Inspection on 02/07/07 for Lynwood

This inspection was carried out on 2nd July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 20 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lynwood 21/11/07

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Lynwood 14 Beccles Drive Barking Essex IG11 9HX Lead Inspector Harbinder Ghir Unannounced Inspection 2nd July 2007 06:50 Lynwood DS0000068972.V344088.R01.S.doc Version 5.2 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 Lynwood DS0000068972.V344088.R01.S.doc Version 5.2 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. Lynwood DS0000068972.V344088.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lynwood Address 14 Beccles Drive Barking Essex IG11 9HX 020 8594 6786 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) Dharshivi Limited Glory Furo Diri Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Lynwood DS0000068972.V344088.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care (excluding nursing) and accommodation to service users of both sexes whose primary care needs on admission to the home are within the following category:Service users with a learning disability (Category LD) The maximum number of service users who can be accommodated is 7 2. Date of last inspection 5th January 2007 Brief Description of the Service: Lynwood Care Home is a semi detached older style property situated in a residential area of Barking. The home provides care to adults with learning disabilities. The home has over the last year been extended to accommodate 7 people and at the time of the inspection building works were continuing to the 2nd floor, which will provide a staff sleep in area and shower. These have taken some time as every effort has been taken to ensure that the works do not interfere with residents and the operation of the home. The home is situated close to local shops and facilities. The building has seven bedrooms, a communal lounge, kitchen, conservatory, visitor’s room, office, laundry room, bathroom and two showers. The house, front and rear gardens are well kept. A service users guide is available for prospective residents and the current fees are £800.00 to £1300.00 per week. Additional charges are made for personal items such as toiletries, newspapers, hairdressing, holidays and some activities. Lynwood DS0000068972.V344088.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection undertaken by Regulation Inspector Harbinder Ghir. The inspection took place on the 02nd July 2007 between 6.50am and 2.00pm. A spot check was also completed on the 19th June at 6.45pm. The registered manager of the home was available throughout the time to aid the inspection process. The home has been under a new proprietor since the 30th March 2007. During the inspection the inspector was able to talk to the service users residing at the home and members of staff. Relatives were also spoken to who were contacted by phone. A day centre manager, club manager, a Learning Disabilities Nurse and The Team Leader for Learning Disabilities Nurses were also contacted as part of the inspection. The actions taken by Newham and Barking and Dagenham Social Services following two complaints regarding the practices at the home have been included in the report. The inspector toured the home, read records of people who use the service and examined documents in relation to the management of the home. At the end of the inspection the inspector was able to provide feedback to the manager and the proprietor of the home. The inspector would like to thank everyone involved in the inspection process. What the service does well: Residents’ needs are fully assessed prior to admission, ensuring their needs can be met by the service. Risk assessments are undertaken routinely to ensure residents are supported to take risks as part of an independent lifestyle. Residents live in a comfortable environment, and décor is of a good standard and provides a homely and pleasant living environment enhancing residents’ comfort. Residents are supported to maintain family links and relationships inside and outside the home. The service has an equal opportunities policy to ensure residents or staff members are not discriminated against on the grounds of race, culture, age, sexuality or gender. Lynwood DS0000068972.V344088.R01.S.doc Version 5.2 Page 6 The service has good recruitment procedures in place that protect residents. The health and safety of residents and staff is promoted. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Lynwood DS0000068972.V344088.R01.S.doc Version 5.2 Page 7 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 Lynwood DS0000068972.V344088.R01.S.doc Version 5.2 Page 8 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are provided with all the information required by the Care Regulations 2001, to enable them to decide whether they would like to live at the home. However, this information needs to be provided in formats suitable for the people for whom the service is intended. Service users needs are fully assessed prior to admission, ensuring their needs can be met by the service. EVIDENCE: The Statement of Purpose provides adequate information for residents and prospective residents in line with the Care Homes Regulations 2001. The Service User Guide has not been updated since the take over by the new proprietor as the document makes reference to the previous owner of the service. It is Requirement 1 that the document is updated