Inspection on 19/04/09 for Lynton

This inspection was carried out on 19th April 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lynton 30/09/09

Lynton 22/04/08

Lynton 16/04/07

Lynton 06/11/06

Lynton 03/11/05

Lynton 25/05/05

Lynton 20/09/04

Lynton 29/04/04

Lynton 22/07/03

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Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Lynton London Road Ashington West Sussex RH20 3JS     The quality rating for this care home is:   one star adequate 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: David Bannier     Date: 1 9 0 4 2 0 0 9 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. that people have said are important to them: They reflect the things 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: • • • • 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 Adults (18-65 years) Page 2 of 31 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.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Lynton London Road Ashington West Sussex RH20 3JS 01903893406 Telephone number: Fax number: Email address: Provider web address: jallies@btinternet.com www.caremanagementgroup.com Name of registered provider(s): Type of registration: Number of places registered: Care Management Group Ltd care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 3 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD Date of last inspection Brief description of the care home Lynton is a care home, which is registered to provide personal care for up to three service users in the category learning disability (LD) who are between the ages of 18 to 65 years of age. It is a detached property, which has been adapted for its current use, and is located in a residential area of Ashington, a small village approximately 20 minutes from both Worthing and Horsham town centres. There are local shops and a pub in the village and residents can access nearby leisure facilities, colleges and work placements. There is a bus service from the village that connects with mainline Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 3 Brief description of the care home trains. The property is a two -storey building providing private accommodation to service users in single bedrooms located on the ground and first floors. Communal accommodation is made up of a lounge and a dining room located on the ground floor. A garden which has been laid to lawn, with flowerbeds is available to service users, and is located to the rear of the premises. Fee levels currently range from #1,080.00 to #1,532.00 per week. Personal items such toiletries and hairdressing are not included. The registered provider of this service is Care Management Group Ltd. The registered provider has identified Mr Peter Kinsey to be the responsible individual and to supervise the management of the care home. The post of registered manager is currently vacant Care Homes for Adults (18-65 years) Page 5 of 31 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: one star adequate 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 peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. The inspection has followed the Inspecting for Better Lives methodology and is called a key inspection as it assesses those standards determined by the Commission as key standards. This inspection will also determine the frequency of inspections hereafter. The registered provider returned an Annual Quality Assessment Form (AQAA) prior to the inspection. The information received from this document will be referred to in this report. A visit to the care home was made on Monday 20th April 2009. This was an unannounced inspection. This means the registered provider had no prior warning of Care Homes for Adults (18-65 years) Page 6 of 31 our visit. We spoke to all of the residents in order to form an opinion of how it is to live at the care home. We spoke to the staff on duty in order to gain a sense of how it was to work at the care home. We also viewed the accommodation and observed care practices. Some records were also examined. The visit lasted approximately five hours. The acting manager and the regional director made themselves available during our visit. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 31 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 9 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of prospective residents have been assessed prior to admission. However, there was no evidence to demonstrate how the decision to admit residents is made. Evidence: We looked through the care records of the only resident who had been admitted since we last visited. This showed that a comprehensive assessment had been carried out which provided information in terms of the residents background, health care needs, communication, daily life and ability to self care, behavioural support, and needs related to occupation and education. We noted that the information seen indicated the identified resident had a high level of need. We expect that admissions to the care home only take place if the service is confident staff have the skills, ability and qualifications to meet the assessed needs of prospective residents. In order to confirm this the management team may consider the application together with other staff, where all information is shared and views, and comments and listened to and fully debated before agreement is given for the admission. Following discussion with staff on duty it became clear that staff had not Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: been involved in such discussions. We could find no evidence of the process followed to consider if Lynton had sufficient resources to meet the residents identified needs and how the decision to admit the resident had been made Information provided in the AQAA confirmed that, Person centred plans are now up and running for two service users and incorporate their likes and dislikes. Health action plans are detailed and comprehensive and includes are professional contacts involved with the service user. Care Homes for Adults (18-65 years) Page 11 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans have been drawn up for each resident after consultation with them. They include residents own aspirations and goals. However, the care plan of one resident did not include clear information and guidance for staff to follow when managing challenging behaviours. Residents make their own choices about their lifestyles with support from staff where necessary. They are also involved in the day to day running of the care home. Evidence: The care records we examined confirmed that a care plan had been drawn up for each resident. There was evidence that residents have been consulted during this process. The information they contained had been taken from the initial assessments of each residents needs. We also noted that not all information from the assessment of the resident who has been most recently admitted has been transferred to the care plan. This is with regard to the support needs of the resident in terms of challenging Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: behaviours. This means there is no clear guidance for staff to follow with regard to how this is to be managed. This is of concern as we have recently received a number reports of incidents where the resident has displayed aggression and violence towards staff and other residents. In one incident an arguement took place over breakfast between two residents resulting in one resident scratching the other on the face. We also noted that, following this incident, had not been amended to ensure staff know what to do to protect and safeguard residents should violent incidents occur again. We noted that a sensor had been fitted at the bottom of the stairs. We were informed that this is switched on at night so that the sleep in staff will be alerted if a resident goes upstairs during the night. We were informed that the alarm had been fitted following an incident when two residents had an argument which had escalated into a violent confrontation. However, the residents care plan does not include any amendment or guidance to staff to outline why it has been fitted, when it is to be used and what staff should do if the alarm is set off. In addition, it was not clear from the information seen if the residents had been made aware of the alarm and its purpose. We spoke to the regional director and acting manager about this. They were unable advise us why care plans had not been amended in this way. We were notified of the incident and a safeguarding alert was raised with social services. The incident is currently being investigated by them in accordance with local safeguarding adults procedures. We spoke to staff on duty who were able to demonstrate they knew about the needs of the resident documented in the care plan. This was with particular regard to their personal care needs in terms of diet. However, they were unable to tell us about what they should do to ensure the challenging behaviours of the identified resident would be appropriately managed. We observed care practices which related to staff supporting residents during morning routines. We observed residents being helped with breakfast, medication and preparing to take a bath. As it did not occur during our visit we did not observe how staff manage a residents challenging behaviour should it be necessary. We were informed that, on the day we visited all three residents accommodated were at home. This is not usually the case as each resident has their own plan of activity. We observed residents getting up and starting their day at a pace and in a manner which suited them. We observed residents being helped to select and prepare their own breakfast individually. One resident had chosen to return to their room after Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: getting up. Another resident went out into the garden to mow the lawn and to tend the garden. The third resident was seen preparing drinks for themselves during the day. The overall atmosphere was relaxed with residents deciding the pace of the day. We spoke to residents about the activities they enjoy and what they like to do. One resident is a football fan and enjoys watching matches on the television. Another resident enjoys looking after the garden and proudly explained to us what had been planted and what was growing in the garden. Information in the AQAA informed us that, Service users are actively involved in planning their menus and choices of food and participate in preparation of food. One service user has contributed to their healthy eating plan although on occasions does not rigorously follow this. Staff within Lynton remind, prompt and support him in choosing healthier options. Care Homes for Adults (18-65 years) Page 14 of 31 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. Residents are supported in taking part in appropriate activities, including events and activities organised in the local community. Where necessary, residents are supported in maintaining contacts with family and friends. A varied, nutritious and appropriate diet has been provided to residents. Evidence: During our last visit we found evidence that each resident has an individual activity programme for each day. We also found evidence which confirmed they had been drawn up to cater for the interests and hobbies of residents that had been identified following discussion with them. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: We were informed that, during this visit all three residents accommodated were at home. This is not usually the case as each resident is usually taking part in a variety of activities. These range from attending college courses to enjoying trips to a local leisure centre, or going down to the local pub for lunch. We spoke to one resident who was in their bedroom. We noted that there was a whiteboard in the residents room which lists the activities they enjoy. The resident told us they enjoy visits to see the Bluebell Railway and trips to the local pub. We noted that the lounge had been equipped with a television, a DVD player, CD player and radio. There were also a selection of games available. This means that residents also have a range of activities they can enjoy when they are at home. Records we saw during our last visit clearly indicated that residents are encouraged to keep in touch with family and friends. We noted, on this occasion that care records still include information about each residents relatives with guidance for staff with regard to the support they require to keep in contact. During our last visit we were informed that the main meal of the day is taken in the evening when residents return home and they can sit down together with the staff on duty. We were also informed, where appropriate, residents are expected to help prepare the meal. During this visit we noted a resident being helped to prepare a sandwich for their lunch. Whilst we did not observe the main meal, we were informed that the main meal continues to be taken in the evening when the staff and residents sit together to eat. Whilst we did not look through menus on this occasion residents informed us they are able to choose what they want to have to eat. They also told us they continue to be very happy with the catering arrangements. Information within the AQAA confirmed that, We have a stable service user group who are settled and have lived there for over a year. Service users are supported in social, recreational and activities and choice that include accessing local amenities such as Worthing town centre. One service users gets the bus to work and is supported by the staff team by dropping him off at the bus station and picking him up. Service users are able to articulate their desires and wishes to the staff team and these are listened to and acted upon to ensure their needs are met. Those service users who have family are encouraged to maintain family links either by visits to the home or telephone. Service users assist with the weekly menu planning and weekly shop of the home. Care Homes for Adults (18-65 years) Page 16 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff take into account the wishes and personal preferences of residents when providing support and personal care. As staff do not have sufficient guidance to manage the challenging behaviour of residents, the physical and emotional health needs of residents have not always been met. Staff take care of prescribed medications in a way that protects and supports residents. Evidence: The regional manager and acting manager informed us that the provider uses a separate format to the care plan to record the wishes and choices of individual residents. This is known as the Person Centered Plan (PCP). Each resident has been allocated an individual support worker who is responsible for drawing up the PCP with them. We were informed this has recently been developed. Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: As we have already mentioned, we noted that not all information from the assessment of the resident who has been most recently admitted has been transferred to the care plan. This is with regard to the support needs of the resident in terms of challenging behaviours. Recent notifications we have received indicates that, staff are unable to manage the residents care needs safely without appropriate guidance. Records seen included a clear record of medical appointments made to health care services such as residents GPs, dentists and chiropody. This also includes a record of the outcome of the consultation and, where necessary, the treatment to be provided. We noted that medication has been appropriately and securely stored. Records seen had been well maintained and were up to date. We were advised that only staff who have been appropriately trained are allowed to administer medication. Training records seen confirmed that staff have received in house training in the safe administration and dispensing of medication. Staff on duty were able to show us how medication is stored, administered and recorded. We noted that some residents have been prescribed medication on an as required basis. Guidelines have been drawn which indicate staff must consult with a senior manager before adminsitering this medication. However, guidelines we saw were not clear with regard to the circumstances when such medication should be administered. This information should also be included in residents individual care plans. We discussed this with the acting manager and the regional director. They agreed to make the necessary amendments. Information provided within the AQAA confirmed that, All service users have a health action plan which support their personal healthcare and support needs. All service users are registered with a local GP, dentist and optician. Service users are supported in being as independent as possible in this area. Service users who are taking medication on a regular basis have reviews of their medication. Training and safe storage of medication is in place for staff and the staff are assessed on their competency levels. Care Homes for Adults (18-65 years) Page 18 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered provider has ensured residents views and ideas are listened to. The homes written complaint procedure needs to up dated. Care plans need to include specific guidelines on how to manage challenging behavior for each resident to ensure they are sufficiently protected from abuse. Evidence: During our last visit we found evidence that resident meetings are held regularly. We were informed residents are supported in using meetings to discuss disagreements that can be sorted out before they become major concerns. During this visit we were informed residents do continue to meet together to discuss issue issues related to the day to day running of the care home. We saw that a written complaint procedure was on display in the dining room and included information with regard to whom complaints should be made and the timescale by which the complainant should expect to receive a response. As it was not clear