Inspection on 23/05/06 for Lynton Terrace, 1-3

This inspection was carried out on 23rd May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 21 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lynton Terrace, 1-3 09/05/07

Lynton Terrace, 1-3 04/12/06

Lynton Terrace, 1-3 13/10/05

Lynton Terrace, 1-3 29/04/05

Lynton Terrace, 1-3 20/09/04

Lynton Terrace, 1-3 01/06/04

Lynton Terrace, 1-3 23/06/03

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Lynton Terrace, 1-3 Lynton Road Acton London W3 9DU Lead Inspector Ms Jane Collisson Unannounced Inspection 23rd May 2006 10:20 Lynton Terrace, 1-3 DS0000027756.V288647.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lynton Terrace, 1-3 DS0000027756.V288647.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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. Lynton Terrace, 1-3 DS0000027756.V288647.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Lynton Terrace, 1-3 Address Lynton Road Acton London W3 9DU 0208 992 3343 0208 992 1154 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Hestia Housing & Support Oladipo Babatunde Fagunwa Care Home 10 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (10) of places Lynton Terrace, 1-3 DS0000027756.V288647.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th October 2005 Brief Description of the Service: 1/3 Lynton Terrace is a detached property, situated in a residential area of Acton and close to Acton Main Line Station and bus routes. Acton town centre is about a mile away and there are local shops nearby. The home is a mental health facility for ten service users, providing medium to long-term accommodation. Hestia Housing and Support manage the home. The communal areas consist of two lounges, a dining room, kitchen and games room on the ground floor, and a small kitchenette on the first floor. There are ten single bedrooms, four of which are on the ground floor. A total of three bathrooms, one with a separate shower, are available for ten service users. All of the bathrooms have toilets and there is one separate toilet close to the communal facilities. The sleeping-in room, which has its own bathing facilities, is on the first floor. There is a small garden to the rear, with a separate building which houses the laundry room. The staff team consists of a Project Manager, two Deputy Managers, and a team of five Project Workers who support service users with personal care, practical tasks and leisure activities. There are no waking night staff and one member of staff sleeps in at night. The domestic work is contracted to an agency. Lynton Terrace, 1-3 DS0000027756.V288647.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on the 23rd May 2006 between 10.20am and 6.20pm. There has been an Acting Manager in post, seconded from another Hestia home, as the Registered Manager and two Project Workers are currently suspended in relation to two ongoing investigations under the Protection of Vulnerable Adults procedures. An additional visit was made on 30th May, at 1.15pm, for one hour, to examine further records. The inspection process took a total of 11 hours. There are nine service users in the home at the present time, with one vacancy. One new service user was admitted since the last inspection but the placement was not made permanent and the service user has now left the home. Five of the service users, the Acting Manager, two Deputy Managers and three project workers, were met during the two visits. Some discussions were held in private and a tour of the communal areas took place. Two Hestia staff were carrying out the unannounced monthly visit to the home on behalf of the Registered Providers at the first visit. A Care Programme Approach meeting was due in the afternoon of the second visit for one of the service users. With staff suspended for some months, there has been disruption to the running of the home. However, some improvements have been made to the environment, efforts are being made to try and involve the service users further in the running of the home, and to provide more activities. A number of the requirements made at previous inspections, particularly those relating to the records, have not been fully completed and seven of the fourteen made at the last inspection are repeated. A further eleven requirements have been made. What the service does well: What has improved since the last inspection? Updated care plans are in place and efforts are being made to ensure that all the required reviews take place. Lynton Terrace, 1-3 DS0000027756.V288647.R01.S.doc Version 5.1 Page 6 What they could do better: The Statement of Purpose and Service Users Guide have not been reviewed since 2004 and a number of changes have taken place since then. Once the current concerns in the home are concluded, these documents must be reviewed and made available to the service users and the Commission for Social Care Inspection. While staff try and involve the service users in the running of the home, it is not always clear how the service users are being supported to meet their long term needs and aspirations. Where this is in relation to moving on to alternative accommodation, for instance, it needs to be demonstrated how efforts are being made to achieve this goal. This has been an outstanding requirement and still needs to be addressed. The routines that some service users prefer do not support them to maintain good health and a reasonable quality of life. With the help of the professionals involved in their support, it needs to be demonstrated that every effort is made to