to provide the correct information on the service. The documents were also presented in text formats, which are unsuitable to the communication needs of residents living at the home. The documents should be considered to be made available in formats such as Braille, appropriate languages, pictures, video and audio, that are suitable for the people who use the service. This is Recommendation 1. Lynwood DS0000068972.V344088.R01.S.doc Version 5.2 Page 9 The pre-admission process could not be fully tested, as the service does not have any recently admitted residents. The service has a comprehensive preadmission policy and procedure in place and has also introduced a new preadmission assessment form. A service user file seen evidenced that adequate pre-admission assessments are completed and information by the placing Local Authority was also included. The resident at the time of being admitted was able to test-drive the home by completing regular visits and meet other service users residing at the home. Several relatives were asked about how they feel about the quality of care provided at the home. Comments included “The care provided is really good. We can visit any time and they let us know of any changes, we are always kept informed and are invited to attend reviews.” Another relative spoken to stated, “The home and the staff are very good, we are very pleased with the care provided”. Signed copies of the individual contract by the resident and the service were seen, ensuring residents agreed to the terms and conditions of the service. Lynwood DS0000068972.V344088.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans do not reflect the changing needs and personal goals of people who use the service. The right for residents to exercise choice and control is not promoted by the service and they are not actively consulted on, and participate in, all aspects of life in the home. Risk assessments are undertaken routinely to ensure residents are supported to take risks as part of an independent lifestyle. EVIDENCE: Four care plan files were closely examined. Care plans were very brief and need to be more specific with regard to the tasks to be completed around personal care and how the social, emotional and care needs of residents are to be met, and the outcomes to be achieved. Care plans did not include information on whether residents required the assistance of two, shaving, Lynwood DS0000068972.V344088.R01.S.doc Version 5.2 Page 11 washing, and dressing etc. As part of the inspection the Community Learning Disabilities Nurse was contacted by phone. She informed she was contacted by the service, as a result of a resident who was able to use the toilet but kept smearing faeces over the toilet each time he used it. On completing her assessment she stated, “The service user was smearing because he required some prompting and assistance and not all staff were assisting him and were leaving him to use the toilet independently”. If the need for assistance had been identified by the service and had been reflected in the care plan, the situation above could have been avoided. Limited evidence was seen of care plans being developed in partnership with residents, representatives and relevant agencies or specialists. Care plans included a list of likes and dislikes of foods and preferences of social activities, which were completed with the residents. No other evidence was seen of residents contributing to the development of their care plan. It is Requirement 2 that the service prepares care plans in specific detail as to how the residents’ needs in respect of their health and welfare are to be met, in consultation with the resident and their representatives. It was concerning to find statements in the care plan that infringed on the choices and autonomy of residents. Care plans were service led and were not devised around the needs of the resident. Statements in the care plans seen included “X will wake early in the morning but will not get out of bed. Staff need to get x up as soon as she wakes. If x is left laying in bed she will start to mess with her pad and has been known to smear.” Another statement in response to managing a resident’s expression of sexuality in public included “Y is to stop this behaviour”. Care plans do not focus on positive outcomes for residents and do not provide strategies to meet residents’ needs in a person centred way and assist residents to make decisions. A requirement in relation to the above will be stated as Requirement 3. The manager had reviewed care plans on a monthly basis, but there was no recording of any changes that were identified, or the views of the resident and any other parties present. Some care plans seen had not been amended for over a year. One care plan seen had been amended in regards to the changing mobility needs of the residents, but no evidence was seen that the resident had been consulted of the revisions made to their care plan, or whether she was present at the review. Care plans must be reviewed in partnership with residents and must evidence any revisions made and consultations taken place with residents. This is Requirement 4. Residents were seen to be involved in the daily running of the home in regards to cooking and cleaning. One resident was observed as making her breakfast and another was assisting to clean the bathroom. However, no further evidence was seen of residents consulted on the running of the home. Residents were not invited to attend staff meetings or other forums or had any Lynwood DS0000068972.V344088.R01.S.doc Version 5.2 Page 12 representation in management structures of the home. It is Requirement 5 residents are enabled to be involved and make decisions in regards to the care they are to receive by the service, such as the recruitment of new staff or admissions of new service users. Risk assessments are routinely undertaken for all residents around nutrition, manual handling, continence, falls, challenging behaviour and are reviewed on a monthly basis. Risk assessments were case tracked for one resident whose mobility needs had changed. The risk assessment seen was updated and included how the risks were to managed by staff and the outcomes to be achieved. Lynwood DS0000068972.V344088.