The residents finances were not inspected, these will be looked at during the next inspection. Lyngate Care Home DS0000059303.V361272.R01.S.doc Version 5.2 Page 26 Information provided on the AQAA indicated that the following checks have taken place and certificates were available to verify that: Hoists – serviced January 2008 Gas – serviced January 2008 Electrics serviced– September 2005 (five years) Hoist – serviced February 2008 Fire detection serviced – February 2008 Lift serviced – January 2008 The requirements made on the fire officer’s last report have now been completed and there was evidence to support the work had been done. The home’s accident book was available for inspection and incidents, accidents and injuries had been documented. The CSCI are now made aware of any injuries or accidents that may occur to residents. Lyngate Care Home DS0000059303.V361272.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x 2 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x 2 x x 3 x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 2 x x x x 2 Lyngate Care Home DS0000059303.V361272.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation 5 (1)(c) Requirement All residents must have a written contract/statement of terms and conditions regardless of how their care is purchased. Care plans must be securely stored when not in use. The recording of the daily progress notes must be improved to inform staff of how the resident has been during the day and night and not written just as a paper exercise. Arrangements must be made for the recording, handling, and safe keeping of medicines received in the care home, so as to ensure residents receive the appropriate medication. Unmet from 16/11/07 1.All records regarding medication must be clear and accurate to show that medicines are all accounted for and given properly. 2. All medication must be administered in strict accordance with the prescribers’ directions to Lyngate Care Home DS0000059303.V361272.R01.S.doc Version 5.2 Page 29 Timescale for action 30/05/08 2. OP7 15 30/05/08 3. OP9 13 03/04/08 ensure the safety of residents’ health. 3. All medication must be accounted for by means of a reliable auditing system, and medication must be audited on a regular basis to ensure it is not being mishandled and residents are safe. 4. OP9 13(2) All medicines must be stored securely and ensure that controlled drugs are stored in controlled drug cabinet in line with current legislation. The rolling programme of maintenance must continue, including work on the bathrooms to ensure the care home is kept in a good state repair. The registered person must ensure that suitably qualified staff are working at the care home. The registered person must ensure that regardless of training undertaken by staff that they are competent to carry out their role, e.g. recording and administering of medication. The manager must ensure that the home is properly run at all times and that the welfare of the residents is protected with regard to record keeping, audits and regular environmental checks. The manager must ensure that all parts of the home to which residents have access to are free from hazards to their safety, e.g. communal toiletries left in bathrooms. 01/07/08 5. OP19 23 30/05/08 6. OP28 18 30/05/08 7. OP30 18 30/05/08 8. OP31 12 30/05/08 9. OP38 13 (4) (a) 03/04/08 Lyngate Care Home DS0000059303.V361272.R01.S.doc Version 5.2 Page 30 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. 2. Refer to Standard OP15 OP31 Good Practice Recommendations The person in charge of ordering food and supplies should ensure that food is available that corresponds to the menus. The manager is part way through the NVQ level 4 course and she needs to continue to progress with this until completed. Lyngate Care Home DS0000059303.V361272.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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