Inspection on 24/11/08 for Lyngate Care Home

This inspection was carried out on 24th November 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Lyngate Care Home 22/07/08

Lyngate Care Home 01/04/08

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 06/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Lyngate Care Home 236 Wigan Road Bolton Lancashire BL3 5QE     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: Judith Stanley     Date: 2 4 1 1 2 0 0 8 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. the things that people have said are important to them: They reflect 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 26 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 26 Information about the care home Name of care home: Address: Lyngate Care Home 236 Wigan Road Bolton Lancashire BL3 5QE 0120462150 01204657441 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Lyngate Health Care Limited care home 41 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 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. Date of last inspection Brief description of the care home 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 homes services is available and the provider gives other Care Homes for Older People Page 4 of 26 Over 65 41 0 Brief description of the care home information about the home to new and prospective residents and their families verbally and they are also offered a copy of the homes Service User Guide (Residents Information Guide). The current weekly charge for accommodation and services range from 349 pounds and 93 pence to 355 pounds and 08 pence with additional charges being made for hairdressing, chiropody, extra toiletries, newspapers, holidays and trips out. Care Homes for Older People Page 5 of 26 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: This unannounced inspection was conducted over a seven hour period by two inspectors. Part of the time was spent looking at information the home holds on residents (care plans) and other records such as activities, menus, minutes from staff and residents meetings, staff files and staff training. The pharmacist inspector looked at the medication and recording systems. We, The Commission for Social Care Inspection (CSCI) looked around the home and spoke with residents and staff during the course of the day. Prior to the inspection the home was sent an Annual Quality Assurance Assessment (AQAA) to complete. This tells us what the home does well at and in which areas they need to develop and improve. To find out further information we sent surveys to some Care Homes for Older People Page 6 of 26 residents and staff. Six residents returned surveys and all were satisfied with the care provided. Comments received included: Its a nice home, and The meals are very good, there is always a choice. One staff survey was returned and indicated that new ways of working are constantly tried out so that residents needs are attended to as soon as possible. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 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 8 of 26 Care Homes for Older People Page 9 of 26 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 26 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. The home provides residents and their supporters with up to date information about the home that helps them on making a decision about moving in to the home and the services provided. A full pre admission assessment is carried out prior to admission to ensure the home can meet the needs of the individual. Evidence: The home had a statement of purpose and a service users guide. Additionally, there was a brochure which is up to date and contains photographic information about living at Lyngate. These documents were available to prospective residents and for those people already living at the home. The information informs people about the management and staffing structure within the home and about the services and facilities available that helps them make a decision about moving in to the home. The last report from the Commission for Social Care Inspection (CSCI) is available for people to read if they wish. We received six completed surveys from residents and all Care Homes for Older People Page 11 of 26 Evidence: indicated that they were provided with sufficient information about the home prior to moving in. We selected three residents files (care plans) to work with throughout the inspection. We asked to see the written contract/statement of terms and conditions for the three residents whose files we were working with. A separate file is held in the main office with all residents contracts in place. Where possible residents are encouraged to sign their own contracts. One was waiting to be signed by the residents next of kin. On examination of the files, all three had a pre admission assessment in place. The assessment is carried out by a suitably qualified member of the staff team to ensure the home and staff can meet the personal and social care needs of the individual. The homes assessment is completed regardless of any other assessment which may have been carried out by the residents social worker ( if they have one ). A letter of confirmation is forwarded to the prospective resident and/or their relative indicating that the home can meet their needs in full. The assessment is detailed and covers: residents details such as date of birth, address admitted from, preferred term of address, doctor, allergies, medical history, personal care required, nutrition, sight, hearing and communication, oral health, foot care, skin care, mobility, history of falls, continence, medication, mental and cognitive state, previous occupation and carer involvement. The family are encouraged to be part of the assessment as they can provide invaluable information about the resident such as: how the person has come to this point and how these problems have affected their relatives the home is caring for. Some of the residents living at the home have a dementia related illness. Some staff had undertaken training in this area of care, however the new owners are currently reviewing all areas of staff training. Care Homes for Older People Page 12 of 26 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. Care plans are clear and concise and provide staff with the information they need to meet the needs of the residents. Personal care and support is offered in such a way as to promote and protect residents privacy and dignity. Evidence: We continued with the same three care plans. Since the new owners took over in October 2008 the format for the care plan had been changed. The plans were easier to follow and provided staff with all the necessary information they need to meet the individuals health and social care needs. Staff spoken with confirmed that the care plans were now easier to work with. The care plans are drawn up from the initial assessment and include personal details, mental health, personal care, mobility, communication, nutrition, continence etc. Risk assessments had been reviewed and covered areas such as moving and handling, risk of falls, bathing and pressure care were in place