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17 Quality in this outcome area poor. This judgement has been made using available evidence including a visit to this service. Residents are not always provided with support to maintain their independence and in areas of personal development according to their needs and wishes. Residents are engaged in limited community life during the evenings limiting opportunities for them to be part of the local community. Daily routines do not respect the rights of residents and have caused the Commission for Social Care Inspection grave concern. Residents are not offered meals that promote their choices and respect their individual preferences. Residents are supported to maintain family links and relationships inside and outside the home. EVIDENCE: During the day of the inspection six of the residents attended their day centres and colleges. Each resident has a weekly activity planner, which was displayed, Lynwood DS0000068972.V344088.R01.S.doc Version 5.2 Page 14 in the staff room, which included activities such as attending college, day centres and swimming clubs. Some residents also attended employment service centres, which provided training facilities and skills development for employment. Day centres provided residents with opportunities to be involved in crafts, games and enjoy outings for the day. Limited activities during the evenings and weekends were recorded on the planner, which included going to the cinema, pub or the local club once a week, which arranges discos. One resident spoken to stated “ I don’t go out much during the evenings, and only go to the club on a Tuesday evening”. Residents must be provided with increase social activities in the evening with their consultation and preferences, to ensure they are supported to pursue their own interests. This is Requirement 5a. It is Recommendation 3 residents’ activity planner is displayed where it is accessible to them and is in a format, which is suitable to their communication needs. Family and personal relationships are actively promoted by the home. Residents can develop and maintain intimate relationships with people of their choice. One resident spoken to stated “I have a boyfriend and see him at the local club, who I see when I go out”. Family can visit anytime and some residents regularly visit family over weekends. The services Statement of Purpose states “Arrangement for ensuring that our service users are treated with respect and dignity are clearly shown in all our policies, procedures and actions.” The Commission for Social Care has grave concern, at the rigid and service led daily routines of residents. The inspector arrived at the premises at 7.00am and found one resident dressed and preparing her breakfast and another resident was being assisted by staff to get ready. A further four residents were ready and were having their breakfast by 8.00am. Only one resident was observed to be assisted by staff to get ready after 8.00am. On speaking to a member of staff who was on duty, on why residents get up so early she stated “Its nice to have the residents half ready by the time the morning staff come in which is about 8.00am.” One resident spoken to stated, “I get up first and early because x also needs help”. A spot check visit was also conducted by the inspector at 6.45pm on a separate occasion and observed a resident being assisted to get ready into her night clothes and another resident was already in her night clothes. The communication book seen evidenced residents woken up as early as 6.35am. On speaking to the manager of the home on the daily routines of residents, she informed that residents choose and request to be woken up at these times. On viewing residents care plans no information was found highlighting residents specified times of going to bed or waking up. It is Requirement 6 that residents are consulted on their preferred daily routines which is recorded in their care plans and the service adopts a person centred way of working instead of residents having to fit in with staff routines. Lynwood DS0000068972.V344088.R01.S.doc Version 5.2 Page 15 Residents are not offered a choice of meals and evidence was seen of residents’ weekly menu’s devised by members of staff from the residents list of likes and dislikes included in the care plan. Residents were not consulted on their choice of meal each day or whether they preferred to eat out some days. Meals times were set by the service and did not provide flexibility or choice for residents. This is poor practice and does not promote the rights and choices of residents. Meals must be varied and menus must be devised in consultation with residents and available at such times as required by the individual. This is Requirement 7. Lynwood DS0000068972.V344088.