Inspection on 21/11/07 for Lynwood

This inspection was carried out on 21st November 2007.

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 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lynwood 02/07/07

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 21st November 2007 10:00 Lynwood DS0000068972.V354992.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.V354992.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.V354992.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 Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Lynwood DS0000068972.V354992.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care (excluding nursing) and accomodation 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 2nd July 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, visitors’ 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.V354992.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the 2nd key unannounced inspection for the service since the 2nd July 2007 the last inspection. This inspection was underdertaken by Regulation Inspector Harbinder Ghir on Wednesday 21st November 2007 between 10am and 3.55pm. The registered provider was available throughout the day of the inspection. During the inspection the inspector was able to talk to the residents residing at the home, staff and one professional who was visiting during the inspection. Relatives were also contacted by telephone for their views on the service. As part of the inspection 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. The inspector would like to thank everyone involved in the inspection process. What the service does well: What has improved since the last inspection? At the last key inspection 19 requirements were made in the following areas; service user guide; care planning; risk assessments; health and welfare of residents; service led daily routines; the choice of meals; personal care support; complaints; safeguarding adults training for staff; environment; staff training; low staffing levels; health and safety. Lynwood DS0000068972.V354992.R01.S.doc Version 5.2 Page 6 At this inspection 16 of these requirements had been complied with. I was pleased to see that these requirements had been complied with at this inspection, and that there is evidence of great improvement since the last inspection. However, 3 requirements have not been met within its timescales and will be repeated at this inspection. However, further work is being undertaken by the service to meet these outstanding requirements. 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.V354992.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.V354992.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 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The Statement of Purpose provides detailed information on the services provided by the home, but needs to be updated to reflect the staffing changes that have taken place. The service completes comprehensive pre-admission assessments, to ensure they can fully meet the needs of prospective residents. Trial visits are offered to all prospective residents, to ensure residents have information on the services and facilities provided at the home. Each service user has an individual written contract of the statement of terms and conditions, to ensure they agree to the services provided at the home. EVIDENCE: The service updated its Statement of Purpose in April 2007. The document does not provide all the information required by the Care Homes Regulations 2001, and needs to be further amended to reflect the changes that have taken place at the home. Some members of the staff team are no longer working at Lynwood DS0000068972.V354992.R01.S.doc Version 5.2 Page 9 the home and new additional members have joined, this information needs to be included in the document. The complaints procedure also does not refer to the Commission for Social Care Inspection as contactable at any time or stage of a complaint being made. The complaints procedure will be further discussed under standard 22 of the report. Unfortunately this document is only provided in text format and is not suitable to the communication needs of people living at the home, as one resident is partially blind and others would not be able to understand the information. It is Requirement 1 that the Statement of Purpose is updated to meet the requirements of the Care Homes Regulations 2001. The Service User Guide has also recently been updated. The document is provided in a combination of text and picture formats. It is very easy to read and understand and is commended for its simplicity. The pre-admission assessment process could not be fully tested at this inspection, as the service does not have any recently admitted residents. For new prospective residents, the service has a comprehensive pre-admission policy and procedure in place. New prospective residents would be also able to visit the home as many times as they like and have an opportunity to stay overnight. Relatives and family are also invited to visit the home. On viewing the care plan files of three residents, they all had a contract of terms and conditions. Each resident had signed the document. Unfortunately the documents were in text format and were not easy to understand and were also not provided in picture formats, which would have been more suitable to the communication needs of residents. It is therefore Recommendation 1 that the documents are provided in formats suitable to the communication needs of residents living at the home. Lynwood DS0000068972.V354992.