CARE HOMES FOR OLDER PEOPLE
Lynhales Hall Nursing Home Lyonshall Kington Herefordshire HR5 3LN Lead Inspector
Sandra Bromige Unannounced 26 July 2005 10:45 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 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. Lynhales Hall Nursing Home E52 E02 S61071 Lynhales Hall Nursing Home V241104 260705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Lynhales Hall Nursing Home Address Lyonshall Herefordshire HR5 3LN Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01544340642 01544 340644 Lynhales Hall Nursing Home Limited Mrs Margaret Ann Fallon CRH Care Home 47 Category(ies) of DE Dementia 1 registration, with number DE(E) Dementia - over 65 47 of places OP Old Age 47 PD Physical disability 1 TI(E) Terminally ill 47 Lynhales Hall Nursing Home E52 E02 S61071 Lynhales Hall Nursing Home V241104 260705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1 Three named service users under the age of 65 years, this includes one named service user with dementia. 2. The Manager must undertake a recognised course for Dementia Training within 12 months from the date of registration. 3. The Manager must undertake a recognised course in Health and Safety within 3 months from the date of registration.. Date of last inspection 18 January 2005 Brief Description of the Service: Lynhales Hall, which is located on the outskirts of the village of Lyonshall, is approached by a long drive and is in a very rural situation. Set in its own extensive grounds, it was originally built as a ‘gentleman’s residence’. Now modernised and extended, it is a care home with nursing, offering services for up to 47 older men and women with a variety of frailties and associated difficulties. The Home is also registered to provide care for people who are terminally ill. Lynhales Hall Nursing Home E52 E02 S61071 Lynhales Hall Nursing Home V241104 260705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection which took place over 6.5 hours. The Inspector looked around some parts of the building and a number of records were inspected. The owner, manager, residents and staff were spoken with. Comments cards and staff questionnaires were sent to the Home prior to the inspection to enable residents, staff and visitors to comment on the service provided. Since the last inspection 2 complaints has been made to the Commission about this service. One was investigated by the Home and one by the Commission. The outcome of the complaint investigated by the Commission is included in this report. What the service does well:
Lynhales Hall is set in a very rural location in extensive grounds and is approached by a long drive. The Home is very well maintained, clean and free from any bad smells. Relatives have commented that the Home is “well run and very clean”. Staff are described as “pleasant and they carry out their duties with a smile” and “are approachable”. Assessments are done for prospective residents to ensure that the Home is able to meet the resident’s needs. The standard of care is good. Relatives have commented, “ I am delighted at the way my mother is treated”; “staff are very attentive”; “she has received and appreciated as have I, all the wonderful care, love and attention she has received from all members of the staff”. The Home produces a newsletter, which is distributed to the residents and their relatives. A relative has commented on this saying that “ the newsletter is very helpful for relatives, to see the activities are available for their relatives”. Staffing levels are satisfactory. Staff are not allowed to start work until thorough checks have been carried out by the Home. In addition to the manager the Home employs a trained nurse as the training officer. This person undertakes and co-ordinates all the training in the Home. A good range of equipment is in use for residents to prevent skin damage by sitting or lying. A range of equipment is also provided to enable staff to move residents who are not able to stand.
Lynhales Hall Nursing Home E52 E02 S61071 Lynhales Hall Nursing Home V241104 260705 Stage 4.doc Version 1.40 Page 6 Complaints and concerns are listened to and acted upon. What has improved since the last inspection? What they could do better: 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. Lynhales Hall Nursing Home E52 E02 S61071 Lynhales Hall Nursing Home V241104 260705 Stage 4.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection Lynhales Hall Nursing Home E52 E02 S61071 Lynhales Hall Nursing Home V241104 260705 Stage 4.doc Version 1.40 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3 & 5 Residents are aware of the Home’s terms and conditions when entering the Home as assessments are done prior to admission assuring all care needs can be met. EVIDENCE: A large print and detailed contract is given to residents when they enter the Home. A recently admitted resident had been assessed by the manager prior to coming into the Home. The resident had visited the Home to look around and to have lunch with the residents. Residents are able to come into the Home for a trial period. Lynhales Hall Nursing Home E52 E02 S61071 Lynhales Hall Nursing Home V241104 260705 Stage 4.doc Version 1.40 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 9 & 10 There is a clear and consistent care planning system in place to ensure that the health needs of the residents are well met. The medication is well managed promoting good health. Good practice and procedures are in place to ensure that resident’s privacy and dignity is respected. EVIDENCE: Individual care plans are available for each resident. The care plans are informative and regularly updated. They give clear information for care staff so that they know what to do for each resident. Assessments to identify the need to use bedrails and that they are safe for the resident, need to be reviewed every month. Not all the residents sitting in the one lounge can be properly observed by staff when passing. Air conditioning units have been installed in both of the medicine storage rooms. Staff