improve the situation. The staff have taken action where the situation has become acute. Further work needs to be carried out, at an earlier stage, to try and ensure that service users comply with their medication regimes, are encouraged to eat a good diet, and participate in more meaningful activities. This includes encouragement with educational and day activities. Although efforts have been made to improve the environment, the kitchen worktops need to be replaced to improve hygiene, the ground floor bathroom needs refurbishment, and the garden needs to be maintained to an acceptable standard. It has been an outstanding requirement that service users’ bedrooms are shown to have sufficient storage, furniture and fittings to meet their individual needs, with clarity about the responsibility for purchase of bedding and other items. Cleanliness in the home, particularly the kitchen, needs to be monitored more robustly. The recruitment of a cleaner/housekeeper is planned but monitoring is still required, by management staff, to maintain a good standard. The training records did not evidence that staff have the up-to-date training and induction that they require to support them with their work. This is particularly so for training in mental health, where a more comprehensive and ongoing programme would benefit staff in their work with the service users. Some improvement in record keeping, and the monitoring of this, is still required. In particular, staff records, medication, meals and fire maintenance and testing need attention. While the Registered Providers and staff try to ensure that consultation with service users takes place, not all of the service users are involved. A review of Lynton Terrace, 1-3 DS0000027756.V288647.R01.S.doc Version 5.1 Page 7 the quality of care, using quality assurance and monitoring systems, needs to take place regularly to demonstrate how the home can develop its services and show improvement. The financial recording has improved but, to ensure confidentiality, individual records of service users’ finances must be maintained. 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. Lynton Terrace, 1-3 DS0000027756.V288647.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lynton Terrace, 1-3 DS0000027756.V288647.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The information, which is required for new service users to make a decision about living in the home, needs to be updated. The admission and assessment procedures were found to be satisfactory. EVIDENCE: The Statement of Purpose and Service Users Guide have not been updated since October 2004 and are in need of review because of the changes which have taken place. The Acting Manager said that he is in the process of updating them although this work cannot be completed because of the current uncertainty around the management and staffing of the home. As soon as the situation is resolved, the documentation must be reviewed, updated and made available to the service users and the Commission for Social Care Inspection. Since the last inspection, one service user was admitted to fill the vacancy but has since been readmitted to hospital and is no longer a resident of the home. An examination of the admission process was made. A comprehensive assessment had been received from the contracting agency and care plans had been drawn up, after admission, to show that the service user’s needs could be met. Production of the service user’s plan, during the process of admission, may have helped to identify any shortfalls or potential problems with the placement. The Acting Manager was also advised new service users should be Lynton Terrace, 1-3 DS0000027756.V288647.R01.S.doc Version 5.1 Page 10 informed, in writing prior to admission, that their needs can be met. It was planned that the last admission would take place over a period of time to allow the service user to adjust to life in the home and the service user had the opportunity to visit, and stay in the home, on a number of occasions. It is one of the stated aims of the service that it is for medium and long term stays. It is, however, not always clarified in the care plans and reviews how the needs and aspirations of the service users are compatible with the aims of the service. Where service users may aspire to moving on to more independent accommodation, for instance, it needs to be shown that the plans to work towards this goal are in place and that staff are all supporting service user to achieve this. This would involve a more active programme of promoting independent living skills. It is recommended that, when the next reviews take place with the service users, that is clarified so that the care plans can be seen to be working towards the service users’ long term aims. Lynton Terrace, 1-3 DS0000027756.V288647.R01.S.doc Version 5.1 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. While improvements are seen to have been made to involve some of the service users in the life of the home, other service users have very limited input from the staff. Programmes to encourage the service users to participate more fully, and benefit from the support of the staff team, need to be devised to enable them to reach their full potential. EVIDENCE: It has been a requirement at previous inspections that the care plans needed to be improved and this work has commenced. The Primary Care Trust also found that improvements were required. The care plans in place are now more clear and concise, but it needs to be seen that any objectives that have been set are