Inspecting for better lives Key inspection report
Care homes for adults (18-65 years)
Name: Address: Lynray Residential Care Home Lynray The Gore Rayne Braintree Essex CM77 6RL 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: Sara Naylor-Wild Date: 1 9 1 2 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. They reflect the things that people have said are important to them: 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 Adults (18-65 years) 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: ï· Put the people who use social care first ï· Improve services and stamp out bad practice ï· Be an expert voice on social care ï· Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information
Document Purpose Author Inspection report CSCI
Page 2 of 30 Care Homes for Adults (18-65 years) Audience Further copies from Copyright 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 Adults (18-65 years) Page 3 of 30 Information about the care home
Name of care home: Address: Lynray Residential Care Home Lynray The Gore Rayne Braintree Essex CM77 6RL 01376329437 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): New Partnerships Limited Name of registered manager (if applicable) Clair Denise Leonard Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 3 0 care home 3 learning disability Additional conditions: The Registered person may provide the following categories of service: Care Home only - Code PC To service users of the following gender: Either Whose primary care needs on admisssion to the home are within the following categories: Learning Disability - Code LD The maximum number of service users who can be accomodated is: 3 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 30 A bit about the care home Lynray is registered for 3 people with learning disabilities to live there. The service is positioned in a quiet residential area on the outskirts of Braintree, North Essex. The home consists of three single rooms spread over two floors. All three have large ensuites attached. There is one further bathroom on the ground floor. They are all light and airy with large windows overlooking the grounds or surrounding areas. All bedrooms are lockable and contain; television aerial and sky connections; telephone and computer broadband points. The home further contains a large kitchen with separate utility for the laundry equipment. There is a comfortable lounge/diner with french doors out into a small secure garden area, which is partly paved. Care Homes for Adults (18-65 years) Page 5 of 30 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 30 How we did our inspection: This is what the inspector did when they were at the care home This unannounced key inspection was carried out on the 19th December 2008. The service was registered with the Commission in July 2008 and this was the first inspection of the service. As part of the inspection we checked information received by the Commission for Social Care Inspection (CSCI) since the last inspection, looking at records and documents at the care home and talking to the care staff and the people living at the home and a tour of the premises was completed at the visit to the home. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well The assessment and admission process undertaken for each person before they move into the service was comprehensive and would ensure that both the service and the person themselves were ready for the admission. The care planning documents incorporated both the professionals’ views of the person and their support needs as well as the views of the person themselves. There was a strong person centred ethos throughout the documents that supported the individual and explored how their abilities could be supported and strengthened. Care Homes for Adults (18-65 years) Page 8 of 30 People are supported in making choices and taking part fully in the local community. They enjoy a variety of opportunities that meet their preferences and abilities. The staff work with individuals in assessing the risks present in activities they undertake and agreements are made in how these will be reduced whilst supporting their independence. Staff are employed following a thorough recruitment process that includes input from people living in the home. They undergo checks that would ensure a robust process for protecting people who live at the home from abuse. The premises were clean, safe and free from odours. People were able to move around the home freely and enjoy the resources on offer. Care Homes for Adults (18-65 years) Page 9 of 30 People living at the home told us I like living here, the best thing is there is so much to do and the staff are all nice to me The service has achieved a high standard of quality in its provision within the short time it has been operating. There is a genuine sense that the people living at the home and how their lives can be enriched are central to everything that the staff and manager do. What has got better from the last inspection This is the first inspection of this service. Care Homes for Adults (18-65 years) Page 10 of 30 What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Sara Naylor-Wild Csci CPC1 Capital Business Park Fulbourn Cambridge CB21 5XE 01223 771350 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.