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents do not always receive personal care and support in the way they prefer. Medication practices do not ensure the safety of people who use the service. EVIDENCE: Residents do not always receive personal care and support in the way they prefer. During a spot check visit to the service at 6.45pm the inspector observed a female resident’s personal care attended to in her bedroom with the door open. As part of the inspection a healthcare professional spoken to raised further concerns about the way staff members provide support to residents. She informed “I observed a member of staff with a resident who was very anxious and nervous about receiving medical treatment. I saw the member of staff teasing the resident about her going to receive treatment, upsetting the resident even more”. This practice is abusive. Residents must be supported to receive personal care support the way they prefer and their rights to dignity and privacy must not be compromised at any time. This is Requirement 8. Staff must be provided with Lynwood DS0000068972.V344088.R01.S.doc Version 5.2 Page 17 the training and competences to ensure they can meet the needs of residents. Please refer to requirements under standards 32 and 35. Residents’ health care needs are set out in individual care plans but need to be specified in more detail as discussed under standard six of this report. The team leader for the Community Learning Disabilities Nurses was spoken to who highlighted concern that staff did not always follow their instructions on how to manage residents’ health. He stated, “We instruct staff on how to manage residents challenging behaviour and to record any incidents on charts we provide. Instructions are not always followed and staff do not record these charts correctly”. The service must make proper provision for the health and welfare needs of service users to be met, to ensure they are supported and that their healthcare is promoted. This will be stated as Requirement 9. Evidence was seen of healthcare provided by occupational therapists, dentists, chiropodists and female residents going for well women checks. Care plans also included hospital appointment record sheets and monthly weights checks. There are policies and procedures for the handling and recording of medicines. An audit was undertaken of the management of medicine within the home and a random sample of Medication Administration Records (MAR) charts were examined. The following issues were discussed with the manager of the home. Medication was stored in a locked cabinet, but the cabinet was not fixed to the wall. Medication leaving the home for each resident was all transferred into one cubicle of a dosette box for the individual. When the medications were taken out of their blister packs it was impossible to identify which tablet was which and what time it should be administered. Medication Administration Records repeatedly included the code O for other. Staff informed the code was used to refer to various reasons why medication was not administered. If the code O is going to be used, staff must record on the back of the MAR sheet the date, the name of the medication and a description of why the code was used and the statement to be signed by the member of staff making it. Medication was secondary dispensed into dosette boxes by staff for residents when leaving the home. If the home fills medicine containers or compliance devises then a written policy is required that includes the procedure to be followed and the precautions to be taken, including a witness to the transfer. A fully documented record of the transfer would need to be retained and signed by staff involved. The procedure would need to include the staff trained as being authorised to transfer medication and they will require contacting their pharmacist for advise DS0000068972.V344088.R01.S.doc Version 5.2 Page 18 - - Lynwood before transferring medication as the transfer of some medicines from the manufacturer’s packaging is contraindicated. A signature of the person accepting receipt and return is required. While examining medication practices a tablet had fallen out from the medication cupboard. It is Requirement 10 that medication practices are reviewed to ensure the safety of residents. Due to the number of concerns identified in regards to unsafe medication practices the service has been referred for a pharmacy inspection. Lynwood DS0000068972.V344088.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The complaints procedure and practices of how complaints are investigated does not ensure the views of people who used the service will be acted upon. Not all staff have received up to date training in Adult Protection, which does not ensure the protection of residents. EVIDENCE: The complaints procedure was seen which was provided in text format and was included in the Statement of Purpose. The home has a clear complaints procedure, but needs amending to state that the Commission for Social Care Inspection can be contacted at any stage of a complaint being made. The home had devised a complaints book, in which no complaints have been recorded. A record of a complaint made was found in a staff file concerning her conduct and behaviour with a resident. This was not logged in the complaints book. However, evidence was