if the format in which it was written was suitable for residents we asked the regional director if this was the case. We were informed that the organisation does produce complaint procedures in a pictorial format. When we visited the care home in April 2007 and in April 2008, we found evidence Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: that complaints were not being adequately recorded. Whilst a brief description of complaint received had been recorded it did not include any information to demonstrate that they had been investigated and there was no evidence of the outcome of the investigation. On this occasion the regional director advised us that the procedure has changed. All complaints are now sent to his office and he is responsible for looking into them. We were also informed that the regional director keeps records of complaints received, including details of investigations and their outcome. We noted that the complaint procedure which was on display did not reflect what we had been told. When we informed the regional director the procedure was taken down and we were advised that this was no longer correct. We advised the director to amend the procedure to ensure it reflects current practices and it is in an appropriate format for residents. Residents should also be helped and supported where necessary so that they are able to make a complaint. We looked through a sample of staff training records. They confirmed that staff are provided with training about safeguarding adults procedures and reporting abuse. Information provided in the AQAA confirmed that, Lynton recently had a safeguarding issue and the home actively sought advice and support from the Regional Director and the local safeguarding team. A strategy meeting was held and then a further case conference and appropriate measures were put in place to protect vulnerable service users against one another. The home has a procedure on reporting abuse and named individuals who service users can contact. The AQAA was completed in January 2009. Since February 2009 we have been notified of a further four incidents which have resulted in alerts being sent to West Sussex Adult Services in accordance with local safeguarding adults procedures. They are currently under investigation by West Sussex Adult Services. The incidents include instances where one resident has physically attacked another resident and staff on duty. We could find no evidence that, following such incidents, risk assessments had been carried out and care plans amended. Since our visit West Sussex Adult Services have made us aware of further alerts they have received. The registered provider has since the inspection produced a positive behavioural support plan for a resident and advised the staff team to ensure that they are followed and vigilant in monitoring behaviour of the service users. . The care plans need to provide staff with sufficient guidelines when managing Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: challenging behaviours of identified residents. Notifications of recent incidents also indicate that as a result, care practices may not be providing sufficient protection to vulnerable residents. Care Homes for Adults (18-65 years) Page 21 of 31 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. Residents have been provided with a homely, comfortable and safe environment in which to live. The home has been kept to a good standard of cleanliness and hygiene. Evidence: We visited the private accommodation of a resident who was happy for us to enter. We also visited the lounge and the dining room. Those areas of the home seen were presented in a homely and comfortable manner. We found no evidence that the accommodation is unsafe. The decoration and furnishings have been provided to a good standard and ensured residents live in a comfortable and safe environment. Residents are encouraged to individualise their rooms and bring any possessions they may wish to make it has homely as possible. Residents we spoke to told us they very satisfied with the accommodation provided. We also visited a bathroom, the kitchen and the utility room. These areas of the premises were fresh, clean and hygienic. Information provided in the AQAA confirmed that, Lynton provides a clean, safe and comfortable environment. All service users bedrooms are decorated to personalised Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: taste. Two service users are Manchester United Fan and have pictures, bedding of the Manchester United football team around their bedrooms. . Care Homes for Adults (18-65 years) Page 23 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported by competent and qualified staff. Residents have been protected by the homes recruitment practices and procedures. Not all residents needs have been met by the staff team. Evidence: We were informed that no new staff had been recruited since our last visit. We met one member of staff who had been transferred to Lynton from another service owned by the same provider. We did not examine this persons recruitment details. The regional director assured us that all appropriate checks had been taken up on appointment. We spoke to two staff who were on duty and observed care practices. They were able to demonstrate they were familiar with the contents of residents care plans and understood what was expected of them to meet residents identified needs. However, they were not able to confirm the actions they were expected to take as part of the management of the challenging behaviour of identified residents. During our last visit we examined staff training records. They demonstrated newly Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: appointed staff undertake a structured induction programme. On this occasion we noted that a training matrix was on display in the office. This provided details of training provided to each member of staff, together with training planned for the future. This confirmed that staff have been provided with mandatory training including identifying and reporting