monitored regularly. There is the opportunity for the service users to sign the care plans but not all have chosen to do so. The Care Programme Approach review meetings have not all been held on a regular basis. Minutes of the meetings are not always forwarded to the Lynton Terrace, 1-3 DS0000027756.V288647.R01.S.doc Version 5.1 Page 12 home. This had made it difficult to demonstrate that the service users’ needs are being kept under review by the health care professionals. The Acting Manager has put into place a system to try and ensure that the meetings are held on a regular basis and the minutes of the meetings are available to evidence that appropriate care plans and risk assessments are in place. All of the service users are able to make decisions about how they spend their time. One service user was seen to be more relaxed and at ease in the home than at previous inspections. Some service users choose to spend most of their time in their rooms, or out of the home for long periods. This does not assist in providing a regular routine for meals or any activities which might improve the quality of life for the service users and non-availability for medication taking is one of the consequences. Two service users were requiring medical intervention and information in the files evidenced that the staff have taken the necessary action in seeking professional support. An emergency Care Programme Approach meeting was being held during the inspection to address the issues with one service user. While staff do offer support to service users with most aspects of daily living, not all of the service users are receptive to this. In order to encourage service users to benefit from living in the home, strategies for involving the service users more fully need to be sought. There are systems in place to consult with service users, with regular meetings being held to discuss a variety of subjects, including plans for outings. Approximately half of the service users usually attend. In the minutes of the meetings, which service users are encouraged to take, one of the service users had recently presented an item on fire safety. This type of involvement is good practice and is to be commended. Confidentiality is maintained by the keeping of staff and service user files in lockable cupboards, within the general office or the manager’s office which are also locked when not in use. Lynton Terrace, 1-3 DS0000027756.V288647.R01.S.doc Version 5.1 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 15, 16, 17 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. It is recognised that service users need encouragement to participate in leisure pursuits and activities and staff are making efforts to improve access to these. Most service users are not involved in any formal activities outside of the home and there is limited community involvement. The Acting Manager is aware of the need for the service users to be encouraged to participate and to develop their skills and interests and this needs to be reflected in their support programmes. EVIDENCE: It has been noted at previous inspections that the opportunities for the development of the service users’ independent living skills has been limited. Some improvements appear to have been made but there is still scope to involve the service users further in trying to develop their practical life skills, such as shopping, cooking and domestic tasks. Plans were in place to try and get service users involved in maintaining and improving the small garden, although had not been actioned. Lynton Terrace, 1-3 DS0000027756.V288647.R01.S.doc Version 5.1 Page 14 Two service users are able to cook for themselves, and one does so twice weekly. Service users are expected to assist with the cleaning of the own rooms. Although there are systems in place, such as key worker meetings, reviews and discussion in staff meetings, it is not always seen if the goals set are achieved. It was suggested to the Acting Manager that better use is made of the care plans to show the progress of the goals, which need to be realistic and achievable. There is limited involvement by the service users in employment and occupation outside of the home. One service user was in the process of having interviews for work with therapeutic earnings and one other service user goes regularly to a centre for people with mental health needs. However, none of the other service users attend day services although these are available in the local area. One service user prefers not to leave the home apart from going to the local shops. While it is recognised that some of the service users are reluctant to participate in outside activities, it must be demonstrated that the opportunities for educational and day activities are actively offered and encouraged. The home is located near to a small parade of local shops and there are public transport links very close by to the Acton High Street, which is within walking distance. The home is also close to a main line station to Paddington. Only one service user is involved in any cultural or religious activities, only choosing to attend an event on an annual basis. The home has a converted garage which has, in the past, been used as a games room with small pool table. This has not been used on a regular basis but the room has now been tidied and service users are being encouraged to use it. None of the service users have taken holidays with the staff but day trips are arranged. A planned day outing was postponed, due to poor weather prospects. Transport has to be hired in advance