seen of how the complaint was dealt with by the manager who had responded to the complainant in writing. On speaking to the Learning Disabilities Nurse as part of the inspection, she informed that she had complained to the manager of the home regarding a staff member’s behaviour towards a resident and has not been informed about the outcome of the complaint. She also stated “After I had made the complaint the member of staff I had made the complaint against did not talk to me and was not very friendly.” No record of this complaint was found. All complaints about the care of service users, regardless of source, must be recorded and thoroughly investigated and responded to appropriately and all complaints Lynwood DS0000068972.V344088.R01.S.doc Version 5.2 Page 20 must be recorded centrally and held for inspection. Those making complaints must not feel victimised in any way and must be assured their complaints are listened to and will be acted upon. This is Requirement 11. Two formal complaints have been made regarding the practices at the home. The first complaint received by the Commission for Social Care inspection alleged medication was not stored safely, placing residents at risk. The Commission for Social Care Inspection conducted an unannounced visit to complete a spot check of medication storage at the home. No evidence was found of the allegations made by the complainant at the spot check, but there are concerns about unsafe medication practices at the home, which are discussed under standard 20 of this report. The second complaint referred to the service led daily routines of residents, which are fitted in with staff’s personal circumstances. The second complainant has also made allegations of residents being bullied by a member of staff and that residents are scared of the staff member. A series of unannounced visits by Newham and Barking and Dagenham Social Services have taken place, the placing authority and the host authority have found the allegations to be true. Newham Social Services who are the placing authority for all seven residents placed at the home are to formally review residents care. The service has suspended the member of staff and are to investigate the allegations made. Not all staff have attended training in POVA and adult protection. In regards to the nature of complaints made about the practices at the home. It is imperative that all staff receive up to date training in Adult Protection to ensure the safety of residents is safeguarded. This is Requirement 12. Lynwood DS0000068972.V344088.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 28, 29, 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home does not reduce the risks of infection by its practices, which may place residents at risk. Residents live in a comfortable environment, but further environmental safety checks would minimise risks presented to residents. Décor is of a good standard and provides a homely and pleasant living environment enhancing residents’ comfort. EVIDENCE: The premises were comfortable, bright, airy, clean and free from offensive odours. Furnishings and fittings in communal areas were of good quality, domestic and unobtrusive. The home provides a main lounge, kitchen and a conservatory. Three bedrooms are situated on the ground floor which are wheelchair accessible and a further four bedrooms are situated on the first floor. All bedrooms are provided with en suite facilities. Some of the residents’ Lynwood DS0000068972.V344088.R01.S.doc Version 5.2 Page 22 rooms were seen during the inspection. The rooms were comfortable with adequate furnishings and was also personalised by the resident. One resident showed the inspector her room and stated, “I like my room and I furnished it myself”. All rooms were lockable and can be overridden by staff in an emergency. Specialist equipment for residents was provided. During a tour of the home a sewing kit with needles was found in a unlocked bathroom cabinet. The meter storage room was also unlocked. Household hazardous products were found in an unlocked cupboard under the kitchen sink. One bedroom seen had a broken chest of draws, which required repair. All parts of the home to which residents have access to must be so far reasonably practicable made free from hazards to their safety and unnecessary risks to residents are identified and so far as possible eliminated, this is Requirement 13. A log of fridge, freezer and food temperatures was seen, which staff did not consistently complete and no recordings were found for some days. Food was also not stored in airtight containers. It is Requirement 14 that to reduce the risks of infection and ensure appliances are in working order maintaining the correct temperatures, a daily log of temperatures is recorded consistently and all opened food is stored in airtight containers. Lynwood DS0000068972.V344088.