as required. Involvement with outside agencies had improved. Residents had access to a doctor of Care Homes for Older People Page 13 of 26 Evidence: their choice (subject to doctors approval) and have indicated on returned surveys that they always get the medical support they need. The home works closely with the specialist teams including the Continence Support team, the Mental Health Team and the District Nurses. For residents having to attend hospital appointments the home has its own transport and a member of staff will accompany the resident if required. Supplementary information was seen in the care plans and including personal care, record of bathing and weights. Daily progress notes are also maintained. During the inspection the pharmacist inspector looked at how well medicines were handled to make sure that residents were being given their medicines properly. Medication records belonging to two residents were looked at together with their medicines. We saw that the medication records showed clearly exactly what medicines had been administered to residents and that they had been given their medicines as prescribed. Medication records also clearly showed that medicines could all be accounted for and that they had not been mishandled. Staff had made good records when doctors had changed residents medicines or doses and that residents were given their new doses or new medicines properly. We were told that all staff that handle medication had had recent additional medicines training to make sure that medicines were ordered efficiently and to prevent medicines running out or being overstocked. Staff had been assessed as being competent to handle medicines safely. An auditing system to check that medicines were being handled safely had been put in place. There were some areas of medicines handling which could be improved such as the recording of the administration of creams and where they are stored. Overall residents were given their medicines as prescribed and their health was protected. The clear and accurate records kept about medicines showed that medicines were handled properly and safely. Those residents able to comment indicated that staff respected their privacy and dignity. The importance of this is reiterated in the staff induction programme. During the inspection staff were observed to treat residents with respect and consideration. Staff were seen knocking on bedroom and toilet doors before entering. Residents were observed to be clean and well groomed. The hairdresser attends on a regular basis and was at the home on the day of the inspection. Care Homes for Older People Page 14 of 26 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 are offered a wide range of activities to meet their capabilities and expectations. Residents are provided with well-cooked food, which they like, in good portions at times that suits them. Evidence: The home has a full time hobby therapist who is supported by a volunteer. A full programme of activities is available and regular trips out of the home are planned. Activities are planned with input from the residents and include: cards, bingo, arts and crafts, reminiscence, gentle exercise, visits from entertainers and one to one chats. Some residents like to read the papers and enjoy word games. Comments on returned residents surveys included, There is always a lot going on but at the moment I cant get out of bed. The hobby therapist comes to see me and has a chat, we have discussed doing some activities in my room. Another said, I have only been here a few weeks but there seems a lot going on. Residents spiritual needs are addressed with visits from the local clergy. Care plans contain details of residents preferred religion. Visitors are welcome at any time; there are no restrictions as to when people can visit. Care Homes for Older People Page 15 of 26 Evidence: Residents can meet with their visitors in any of the lounges or in the privacy of their own rooms. The resident has the choice of who they wish to see and when. The owners and staff encourage and support people in making their own decisions and choices. Residents confirmed they get up when they want and go to bed at a time that suits them. For residents whose choice it is to smoke the owners have recently purchased a shelter for outside. This has been an added bonus for one resident in particular. There is a choice of food and meals can be taken at a time that suits the individual resident. A choice of bath or shower and how often is offered, again at a time that suits the individuals needs. Since the new owners took over and through discussions with residents the menus had been reviewed. The owners have spent time supporting the kitchen staff with the changes and with new products. Homemade food instead of convenience food is now being served. Homemade soups had replaced tinned or packet soups. The owners ensure a regular supply of fresh meat, fish, fruit and vegetables is always available. Reputable brands of food and beverages are now being purchased instead of cheaper products. One resident said, They had only been in a day when we get proper tea and coffee. Two residents told us how much they had enjoyed the prawn salad and new potatoes they had at teatime, saying It was lovely for a change. The menus offer two main choices or residents can request what they like. Special dietary needs are catered for and snacks and hot and cold drinks are available throughout the day. The introduction of a glass of sherry or alcoholic drink (subject to risk assessment) has been well received. Care Homes for Older People Page 16 of 26 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. Residents and their relatives, can have confidence that residents will be protected from abuse and have their rights, including the right to complain, protected by staff training and procedures. Evidence: The new owners have rewritten the complaints procedure which can be easily understood by the residents. The policy takes into account any concerns that residents may wish to raise. There have been no complaints made about the service and no complaints have been brought to the attention of the CSCI. Residents spoken with had no complaints and were complementary about the new owners and the changes they had already made. All staff had undertaken training in the protection of vulnerable adults and the home has a comprehensive policy on whistle blowing. There has been no adult safeguarding referrals or investigations made to the home and the CSCI has not been made aware of any protection issues. As previously stated the owners are reviewing all staff training and further protection training will be available. Care Homes for Older People Page 17 of 26 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. The environment is warm, safe and comfortable making this a homely and pleasant place for people to live in. Evidence: From a tour of the premises it was evident some improvements had been made to the environment. The cleanliness of the home had improved and in the main was free from any offensive odour. On all six residents questionnaires returned, all have indicated that the home