for the outings and the staff find that some service users, who are often express an interest in going on the trips, do not wish to participate on the day. A more spontaneous approach to outings, perhaps using public transport, might prove to be more successful. Wherever possible, family and friends are encouraged to maintain their links with the service users. One relative visits the home on a weekly basis and others occasionally. One service user stays regularly, and takes holidays, with family members. The rights and responsibilities of service users are sometimes difficult to implement. Whilst the daily routines of the home are generally those which are preferred by the service users, this causes problems in providing the necessary support, particularly in relation to medication administration and meals. There needs to be discussions with the service users, staff and health care professionals regarding the duty that the home has to provide the service to Lynton Terrace, 1-3 DS0000027756.V288647.R01.S.doc Version 5.1 Page 15 the service users and the responsibility of the service users to comply with these. There are sufficient rooms, including a small non-smoking lounge, where the service users are able to have some privacy, though several prefer to stay in their bedrooms. There is a small garden which, although in need of improvement to make it more pleasant to use, does provide another area for service users to access and one was seen to do so. A weekly menu is prepared, which has options for diabetic and vegetarian meals. Some of the service users are encouraged to assist with the preparation of the meals, although not all choose to do so. Following requirements made at previous inspections, some meals taken by service users are now being recorded. However, this is usually the evening meal, and only one service user’s lunch was seen to be recorded. Some service users buy take-away meals and staff said that most of the service users do not have breakfast. The home needs to demonstrate that service users are offered three meals a day and, wherever possible, ways are found to try and improve their nutritional intake. This needs to be carried out in consultation with the service users, and recorded. Lynton Terrace, 1-3 DS0000027756.V288647.R01.S.doc Version 5.1 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Those service users who require personal care are supported by staff to try and maintain a regular routine. Action has been taken to ensure that the mental health needs of the service users are reviewed regularly. EVIDENCE: Not all of the service users require assistance with their personal care but those who do are supported by the staff to maintain or improve their personal care. The daily shift planner details the needs of the service users, in accordance with their care plan, to ensure that they are offered the support. The home has three bathrooms for the ten service users. Key workers assist the service users to try and maintain a routine which suits them and regular meetings are held, which were seen to be recorded. The health needs of the service users are met by general practitioners from three practices. Community Psychiatric Nurses are involved in providing support with mental health needs. One was visiting on the first day of the inspection to provide support following an incident with one of the service users. Not all of the Care Programme Approach meetings have taken place as Lynton Terrace, 1-3 DS0000027756.V288647.R01.S.doc Version 5.1 Page 17 required and the Acting Manager has taken steps to remind the health professionals of the need to carry these out. Because minutes are not always received after CPA meetings, the receipt of these is being monitored more closely. Three errors of non-signing of medication had been recorded since the last inspection. The Acting Manager said that these incidents are discussed, in supervision, with the staff. The medication, which is a monitored dosage system, was received into the home on the day of the inspection and was being checked and recorded by the Deputy Manager. The system in place requires that a second staff member also checks it for accuracy. Evaluations on whether service users are able to self-medicate are in place. None currently do so. Problems with non-compliance are raised with the medical professionals. The Medication Administration Sheets demonstrated that other service users have occasionally missed their medication but the reasons have not been recorded in detail. The staff said that this is usually because service users have been out or asleep, although these have been recorded as refusals. The Acting Manager was asked to ensure that the reasons for non-compliance are recorded accurately in the space provided on the rear of the Medication Administration Sheets. Lynton Terrace, 1-3 DS0000027756.V288647.R01.S.doc Version 5.1 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Efforts are made to ensure that service users know about the complaints procedures and are able to voice their concerns. Action has been taken to ensure that the service users are safeguarded from financial abuse. EVIDENCE: Service users have previously shown that they are confident to make complaints, although only one has been recorded since the last inspection. This involved a concern between two service users. The Acting Manager said that a new form is being introduced, by the Registered Providers, to record disputes between service users. In the service users’ meetings, which are held on a regular basis, the service users