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from a well supervised staff team. Staff training needs to be improved to provide staff with the competences and a range of skills to meet the needs of residents. The service has good recruitment procedures in place that protect residents. EVIDENCE: Training records generally showed that compliance levels with statutory training is good. Evidence was seen of staff completing training, including training in manual handling, epilepsy awareness, disability awareness, food hygiene, medication, and infection control and risk assessments. However, not all members of staff have received up to date training in adult protection and therefore a requirement has been made under standard 23. Due to concerns identified in regards to service led daily routines of the home it is imperative that training is provided to staff highlighting person centred care and promoting the rights and choices of residents. This is Requirement 15. Two Learning Disabilities Nurses spoken to as part of the inspection both highlighted the need for more training in challenging behaviour. One nurse Lynwood DS0000068972.V344088.R01.S.doc Version 5.2 Page 24 stated “There needs to be more training provided in managing challenging behaviour and basic skills on how to complete ABC monitoring charts, as staff don’t know how to complete these correctly”. The second nurse spoken to commented, “There is a lack of experience and training in meeting the needs of people with learning disabilities and challenging behaviour”. Training must be provided in challenging behaviour to ensure staff are equipped with the skills and competences to meet the needs of residents. This will be stated as requirement 16. There is a ratio above 50 of NVQ qualified staff at the home. Staff on duty were observed to be communicating and interacting positively with residents. One resident referred to a staff member as her “friend”. Relatives spoken to all commented positively regarding the attitudes of staff. One relative stated, “Carers are really nice and are always polite when we have visited.” A manager of a club residents attend in the evenings also spoke positively about staff members, she stated “The carers are very good, they stay with service users whilst they are here and they look after them, we have never had any trouble with the home.” Two members of staff are on duty during each shift. Two care staff assist seven service users with varying levels of care needs. During the morning of the inspection staff members were observed to be rushing to get residents ready for their transport to the day centre. There are not enough members of staff to meet the needs of residents at peak times. One resident stated ““I get up first and early because x also needs help.” Staffing levels must be reviewed to ensure sufficient staff are on duty at all times, and in particular at peak times, to ensure residents are not rushed or woken unduly early to fit into staff routines. This will be stated as Requirement 17. Three staff files were closely examined one of which was of a recently recruited member of staff. Files were found to be in good order with all the required checks and documentation being in place. It is recommended that the management team update the application form and develop interview records that include a space for recording any gaps in employment. This will be stated as Recommendation 2. Staff supervision and appraisal records seen evidenced that all staff were supervised regularly and were appraised on a yearly basis. Lynwood DS0000068972.V344088.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management of the home must ensure service led routines are stopped. Quality assurance systems need to be developed further to ensure residents are confident their views underpin all reviews by the home. The health and safety of residents and staff is not always promoted. EVIDENCE: The Commission for Social Care is very concerned at the service led routines of residents, which do not promote residents’ rights or choices. The Commission would like to reiterate that these practices must stop and the service must focus on valuing people and person centred care. The registered persons must Lynwood DS0000068972.V344088.R01.S.doc Version 5.2 Page 26 ensure good practice is complied with and staff are provided with competences and skills to meet the needs of people who use the service. The registered manager is undertaking her registered managers award. The home has been taken over by a new proprietor. The new proprietor has been active in completing monthly Regulation 26 visit reports. The services Statement of Purpose states “Lynwood care home is committed to ensuring that the service users are fully consulted and their views are heard and acted upon”. However, there is insufficient evidence to demonstrate how this statement is being implemented in the dayto-day running of the home. A quality assurance system is in place and completed questionnaires by residents, day centre managers and relatives and families were seen. The results were compiled and were transferred into diagrams and pie charts. However, where there was dissatisfaction with the service on surveys completed by residents, the manager had failed to take prompt action. The manager of the home must action and review the results, reflecting aims and outcomes for residents. This will be stated as Requirement 18. The service has a health and safety policy in place. Safety and maintenance certificated were inspected, including fire safety and were found to be in good order. The records to evidence the regulation of water temperatures throughout the home could not be located and therefore was not seen. It is Requirement 19 that a daily check of water temperatures is taken at all water points to ensure temperatures are close to 43 degrees and do not present a hazard to residents. Lynwood DS0000068972.V344088.R01.S.doc Version 5.2 Page 27 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 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 