is fresh and clean. One resident described the home as, Fit for a queen. The owners have submitted to the CSCI an improvement plan for the home which is include refurbishment of the bathrooms, bedrooms and communal areas. We appreciate that the owners inherited environmental problems, however these do compromise the safety of the residents and time is needed for the owners to address the planned improvements. There are lounge and dining areas on all floors, which were clean and comfortable. Residents of all floors join together for activities but have a tendency to go back to the lounge and dining area on their own floor, as is their choice. Bathrooms and toilet facilities are available on all floors. The home has a passenger lift to all floors to allow residents free access around the home. We looked in several bedrooms, these were seen to be warm, clean and comfortable. It was evident that residents had personalised their bedrooms with their own Care Homes for Older People Page 18 of 26 Evidence: possessions and mementos brought with them from home. The home has CCTV on the door entries for added security for staff and residents. This does not intrude on the residents and does not compromise their privacy. The external areas of the home are well maintained and garden areas are safe and secure. A smoking shelter had been purchased, specially commissioned for safety and use of the residents. New infection control policy and procedures had been introduced. Infection control measures and housekeeping had been reviewed. The overall cleanliness of the home had greatly improved and this was commented on by staff and residents. Staff were provided with protective clothing and gloves for different tasks. The laundry is sited away from residents and does not intrude on them in any way. Residents had no complaints about the laundry services provided. Care Homes for Older People Page 19 of 26 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. Staffing levels were satisfactory ensuring consistency of care for people living at the home. Good recruitment procedures ensure the residents were well cared for by people who had been safely recruited. Evidence: On the day of the inspection, staffing levels were sufficient to meet the the needs of the residents. The manager is on shift most week days and there is always a deputy manager on each shift. A written rota is maintained showing which staff were on duty and at what times. Where possible any gaps in the staff rota due to sickness or annual leave would be covered by the homes staff. The use of agency staff has been reduced. This ensures consistency of care for the residents. One member of staff on a returned survey said, The residents are treated individually according to their needs. They are treated with respect and their dignity is maintained. They are encouraged to choose the lifestyle which suits them. Staff now have the leadership, guidance and support they need to carry out their roles efficiently and effectively. Staff morale appeared good and staff were happy to help one another out as required. Staff spoken with said they liked working at the home. One said working conditions had improved significantly since the new owners had taken over. The atmosphere within the home was relaxed and friendly. Interactions Care Homes for Older People Page 20 of 26 Evidence: between staff and residents were frequent, natural and warm. During the visit staff were observed to respond speedily to requests for assistance made by the residents. The home has now over 50 of staff qualified with NVQ level 2 or above. Mandatory training, such as moving and handling, protection of vulnerable adults, etc had been completed. The owners have produced a training matrix to ensure that staff are suitably trained and plan for refresher courses as required. All staff training is currently under review. A robust and rigorous recruitment procedure is in place. A full copy of each staff members employment file is kept in the home. Three staff files were looked at and information included: a written application form, two written references, job description, Criminal Records Bureau Check (CRB) and other forms of identification. Prospective staff attend for an interview and the recruitment of staff involves an interview by a resident who has volunteered to assist in this process. On commencement of work staff would be supernumery until they are familar with the layout and running of the home. All new staff undertake a full induction programme in line with the Skills for Care requirments. Care Homes for Older People Page 21 of 26 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. Quality assurance systems were in place to ensure the performance of the home is regularly monitored. Residents and staff can be sure that their health, safety and welfare will be promoted and protected. Evidence: The manager has worked at the home for a number of years and has recently completed the NVQ 4 Registered Managers award. The manager is kind, caring and knows the residents well but appears to lack leadership skills. The owners are at the home most days and are in day to day control of running the home, organising staff and residents meetings, carrying out supervisions etc. These are tasks which an experienced manager should be undertaking. We still have some reservations about the running of the home if the owners were to be absent for any length of time. The manager has the support and backing of the owners who are improving the home and the effectiveness of the management of the home in all areas. Care Homes for Older People Page 22 of 26 Evidence: The home operates an open door policy so that the owners and the manager can be approached at any time by staff, residents and relatives. This was observed during the day when a resident had no hesitation in approaching one of the owners. Quality assurance systems had improved, which included satisfaction and quality surveys. Resident/relative and staff meetings are held of which the minutes were available for inspection. Regular audits of care plans, medication etc were taking place. All the home policies and procedures had been updated in October 2008 by the new owners. These were accessible to staff as required. The financial records of three residents were checked. The storage of monies had improved with residents monies being held in separate wallets. There were no discrepancies found. Records of any transactions was clearly documented on the individuals balance sheet. With the pre inspection materials, the owner provided a list of of maintenance checks and serving of equipment such as the lift, hoist, gas and electrics etc. All were seen to be up to date and valid. Accidents, injuries and incidents were suitably recorded and the CSCI notified as required. Care Homes for Older People Page 23 of 26 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 24 of 26 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 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 Care Homes for Older People Page 25 of 26 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. 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