have the opportunity to raise their concerns. It was noted from the records that only half of the service users regularly attend the meetings and some service users never do. It was noted in the minutes of a recent service users’ meeting that the procedures for complaints were explained to those present. Key worker meetings are also held with each of the service users, where they have the opportunity to raise concerns on a oneto-one basis. Since the last inspection, in October 2005, three of the staff have been suspended in relation to allegations of financial abuse, which involved use of the whistle blowing procedures. The investigations are still ongoing with the involvement of the Local Authority’s Safeguarding Adults department. New policies and procedures are in place for the management of service users’ finances and a sample of the finances held were found to be in order. Lynton Terrace, 1-3 DS0000027756.V288647.R01.S.doc Version 5.1 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 30 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. While the environment suits the needs of the service users, and improvements are being made, attention needs to be given to ensuring there is a good level of cleanliness. The refurbishment of the ground floor bathroom and kitchen worktops needs to be given priority. EVIDENCE: Improvements have been made to the main lounge and the games room, located in the garage, has been tidied so that it can be used by the service users for recreation. The ground floor bathroom has previously been identified as needing refurbishment but no work has been carried out. The bath enamel is chipped and the flooring needs to be replaced. Staff said the shower is not in use. Although the bathroom could benefit from better lighting and more thorough cleaning, the room needs to be refurbished to provide a facility which suits the needs of the service users. This bathroom is near to four of the bedrooms and the two further bathrooms available are located on the first floor. The work surfaces in the kitchen are damaged and need to be replaced to ensure good food hygiene is maintained. Lynton Terrace, 1-3 DS0000027756.V288647.R01.S.doc Version 5.1 Page 20 The main lounge is used for smoking and has a large and rather noisy extractor fan. Laminate flooring has replaced the carpet which has improved the look of the room and its cleanliness. There is a small, non-smoking, lounge. The small, private garden could be a useful addition to the communal space and it has some seating. However, there is little of interest in the garden, although staff are attempting to get service users involved to improve it. Should this not happen, the work will need to be carried out by contractors to ensure it is maintained in reasonable condition. There are plans to have the windows replaced throughout the home and quotes were being obtained. This work is required to be agreed with the Primary Care Trust for funding. It has been a previous requirement that adequate and suitable furniture and fittings must be provided in bedrooms to meet the needs of the service users. Staff said that there had been no progress with this. It needs to be shown that the service users have the furnishings and fittings that they need. The items detailed in the National Minimum Standards should be seen to be offered, taking health and safety considerations into account. The Registered Providers’ monthly visits have highlighted where service users need to be supported to maintain their rooms and sufficient storage needs to be seen to be provided. The question of who provides some of the items, such as bedding, was raised and there needs to be clarity in the terms and conditions, and Service Users Guide, regarding the responsibility for furnishings and other items. It is recommended that an audit of the bedrooms is carried out, and recorded, to ensure that all of the service users have the required furniture, fittings and furnishings that they require to support them to maintain a pleasant personal environment. There was a requirement at the previous inspection regarding the cleanliness of the kitchen. Whilst it has improved from that inspection, the tiles need to be thoroughly cleaned. Regular monitoring, particularly of the work carried out by agency cleaners, needs to take place. The Acting Manager said that the home intends to employ a housekeeper/cleaner and this should lead to a better standard of organisation and cleanliness. Lynton Terrace, 1-3 DS0000027756.V288647.R01.S.doc Version 5.1 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Uncertainty in the home in recent months has obviously been disruptive to the staff team. It still needs to be demonstrated, however, that that the training needs of the staff are being addressed with basic courses taken and updated, and mental health training being given priority. The staff records must be maintained in better order to demonstrate that service users are protected by good recruitment practices. EVIDENCE: It has been a requirement at previous inspections that the training staff should receive in relation to mental health should be improved. The Hestia training programme has a training course on mental health awareness only. The Acting Manager said that additional training could be made available and it is strongly recommended that more advanced training is accessed, externally if required. Hestia, as a mental health provider, needs to ensure that all of the staff have the basic and advanced training in mental health to provide them with the expertise to