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 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There is a comprehensive care planning system in place, which provides staff with the information needed, to meet the needs of residents. The right of residents to exercise choice and control is promoted by the service and they are 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, and are always updated according to residents’ changing needs. EVIDENCE: Since the last inspection the service has introduced a new care plan format, which is more comprehensive and is person centred. The plan now concentrates on promoting the independence of residents and positively Lynwood DS0000068972.V354992.R01.S.doc Version 5.2 Page 11 highlights what they can do for themselves. The plans in detail cover the personal care needs, health, communication, mobility, diet, daily routines, social activities and religious needs of residents. Three care plans were closely examined which all referred to the individual preferences of residents and how they would like their needs met. One resident’s care plan stated, “While in my room I like to watch TV or listen to my CDs or listen to the radio or just relax.” Another plan stated “I am able to carry out some aspects of my personal care such as getting out of bed on my own and informing staff I am ready for a shower by pulling the cord, and can get myself into the shower.” Another care plan informed staff of how a resident communicates that they are angry or upset. The care plan stated “When you hear me rattling my beads or rocking vigoursly, shout or put my arms up, I am either angry, frustrated or want something.” Care plans also included the names of all health and social care professionals, family friends involved with the resident who contributed to developing the care plan. It was positive to see that the care plan was devised with the resident’s needs at the core. Further evidence was seen of letters sent to family; relatives and professionals inviting them to attend the care plan reviews of residents. Each resident also has a key worker to promote one to one working. Monthly meetings between the resident and key worker have also been introduced to ensure residents are happy with the way their needs are being met. Positive evidence was also seen of residents given the right to change their key worker. All residents at a recent residents’ meeting informed the acting manager who they would like as their key worker, which was arranged by the service. One resident chose to change her key worker, which was done by the service. New documentation has also been introduced by the service on recording reviews and the changes required to the care plan, which is more detailed. Each care plan included the management of risk as positively addressing safety issues whilst aiming for better quality of life. Two residents since the last inspection have been risk assessed safely to use the dial a ride transport independently, promoting their right to choice and independence. Lynwood DS0000068972.V354992.R01.S.doc Version 5.2 Page 12 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 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are provided with support to maintain their independence and in areas of personal development according to their needs and wishes. Residents are engaged in community life, promoting their opportunities to be part of the local community. Daily routines respect the rights of residents ensuring their needs are met in the way they prefer. Residents are 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. Lynwood DS0000068972.V354992.R01.S.doc Version 5.2 Page 13 EVIDENCE: Since the last inspection the service has made a strong commitment to enabling people who use the service to develop their skills, including social, emotional, communication, and independent skills. Individuals are now supported to identify their goals, and work to achieve them. Each resident now has a detailed activity planner in their care plan and a picture format planner displayed in the lounge which each resident plans by placing pictures of activities they want to do each day. Activities included swimming, going to discos, going to church, pubs, restaurants, keep fit classes, shopping, going to the cinema. Residents throughout the day were seen to go out to the local shops; one resident went out shopping with the support of a member of staff. During the afternoon residents had planned to visit St Georges Centre’s open day, which was providing information for people with learning disabilities, which they went to. One resident takes part in paid employment twice a week. Two further residents have made applications for voluntary employment. During the inspection one of these residents informed the acting manager that she had just got a part time job at the local charity shop, which she was very happy about. Family and personal relationships are actively promoted by the home. Family, friends and relatives are encouraged to visit their loved ones and some residents also visit family over the weekends. Personal relationships are also promoted by the service. One resident has a boyfriend, she stated “I see him at the centre, and we go to discos together, he has also come to the home.” The resident has taken a picture with her boyfriend at a disco she went to, which staff supported her to frame and place in her room during the inspection. Evidence was seen of the service promoting residents’ rights by them choosing the times they want to go to sleep and wake up. On the morning of the inspection, the inspector arrived at the premises at 10am. Some residents were just getting up and others were just starting their breakfast. Care plans identified each resident’s preferred times of going to sleep and getting up. Daily case recording notes further evidenced residents going to sleep when they wanted to, and some residents chose to go to bed very late, choosing to watch movies of their choice or relax in the lounge. The service is commended for promoting the rights of people who use the service since the last inspection and eliminating service-led routines, which were identified practices at the last inspection. The home now provides meals which are varied and nutritious and meet the dietary needs of residents. There is a four weekly communal menu, which offers two choices of a hot meal at teatime, a good selection of breakfasts and residents choose what they would like for lunchtime each day. Residents can also choose a meal of their choice from an extensive folder of pictures foods, Lynwood DS0000068972.V354992.R01.S.doc Version 5.2 Page 14 meals and ingredients. Each resident’s choice of meal is displayed on a board in the dining area. The teatime menu for the day was beef or sausages with potatoes, peas and carrots. On viewing the board, all residents had chosen very different meals, from chicken with rice to chicken with curry. Staff were also seen asking residents what they would like for breakfast offering them choice. Staff support residents to devise