were seen to respect residents privacy and dignity. Consultation with residents and their visitors confirm that their privacy is respected and they are able to see their visitors in private. Lynhales Hall Nursing Home E52 E02 S61071 Lynhales Hall Nursing Home V241104 260705 Stage 4.doc Version 1.40 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: Lynhales Hall Nursing Home E52 E02 S61071 Lynhales Hall Nursing Home V241104 260705 Stage 4.doc Version 1.40 Page 11 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 The Home has a satisfactory complaints system with evidence that residents, relatives and staff feel that their views are listened to and acted upon. Arrangements for protecting residents from harm are satisfactory ensuring that they are not placed at any potential risk of harm or abuse. EVIDENCE: The Home keeps a detailed record of all complaints raised by residents and their visitors. The Home’s records show details of the complaints/concerns raised. Action taken by the manager to investigate and resolve the concerns to the complainant’s satisfaction is clearly recorded. The Commission has received two complaints about the Home since the last inspection. The first was referred directly to the Home by the complainant. The second was a complaint alleging poor care practice. One element of the complaint was not upheld and one element was upheld. A recommendation was made by the Commission regarding the use of posture belts fitted to wheelchairs in particular for residents with dementia. The recommendation has been included in this report. Staff upon induction receive training about recognising and responding to any suspected poor treatment of residents. Further training is due to be arranged subject to the timing of the availability of the local trainer. Lynhales Hall Nursing Home E52 E02 S61071 Lynhales Hall Nursing Home V241104 260705 Stage 4.doc Version 1.40 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 26 Not all residents are able to access a call bell at all times to ensure that they can call for help when needed. The systems for the management of infection control are good ensuring that the residents live in a clean environment and are not at risk of cross infection. EVIDENCE: Two residents with mobility problems in one of the lounge areas did not have access to the call bell to ask for assistance from staff. The Home is clean, tidy and free from any bad smells. Hand washing facilities and disposable aprons and gloves are provided for staff. Training is given to staff in the prevention of cross infection. The Home has conducted a very recent audit on the control of infection. The audit was carried out the staff and covered all areas of the service. The outcome of the audit was overall very good. Any shortfalls have been addressed via a written action plan and reaudit of those areas. Lynhales Hall Nursing Home E52 E02 S61071 Lynhales Hall Nursing Home V241104 260705 Stage 4.doc Version 1.40 Page 13 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 29 The deployment and number of staff available are sufficient to meets the needs of the residents. The procedures for the recruitment of staff are robust offering protection to the people living in the Home. EVIDENCE: On the day of the inspection there were 2 trained nurses on duty and 7 care staff. In addition, staff were supported by the Provider, Manager and training officer who are also all trained nurses. 8 ancillary staff were also on duty to cover catering, domestic and maintenance of the Home. The staffing levels are reviewed by the manager on a frequent basis. This is done through using a professional system to audit resident’s dependency and ability. Overall the written feedback from relatives indicated that there are enough staff on duty in the Home. Staff spoken with and those that responded via the written questionnaire confirmed that there are enough staff. The files of two new staff were seen. These contained all the records that the Home need to obtain prior to employing staff. Lynhales Hall Nursing Home E52 E02 S61071 Lynhales Hall Nursing Home V241104 260705 Stage 4.doc Version 1.40 Page 14 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: Lynhales Hall Nursing Home E52 E02 S61071 Lynhales Hall Nursing Home V241104 260705 Stage 4.doc Version 1.40 Page 15 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x
COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x x x Lynhales Hall Nursing Home E52 E02 S61071 Lynhales Hall Nursing Home V241104 260705 Stage 4.doc Version 1.40 Page 16 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. 2. Standard 7 8 Regulation 13 12 Timescale for action Bedrail risk assessments must be Immediate reviewed each month. & Ongoing The current procedures for the 30/09/05 supervision of residents in Goodwin lounge must be reviewed. All residents must be able to Immediate access a call bell at all times to & Ongoing call for assistance from staff. Requirement 3. 22 16 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 2 16 Good Practice Recommendations A revised contract or an addendum to the contract should be issued when any changes are made to the terms and conditions of stay in the home. Staff should be reminded about the potential hazards when using lap straps particularly with service users with dementia. Staff should be supplied with a copy of the MDA alert dated April 2004 called “Posture belts fitted to wheelchairs and seating” Staff should ensure that residents when sitting in the lounge have access to a drink in between the times that staff serve them or have a call bell within reach to enable
E52 E02 S61071 Lynhales Hall Nursing Home V241104 260705 Stage 4.doc Version 1.40 Page 17 3. 22 Lynhales Hall Nursing Home them to ask for a drink. Lynhales Hall Nursing Home E52 E02 S61071 Lynhales Hall Nursing Home V241104 260705 Stage 4.doc Version 1.40 Page 18 Commission for Social Care Inspection 178 Widemarsh Street Hereford HR4 9HN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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