meet the complex needs of the service users. This is particularly important with regard to supporting the service users to become more motivated. Other areas of training that should be considered are around nutrition and activities. Lynton Terrace, 1-3 DS0000027756.V288647.R01.S.doc Version 5.1 Page 22 Not all of the basic training courses, such as food hygiene and first aid, have been undertaken by all of the staff. This must be addressed and staff need to be seen to have had their needs considered by training and development records being available. Three of the current staff team have National Vocational Qualifications, one at Level 2, one at Level 3 and one at Level 4. One staff member has commenced Level 2. The two Deputy Managers have the Registered Managers Award which the Acting Manager has also completed. The Acting Manager also has a National Vocational Qualifications, Level 4, in Care. Two of the managers have the A1 qualification to be NVQ assessors. The staff changes resulting from the adult protection procedures over the last few months have been difficult for the staff team. Although some service users have had to be involved in the enquiries, the staff seem to have maintained a stable environment, as far as has been possible. The service users do not appear unduly affected by the changes. The records of recruitment and employment need to be maintained in better order and to demonstrate that all of the requirements of the Care Home Regulations 2001 have been obtained. This has been a requirement for the last two inspections and the Registered Providers must ensure that no staff are employed without all of the information and documentation being obtained and available for inspection. This includes the agency and bank staff who are employed. The induction, training and supervision records for a newer staff member were insufficient to show the support that should to be offered during the induction period had taken place. This needs to be improved. Lynton Terrace, 1-3 DS0000027756.V288647.R01.S.doc Version 5.1 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41, 42 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The problems encountered over the last few months have had an effect on the smooth running of the home, although staff appear to have done their best to ensure that service users have not been unduly affected. The requirements which were previously outstanding have not all been completed. Action is needed to complete them and to ensure that they are maintained. These include the fire records, training provision, and a review of the quality of care EVIDENCE: As mentioned elsewhere in this report, there have difficulties in maintaining a positive approach in the home with the changes in the staff team. However, the staff spoke positively about the current management and it appears that they have tried to ensure that the difficulties in the home have not impacted too much on the service users. Lynton Terrace, 1-3 DS0000027756.V288647.R01.S.doc Version 5.1 Page 24 Improvements have been made to the monthly visit reports carried out on behalf of the Registered Providers. A more comprehensive report, with an Action Plan, is being produced and submitted to the Commission for Social Care Inspection. Service users have the option of participating in the Hestia Tenants and Residents’ Forum although there is limited involvement from service users at Lynton Terrace. Project days have also been held to look at the running of the service. However, a recent review of the quality of care in the home has not taken place. This is required to be held, at regular intervals, to look at how the service can be improved. A report needs to be produced for the service users and the Commission for Social Care Inspection. This requirement is still outstanding from the last inspection. The way in which the financial records and monies are held on behalf of the service users has changed, following the adult protection issues. An audit took place of the monies held and there are limits on the amount that may be kept in the home for each service user. New policies and procedures are in place. The majority of the service users are able to maintain their own accounts. Only a small number are now managed by staff and transactions are recorded in a bound book. The Acting Manager was advised that there should be an individual record book for each service user, so that confidentiality can be maintained. The records were checked and were seen to be in good order. A sample of health and safety records showed that better monitoring is still required. It was recommended to the Acting Manager that the forms on which the fire records are recorded are pre-dated to ensure that any gaps in testing can be easily seen. Only two of the weekly fire alarms tests had been carried out in April, for instance. The last quarterly alarm service and the annual extinguisher check were in February 2006. The fire risk assessment, which was previously noted to be comprehensive, had been reviewed since the last inspection and was much less thorough. At the second visit to the home, action was being taken to review and improve it. Lynton Terrace, 1-3 DS0000027756.V288647.R01.S.doc Version 5.1 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 2 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 2 26 X 27 2 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 3 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 3 3 3 LIFESTYLES Standard No Score 11 2 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X 2 2 X Lynton