Care Homes for Adults (18-65 years) Page 11 of 30 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 Adults (18-65 years) Page 12 of 30 Details of our findings
Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 13 of 30 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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
. People considering moving into the home can be assured that the home will ensure it can support them before admitting them. Evidence: The service has a statement of purpose that sets out the assessment and admission process. It states that people referred to the service will have their needs fully assessed and be offered introductory visits to the home before there is any agreement to an admission. There had been two people move into the home since the service was registered and their admission documents were considered at this visit. The files contained evidence of both a professionals assessment carried out by the persons social worker and additional assessment information gathered by the service. In particular there was opportunity for the person themselves and their families to contribute to the information gathered about them. The files also contained records of the introductory process the service had undertaken with each individual,. This had taken place over a period of some time and had a total of 13 occasions where either the person visited the service or staff supported them in an activity in the community. This provides the
Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: service and the individual with a good understanding of the support they will require and if the service can provide this. Care Homes for Adults (18-65 years) Page 15 of 30 Individual needs and choices
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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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
. People living at the home can be confident that staff will understand how best to support them and they will be consulted on this. Evidence: Both people living at the home had a personal file that contained information taken from their initial assessment. This had been developed into a care plan for each person covering aspects of their daily living and the support they require to manage these skills. The information was written in depth with a clear perspective on the person as an individual and how they can best be enabled to live their life to the fullest aspect. This is supported by risk assessments that are person centered and state that The risk assessment should promote positive risk assessment, which means that when looking at new opportunities the risk may be greater as we are working toward people gaining more skills and independence. The sheets set out the issues under consideration, what are the restrictions and why they are in place, as well as the planning to develop the opportunity for more decision making in future. During the inspection one of the people living at the home sat with a staff member and completed
Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: an assessment of risk about going out, and was able to agree with the staff member how this should be addressed. Both the care plan and the risk assessments provided clear guidance to the staff in how they should support the person. These are signed off by both staff and the person concerned and supported by behavior contracts that use pictures to help people understand the agreements. One of the people living at the home told us about their opportunities for choice. They said that they liked living at the home because there was more to do and they were able to take part in things. Choices are provided on a daily basis and include areas such as meal planning, decisions on how to spend the day, and where to spend time. People living at the home have also been involved in the appointment of staff and been able to exercise their views about applicants suitability. Care Homes for Adults (18-65 years) Page 17 of 30 Lifestyle
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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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
. People living at the home can be confident that they will be able to exercise choices in how they spend their time and that they will be supported in doing so. Evidence: Both the care plans seen during the inspection contained reference to the development of peoples skills throughout. These included both practical daily living skills and emotional skills in helping them deal with their feelings. People living at the home were encouraged and enabled to take part in their community. This included employment opportunities and at the time of the inspection both people living at the home were employed part time in a mixture of roles. The person had chosen the type of workplace they were interested in and the home had supported them in gaining employment. Both people living at the home took part in their local community. This included
Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: accessing services such as shops, cinemas, pubs and leisure centers. The level and type of involvement was documented in individuals care plans reflected their personal choices and were supported by staff where appropriate. Families were considered an intrinsic part of the life of the home and both people living there were supported in maintaining their links with the families. This included visits to the home and reciprocal visit to the family home. There was also evident that when a person asked not to see someone this had been supported. The daily routine of the home is open to consultation with people living there. This was reflected in the individuals care plans and how they behaved on the day of the inspection. People moved around the home freely and were able to spend time in private if they wished. Bedrooms were able to be locked and the person to whom the room belonged held their own key. The menu for the main meals were planned with people living at the home on a weekly basis. One person living at the home enjoyed cooking meals and participated in the preparation of a number of meals during the week. The menu was varied and nutritious and reflected the preferences of people living at the home. Care Homes for Adults (18-65 years) Page 19 of 30 Personal and healthcare support
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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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
. People living at the home can be confident that the staff understand how they prefer to be supported and monitor their health and wellbeing. Evidence: The care records for each person living at the home documented how much support they required in meeting their personal needs and the way in which they preferred this to be carried out. Health care records were maintained, although due to the short time that both people have lived at the service these were minimal. The present group of people living at the home had only topical medications prescribed. These were being self administered by the individual. Although the risk in the current prescription is minor there should be an assessment of risk for people to administer their own medication and the service were advised to carry this out. There were not any controlled drugs being administered at the time of the inspection, although it is now a requirement of all registered premises that they have a controlled drugs cabinet in situ, should they be prescribed. Care Homes for Adults (18-65 years) Page 20 of 30 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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