2 ENVIRONMENT Standard No Score 24 3 25 2 26 3 27 3 28 3 29 3 30 2 STAFFING Standard No Score 31 X 32 1 33 1 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 1 3 X LIFESTYLES Standard No Score 11 2 12 3 13 1 14 1 15 3 16 1 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 1 x 1 X 2 x X 2 x Lynwood DS0000068972.V344088.R01.S.doc Version 5.2 Page 28 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 45 Schedule 1 15 Requirement The Registered persons must ensure the Service User Guide is updated to provide the correct information on the service. The Registered persons must ensure the service prepare care plans in specific detail as to how residents’ needs in respect of their health and welfare are to be met, in consultation with the resident and their representatives. The Registered persons must ensure care plans focus on positive outcomes for residents and provide strategies to meet residents’ needs in a person centred way and assist residents to make decisions. The Registered persons must ensure care plans are reviewed in partnership with residents and must evidence any revisions made and consultations with the resident. The registered persons must ensure that residents are enabled to make decisions in DS0000068972.V344088.R01.S.doc Timescale for action 30/09/07 2 YA6 30/09/07 3 YA6 12 15 30/09/07 4 YA6 15 30/09/07 5 YA8 12 30/09/07 Lynwood Version 5.2 Page 29 regards to the care they are to receive and their health and welfare. 5a YA13 16 The Registered persons must ensure residents’ are provided with increased social activities in the evening with their consultation and preferences. The Registered persons must ensure residents’ are consulted on their preferred daily routines which is recorded in their care plans and the service adopts a person centred way of working instead of residents having to fit in with staffs routines. The Registered persons must ensure meals are varied and menus are devised with residents and available at such times as required by the resident. The Registered persons must ensure residents are supported to receive personal care support they prefer and their rights to dignity and privacy must not be compromised. The Registered persons must ensure the service makes proper provision for the health and welfare needs of service users to be met. The Registered persons must ensure medication practices are reviewed to ensure the safety of residents. Repeated Requirement. The Registered persons must ensure all complaints about the care of service users regardless of source are recorded and thoroughly investigated and responded to appropriately and all complaints must be recorded centrally and held for inspection. DS0000068972.V344088.R01.S.doc 31/07/07 6 YA16 12 15 16 30/09/07 7 YA17 16 30/09/07 8 YA18 12 30/09/07 9 YA19 12 13 30/09/07 10 YA20 13 30/09/07 11 YA22 22 30/09/07 Lynwood Version 5.2 Page 30 12 YA23 18 13 YA24 16 14 YA30 13 15 YA32 18 16 YA35 18 17 YA33 18 18 YA39 24 Those making complaints must not feel victimised in any way and must be assured their complaints are listened to and will be acted upon. The registered persons must ensure that all staff receive up to date training in Adult Protection to ensure the safety of residents is safeguarded. The Registered persons must ensure all parts of the home to which residents have access to are so far reasonably practicable made free from hazards to their safety and unnecessary risks to residents are identified and so far as possible eliminated. The Registered persons must ensure a daily log of food, fridge and freezer temperatures is recorded consistently and all opened food is stored in airtight containers. The Registered persons must ensure training is provided to all staff highlighting person centred care and promoting the rights and choices of residents. The Registered persons must ensure training is provided in challenging behaviour to ensure staff are equipped with the skills and competences to meet the needs of residents. The Registered persons must ensure staffing levels must be reviewed to ensure sufficient staff are on duty at all times, and in particular at peak times, to ensure residents are not rushed or woken unduly early to fit into staff routines. The Registered persons must action and review the results of quality assurance questionnaires, reflecting aims and outcomes for residents. DS0000068972.V344088.R01.S.doc 30/09/07 30/09/07 30/09/07 30/09/07 30/09/07 30/09/07 30/09/07 Lynwood Version 5.2 Page 31 19 YA42 16 23 The Registered persons must ensure a daily check of water temperatures is taken at all water points to ensure temperatures are close to 43 degrees. 30/09/07 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 Refer to Standard YA1 Good Practice Recommendations It is recommended that the Statement of Purpose and Service User Guide should be considered to be made available in formats such as Braille, appropriate languages, pictures, and video, audio that are suitable for the people who use the service. It is recommended that the management team update the application form and develop interview records that include a space for recording any gaps in employment It is recommended that the residents’ activity planner is displayed where it is accessible to them and is in a format, which is suitable to their communication needs. 2 3 YA34 YA14 Lynwood DS0000068972.V344088.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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