Terrace, 1-3 DS0000027756.V288647.R01.S.doc Version 5.1 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 6 (a) (b) Requirement The Statement of Purpose and Service Users Guide must be reviewed, updated and made available to the service users and the Commission for Social Care Inspection. In order for the needs and aspirations of the service users to be addressed, it must be demonstrated that these have been considered, and can be met, in relation to the aims and objectives of the service. The service users must be offered further opportunities to participate in the day-to-day running of the home and to maintain and to develop social and independent living skills. (Previous timescale of 31/8/05 and 31/12/05 not fully met) In order to encourage service users to benefit from living in the home, strategies for involving the service users in regular routines for medication administration, and other activities, must be in place. The reviewing of the service users’ care plans must DS0000027756.V288647.R01.S.doc Timescale for action 31/08/06 2 YA3 12 (1) (a)(b) 31/08/06 3 YA7 12(1) b 16(2) m, n 31/07/06 4 YA7 12 (1) a 31/08/06 5 YA11 15 (2) b 31/08/06 Lynton Terrace, 1-3 Version 5.1 Page 27 6 YA12 12 (1) b 16 (2) n 7 YA17 16 (2) I, 17 (2) S.4, 13 8 YA20 13 (2) 9 YA24 23 (2) o 10 11 YA24 YA25 13 (3) 23 (2) b 16 (2) c 12 YA27 23 (2) j demonstrate that the goals set to maintain and improve their independence, welfare and health, are realistic and achievable. It must be demonstrated that the opportunities for educational and day activities are actively offered and encouraged. (Previous timescale of 31/01/06 not fully met) The home needs to demonstrate that service users are offered three meals a day and, that wherever possible, ways are found to try and improve their nutritional intake. This needs to be carried out in consultation with the service users and, wherever possible, meals recorded to evidence this. The reasons for noncompliance with the taking of medication must be recorded in detail, and with accuracy, in the space provided on the Medication Administration Sheets. Work must be carried out in the garden to provide a wellmaintained, safe, and pleasant environment for the service users to enjoy. The damaged work surfaces in the kitchen must be replaced. Adequate and suitable furniture and fittings must be provided in bedrooms to meet the needs of the service users. (Previous timescale 31/7/05 and 31/01/06 not fully met) Refurbishment of the ground floor bathroom must be considered to improve the availability of suitable bathroom facilities and to DS0000027756.V288647.R01.S.doc 31/08/06 31/07/06 30/06/06 31/07/06 31/07/06 31/08/06 31/08/06 Lynton Terrace, 1-3 Version 5.1 Page 28 13 YA30 13 (3) 23 (2) d 14 YA32YA35 18 (1) c (i) 15 YA33 17(2) Sch.4 6(g) 16 YA34 19 Sch.4 (6) 17 YA36 17 (2) Sch.4 (6) g 24 (1)(2)(3) 18 YA39 19 YA41 17 (1) b 20 YA41 23 (4) c (v) 17 (2) maintain cleanliness. An Action Plan must be provided, with timescales for the work to be carried out. Better monitoring of the cleaning of the home must take place to maintain good hygienic standards. (Previous timescale of 30/11/05 not fully met) It must be demonstrated that staff have training appropriate to the duties they perform, including advanced mental health training, to support their staff development. (Previous timescale of 28/02/06 not met) Records must be maintained to demonstrate that staff have the required induction and training. (Previous timescale of 31/12/05 not fully met) The information required under Schedule 4 of the Care Homes Regulations 2001 must be available for all staff working in the home, including agency staff. (Previous timescale of 31/7/05 and 31/01/05 not fully met). The induction, training and supervision records must demonstrate that sufficient support is offered to new staff. A review of the quality of care must be carried out at regular intervals and the report provided to service users and the Commission for Social Care Inspection. To maintain confidentiality, individual records of service users’ finances must be maintained. The recording of fire servicing and tests must be monitored to ensure that all of the DS0000027756.V288647.R01.S.doc 30/06/06 31/08/06 31/07/06 31/07/06 30/06/06 31/08/06 30/06/06 30/06/06 Lynton Terrace, 1-3 Version 5.1 Page 29 necessary tests have been carried out as required. 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 YA3 YA25 Good Practice Recommendations That, when the next reviews take place with the service users, it is clarified how the home is working to meet the long terms aims of the service users. That an audit of the bedrooms is carried out to ensure that all of the service users have the furniture, fittings and furnishings that they require to support them to maintain a pleasant personal environment. That additional training is made available, externally if necessary, to ensure that staff have the advanced mental health training to assist them to support the service users. That the forms on which the fire records, or other tests, are recorded are pre-dated to ensure that any gaps in testing can be easily monitored. 3 4 YA32 YA42 Lynton Terrace, 1-3 DS0000027756.V288647.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection West London Area Office 11th Floor West Wing 26-28 Hammersmith Grove Hammersmith London W6 7SE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Lynton Terrace, 1-3 DS0000027756.V288647.R01.S.doc Version 5.1 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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