. People living at the home can be assured that they will be listened to and action taken in response to their concerns. They can be confident that staff understand how to protect them from abuse. Evidence: The service has a complaints policy in place that reflects the expectations of the National Minimum Standards for Younger Adults. This includes timescales and a protocol that the service will follow in response to complaints. The home did not maintain a log book of complaints at the time of the inspection, although minor issues that arose on a daily basis were recorded in each persons daily record. It would be good practice to ensure that complaints are recorded separately to provide an audit of incidences. People living at the home we spoke with during the inspection were clear about their right to complain and who they would address their concerns to. The service has a safeguarding policy on file that reflects the local authority guidance and ensures that staff have a clear understanding of the expectations on them should they witness abusive behavior. Staff demonstrated a competent knowledge of the policy and procedures. Safeguarding training is Incorporated into the staff induction and ongoing training programme. Care Homes for Adults (18-65 years) Page 21 of 30 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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
. People living at the home can be confident that the premises are suitable to meet their assessed needs. Evidence: The premises had been newly converted from a private dwelling within the last 12 months and were registered by the Commission as a residential home in August 2008. This means that the building complies with the Care Homes Regulations 2001 and the National Minimum Standards for Younger Adults. People living at the home have single rooms with en suites and are able to use a communal lounge dining room and kitchen. People are able to decorate their rooms to their own taste and are encouraged to bring personal items with them when they move into the home. Bedrooms are fitted with locks and people are provided with keys to enable them privacy and security of their personal space. Lockable facilities are provided in their rooms for additional security of personal belongings. The grounds are accessible easily from the home and at the time of the inspection one person living at the home had pet rabbits they kept in hutches in the garden. Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: The home appeared clean and tidy on the day of inspection and no unpleasant odours were detected anywhere in the building. There are domestic laundry arrangements that meet the requirements of people living at the home. Care Homes for Adults (18-65 years) Page 23 of 30 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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
. People living at the home benefit from skilled staff who are present in sufficient numbers to meet their needs. Evidence: At the time of the inspection there were four staff employed. This included the manager, the deputy manager and two part time support workers. The staffing arrangements for the service set out in rosters indicate that there are two staff attending during the waking day and one person sleeps in over night. The current occupancy of two people are supported by this arrangement and further admissions to the service would require a review of staffing in accordance with the persons assessed needs. Staff were observed to be able to spend substantial amounts of time with people living at the home and to support them sufficiently in meeting their needs and choices.The relationship between staff and people living at the home was observed. They adopted a positive approach to enabling the person, and were respectful but relaxed in their manner. During the visit there were many instances where staff acted in a positive person centered manner that supported the person to make decisions and be involved in their day to day choices. The files of two staff were considered during the visit. These demonstrated that the
Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: service had undertaken a robust recruitment process that included gaining full application forms, two written references and checks being made against the Criminal Records Bureau and the Department of Health Protection of Vulnerable Adults list. The files also contained the induction/training record for each person. The records demonstrated that staff had attended training sessions in fire safety, challenging behaviors, health and safety, food hygiene, autism, safeguarding and infection control. The training programme for 2009 had not been developed at the time of the inspection. The service had commenced a formal format for supervision with notes being kept of discussions on individuals files. Staff spoken with felt that they benefited from the small size of the staff team and the frequent contact with the manager. Care Homes for Adults (18-65 years) Page 25 of 30 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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
. People living at the home can be assured that a competent manager who listens to their views and takes actions leads the home. Evidence: The manager had undergone a registration process with the Commission in August 2008. As part of this process the manager had to successfully demonstrate that they had both the experience, skills and knowledge required to run a residential home. Miss Leonard has National Vocational Qualification level 4 in Management of Care and has registered for the Registered Managers Award. She is a registered nurse and undertakes regular training in order to maintain her registration. She has worked in residential settings previously and has a good understanding of the responsibilities in managing a residential setting. Staff spoken with during the inspection were complimentary of Ms Leonards management style, stating that they enjoyed working with her and could approach her with any issues. Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: The service had only been registered for 6 months and people had not moved into the home until September and October 2008. It was therefore not possible to consider the annual quality assurance surveys and responses for the service. There was however a policy in relation to quality assurance on the files that demonstrated good practice in the processes. The systems for management of peoples monies was considered. Each person is supported to hold and manage their money by the staff. This is done by the maintenance of a cash book that records each persons transactions from their bank, the cash they have used and receipts for purchases they have made. Discussions with one of the people living at the home demonstrated that they understood how the system operated and what funds they had available. This was a very enabling management of monies that supports people in developing skills and independence. The records relating to the maintenance and safety checks for the premises and equipment were reviewed as part of the registration within the previous 6 months. Annual maintenance had not yet been implemented given the short time the service had been operating. There were however records that indicated that fire safety systems were regularly checked by staff and signed for. Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes ï£ No ï 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 Adults (18-65 years) Page 28 of 30 Requirements and recommendations from this inspection
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No Standard Regulation Description 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 Description 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 1 2 20 20 The service should assess the risk of people managing their own medication to ensure they are safe to do so. the service should install a controlled drugs cabinet that is compliant with the guidance produced by the CSCI. Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web:www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website.
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