their individual menu every evening for the next day. Residents’ dietary preferences were also recorded in residents’ care plans, also positively meeting the cultural dietary needs of residents. One resident’s care plan recorded that she was of Muslim faith and of Turkish descent and could not eat pork. To promote her Turkish descent staff prepared Turkish cuisine and supported her to visit Turkish Restaurants. On speaking to the resident she informed, “I visit the local Turkish restaurant with staff, its lovely there.” On speaking to a member of staff he informed that “Things are a lot better here now, they are free to do what they want. We all went to Nando’s restaurant recently, which they really enjoyed.” Another resident of German heritage was supported to visit a German restaurant every month. Residents were also observed going into the kitchen and independently making cups of tea and helping themselves to snacks and preparing lunch throughout the day. The daily case record notes also evidenced that meal times were flexible and were not service led anymore. Lynwood DS0000068972.V354992.R01.S.doc Version 5.2 Page 15 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, 21 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents receive personal support and care in the way they prefer and require. Medication practices when residents take medicine home for the weekend do not always ensure the safety of people who use the service. The ageing, illness and death of service users are handled with respect and as the individual would wish. EVIDENCE: All residents have a detailed plan of their daily routine including the type of support needed in relation to personal hygiene, according to their level of care needs. All residents have a designated key worker to promote their privacy and dignity, and all personal care is provided in private. Attention is paid to Lynwood DS0000068972.V354992.R01.S.doc Version 5.2 Page 16 personal preferences in relation to the provision of personal care. Personal support takes account of individual preferences and residents’ choice of dress and appearance is respected. Residents were observed to be well dressed and were well groomed. Residents are supported by staff to attend appointments with healthcare professionals and their health is closely monitored and prompt referrals are made. There was evidence of staff taking female residents to well women checks and the involvement of multli-disciplinary healthcare professionals where required were made to dentists, chiropodists, GP’s and community psychiatric nurses. A professional Masseuse who provides hand and feet massages to residents on a weekly basis was spoken to whilst visiting during the inspection. She commented very positively about the care provided at the home and stated “I visit on a Wednesday about 10am and I see residents getting up later. The residents seem very happy here, I have never had any problems with any of the staff, and the service has improved. The home is always clean and residents are well dressed. ” A relative spoken to as part of the inspection also commented very positively on the care provided at the home and stated “I am very happy with the care at the home, and have had no reason to complain.” There are policies and procedures for the handling and recording of medicines. Each resident has a medication care plan file, including information on residents’ current medication. A list of all staff authorised to administer medication and signatures trained to administer medication was kept on the medication file. An audit of two residents medication was checked with the quantity administered on the Medication Administration Record, which was found to be in good order. An audit was undertaken of the management of medicine within the home and a random sample of Medication Administration Records (MAR) charts was also examined. The following issues were identified; Medication Administration Records were not recorded in full, as staff had not signed for some entries, where the code L should have been used, where residents had gone home for the weekend. A written policy is required that includes the procedure to be followed and the precautions to be taken, including a witness to the transfer when medication is given by staff to residents or their families when leaving the home. When a resident had returned to the home from a weekend break, the quantity of medication returned had not been checked and the record to confirm this had not been signed by members of staff. - - Since the last inspection the service has worked hard to meet the requirements made in relation to medication practices at the last inspection. They have Lynwood DS0000068972.V354992.R01.S.doc Version 5.2 Page 17 purchased a new medication cabinet, introduced a new medication system when residents take medication to the day centre. All medication is now dispensed by the local pharmacist into dossette boxes, to avoid staff secondary dispensing. However, due to the above findings it is Requirement 2 that medication practices are reviewed to ensure the safety of residents. Steps have been taken to find out the wishes of residents in the event of their death, including contacting relatives or representatives where the resident is unable to express their views. There are policies and procedures for staff to follow in the event of a death; to ensure death of service user is handled with respect and as the individual would wish. Residents’ cultural preferences and faiths were also respected as one resident’s care plan identified the wishes of the resident to be buried at a Muslim Cemetery. Lynwood DS0000068972.V354992.