abuse, fire safety, health and safety, infection control and food hygiene. We also asked the acting manager and regional director about training in physical interventions. We were shown certificates which confirmed the training which staff had received. However, we noted that, of the four staff whose records we saw, the certificates of all but one had expired in January 2009. The regional director showed us documentation he had sent to the registered providers training department which demonstrated he had requested, as a matter of urgency, staff are provided with such training. He also informed us that this had been in response to recent incidents. We observed staff interacting with residents. This showed that staff treat residents with respect and have ensured their dignity has been maintained. Residents we spoke to confirmed they get on well with the staff team. They told us staff do listen to them and act on what they say. The acting manager provided us with evidence that demonstrated staff have received regular support and supervision. Staff we spoke to confirmed that the acting manager has been very supportive whilst the the home has been without a manager. Information provided within the AQAA confirmed that, of the six staff employed to work at Lynton, they have all completed structured induction recommended by Skills for Care. Two staff hold the National Vocational Qualification in Care or Health and Social Care at Level 2 or above. The AQAA also confirmed that, The home has a stable staff team in place which are respectful and supportive of the service users needs. They are highly motivated in empowering service users in developing their lifestyle choices. Staff are encouraged to speak up when they have concerns and regular staff meetings are held to discuss current issues and team development. The staff team are empathetic towards service users needs. Care Homes for Adults (18-65 years) Page 25 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Lynton does not have a registered manager. The registered provider seeks the views of residents with regard to the day to day running of the care home. The registered provider needs to ensured the health, safety and welfare of residents has been protected. Evidence: We have been informed by the provider that on 5th March 2009 the post of manager became vacant. The registered provider has advised us of the arrangements that have been made whilst a suitable person is recruited to the post. We were advised that a manager of another registered service would provide support to staff two days a week. The regional director would also visit regularly to provide management input where necessary. We met the acting manager and the regional director during our visit. A member of staff rang them and they arranged to be present. Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: The regional director advised us that the manager of childrens service, owned by the registered provider, would be transferred to Lynton in the near future. The childrens service is due to close. We were further advised that this would be a temporary arrangement whilst a permanent manager is recruited. Care plans have not included crucial information for staff to follow in the management of challenging behaviours displayed by residents. This means that the health and safety of staff and other residents have not been adequately safeguarded. Staff have been expected to manage potentially dangerous and violent situations. This has resulted in a member of staff being hurt. Since this visist we have been advise by the provider that an experince manager is now in the service and they are actively recruiting a permanent manager. We noted that representatives of the registered provider visit Lynton each month. We looked through the reports of the most recent visit. The regional director advised us that he is responsible for conducting such visits. During our last inspection we found evidence that the views of residents and their families are sought to ensure the home has been run in the best interests of residents. Residents have told us that they meet regularly to discuss ideas for the menu and plans for activities and outings. Reports of monthly visits made by representatives also include discussions with residents. Information supplied in the AQAA confirmed the registered provider has taken appropriate steps to ensure the premises and equipment within the care home is safe for use. For example, gas and electrical appliances have been checked and maintained regularly. We found evidence that a programme of training provided to all staff includes health and safety issues, fire prevention, manual handling and first aid. Care Homes for Adults (18-65 years) Page 27 of 31 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 Adults (18-65 years) Page 28 of 31 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 1 19 15 Care plans of identified residents must include details of how challenging behaviours are to be managed This will ensure staff have clear guidance of how identified residents needs should be met in a consistent manner and in accordance with best practice guidelines 01/06/2009 2 22 22 An up to date written complaint procedure must be produced which is in a format appropriate for the needs of residents. Residents must be provided with support or assistance so that they are able to make a complaint 01/06/2009 Care Homes for Adults (18-65 years) Page 29 of 31 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 This will mean residents know how to make a complaint and will be enabled to do so 3 37 8 The registered provider 01/08/2009 must recruit a suitably qualified person to the post of manager. Once apponted, the manager must submit an application to the Commission This will ensure a person is appointed who is fit to manage the care home. 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 Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.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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