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 People using the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users cannot always be assured their views are listened to and acted on. All staff have received up to date training in Safeguarding Adults, which ensures the protection of residents. But guidance on Safeguarding Adults at the home needs to be amended to ensure all staff are aware and have the information to report incidents of abuse. EVIDENCE: Since the last inspection the service has introduced a book to record minor complaints. In addition to this there is also a main complaints book. The complaints book records the complaints, the action taken and the outcome achieved. On viewing the records, staff had recorded their complaints and incidents in the complaints book, which is the incorrect domain to be recording this information, which should be primarily designated for people who use the service. Some actions and outcomes had also been recorded by staff and not actioned by the management of the home. One member of staff had also recorded a complaint made by a resident about her conduct in the complaints book herself in an inappropriate manner. The manager in post at the time did not address this. The manager of the home or the registered provider must take responsibility for deciding on actions and outcomes to be achieved for all Lynwood DS0000068972.V354992.R01.S.doc Version 5.2 Page 19 complaints made at the home and to record these in the complaints book, to ensure residents feel their views are listened to and acted on. This will be stated as Requirement 3. The complaints book should be considered to be used to record complaints made by people who use the service. This will be stated as Recommendation 2. The complaints procedure was presented in text format and clearly stated that timescales within which a complaint would be investigated. However, the complaints procedure, which was also included in the Statement of Purpose, did not refer to the Commission for Social Care Inspection as contactable at any stage of time of a complaint being made. It is therefore Requirement 4 that the complaints procedure is updated to provide the correct information in line with the Care Homes Regulations. A recommendation has already been under standard 1 of this report that the service considers providing documents in formats which are appropriate to the communication needs of residents, as the complaints procedure was presented in text format and was not service user friendly. Since the last inspection two safeguarding adults investigations have now been closed and the members of staff involved in the investigations have been dismissed by the service, as the allegations were substantiated. Since the last inspection staff have received training in safeguarding adults. The service has obtained Safeguarding Adult procedures devised by The London Borough of Barking and Dagenham. There was also guidance for staff on how to report incidents of abuse but the information did not include guidance on how to report incidents of abuse if the manager in post was a suspect. The guidance needs to be updated to provide this information to anyone who may suspect abuse to ensure the protection of residents. This is Requirement 5. It is Recommendation 3 that there is also additional guidance for staff on how to record incidents of abuse, using body charts, preserving evidence, and provide residents with a picture guide to identify the types of abuse. Lynwood DS0000068972.V354992.R01.S.doc Version 5.2 Page 20 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, 27, 28, 29, 30 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a comfortable environment and décor is of a good standard and provides a homely and pleasant living environment enhancing residents’ comfort. But further environmental safety checks would improve the environment of the home. 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. Since the last inspection, the home has undergone a decoration programme. New carpets have been laid in the hallway on the ground floor and upstairs; walls n\m have been painted throughout the home. Furniture has also been moved around in the lounge with the consent of residents to ensure residents can sit together without anyone becoming isolated. This is had a very positive affect on residents, as during the inspection they were all sitting together, relaxing watching T.V. The home Lynwood DS0000068972.V354992.R01.S.doc Version 5.2 Page 21 provides a main lounge, kitchen and a dining area. Residents’ rooms were seen during the inspection. The rooms were comfortable with adequate furnishings and were also personalised by the residents. All rooms were lockable and can be overridden by staff in an emergency. Specialist equipment for residents was provided where required. Since the last inspection a series of improvements have been made to the environment. The ground and first floor of the home has been repainted and the stairs and the second floor communal areas have been re-carpeted. However, during a tour of the home a hoover pipe and a broken chair was found in the front driveway of the home and the staff toilet on the ground floor had a broken toilet seat. Opened packets of foods were not stored in airtight containers, which could increase the risk of contamination. 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 will be therefore repeated as Requirement 6. Lynwood DS0000068972.V354992.R01.S.doc Version 5.2 Page 22 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): 31, 32, 33, 34, 35, 36 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Recruitment practices are robust and ensure residents are in safe hands at all times. Adequate staff training is provided to all care staff, to ensure they are equipped with the skills and are competent to do their jobs. The service has a good skill mix of staff, and staffing levels at night and at peak times, ensure adequate numbers of staff are on duty to meet the need of residents. EVIDENCE: Three staff files were closely examined, which were all in good order. References and Criminals Records Bureau checks had been obtained for all members of staff. Staff had been on induction programmes and all received ongoing training. Training received this year included training in safeguarding Lynwood DS0000068972.V354992.R01.S.doc Version 5.2 Page 23 adults, communication and interpersonal skills, challenging behaviour, administration of medication, person centred care, moving and handling, basic hygiene and health and safety and risk assessments. Staff qualifications evidenced that the service has a ratio above 50 of NVQ qualified staff. On viewing the staff rota it did not include the full names of staff on duty. The registered provider is currently the acting manager of home and the manager of a sister home is also sharing this role but were not on the rota. It is Requirement 7 that the staff rota is an accurate reflection of the members of staff on duty to ensure the protection of residents. Staff supervision records evidenced that staff were supervised at least six times a year, ensuring staff are provided with the skills, training and knowledge to perform the tasks required by their employment role. Members of staff spoken also to commented that they were supervised regularly. All members of staff were also apprised annually to review performances against job descriptions and agree career development plans. Since the last inspection the staffing levels have been increased to ensure that the needs of residents are met. There are now four members of staff on duty from 8am- 3pm, 3 members of staff on duty from 3pm –10pm and 1 waking and 1 sleep in on duty at night. Care staff are no longer required to complete cleaning duties in the day to ensure they meet the needs of residents and give them one to one time where required. On speaking to members of staff on duty on the day of the inspection they all commented very positively about the changes that have taken place at the home. One staff member stated, “It is much better now, Selvi and Sandra (the acting managers) listen and are very supportive, it has been very stressful these last few months. It is a lot more organised now, we can take the residents out more, and now we realise that they can do more for themselves.” Another member of staff stated, “The increased staffing levels have been fantastic.” Lynwood DS0000068972.V354992.R01.S.doc Version 5.2 Page 24 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 People using the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There is not a manager in post and the registered provider is overseeing the running of the home. The systems for service user consultation are in place, but must also include views from stakeholders to ensure the home is run in the best interests of residents. The welfare of staff and residents is not always promoted by the home’s policies and procedures. EVIDENCE: Lynwood DS0000068972.V354992.R01.S.doc Version 5.2 Page 25 The home does not have a manager in post with the previous manager being dismissed due to being investigated as part of a safeguarding adults investigation, with allegations being substantiated. The registered provider and the manager of a sister home are overseeing the running of the home until a manager is recruited. The registered provider informed that they have contacted recruitment agencies but have not yet found a suitable candidate. The service is trying very hard to recruit a manager to run the home as soon as possible. However, the service must employ a permanent registered manager as soon as possible, in accordance with Care Standards Act 2001. This will be stated as Requirement 8. However, the current management arrangements have had a positive impact on the running of the home as staff spoken to stated that they feel supported and that they have felt no adverse effects on the running of the home by the previous manager being dismissed. One member of staff stated “The home is much better now, it is more organised, the current managers listen and are very supportive.” Another member of staff stated “The staff morale has really lifted since the last manager has left, we have more finances, the residents have more freedom, and we have more freedom to support them to go out, which is promoting their choice. They can do so much more for themselves now. The registered provider has done a really good job.” Since the last inspection the results of quality assurance surveys have not been actioned where there was dissatisfaction with the service. The Registered persons must action and review the results of quality assurance questionnaires, reflecting aims and outcomes for residents. This requirement will be repeated again at this inspection as Requirement 9. Health and Safety records were inspected. All documentation was in order and appropriately completed. Fire drills were completed regularly. However, evidence could not be found that regular servicing of the boiler and central heating system under contract by member of Council of Registered Gas Installers (CORGI) had taken place this year. It is Requirement 10 that the check is made to ensure the safety of residents. Lynwood DS0000068972.V354992.R01.S.doc Version 5.2 Page 26 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 2 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 2 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 2 X 2 X X 2 x Lynwood DS0000068972.V354992.R01.S.doc Version 5.2 Page 27 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 Schedule 1 Requirement The Registered Persons must ensure the Statement of Purpose is updated to provide the correct information on the service. The Registered Persons must ensure medication practices are reviewed to ensure the safety of residents. Repeated Requirement. The manager of the home or the registered provider must take responsibility for deciding on actions and outcomes to be achieved for all complaints made at the home and to record these in the complaints book, to ensure residents feel their views are listened to and acted on. The Registered Persons must ensure the complaints procedure, refers to the Commission for Social Care Inspection as contactable at any stage of time of a complaint being made. The Registered Persons must ensure that Safeguarding Adults guidance is updated to provide DS0000068972.V354992.R01.S.doc Timescale for action 31/01/08 2 YA20 13 31/12/07 3 YA22 22 (3) 31/12/07 4 YA22 22 (7) (b) 31/12/07 5 YA23 12 (a) 13 (6) 31/01/08 Lynwood Version 5.2 Page 28 6 YA24 16 guidance on how to report incidents of abuse if the manager in post was a suspect. 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. Repeated Requirement. The Registered Persons must ensure the staff rota is an accurate reflection of the members of staff on duty to ensure the protection of residents. 31/12/07 7 YA31 17 31/12/07 8 YA37 8, 9,10 9. YA39 24 The Registered Persons must 28/02/08 ensure the service employs a permanent registered manager, in accordance with Care Standards Act 2001. The Registered Persons must 28/02/08 action and review the results of quality assurance questionnaires, reflecting aims and outcomes for residents. Repeated Requirement. The Registered Persons must ensure that regular servicing of the boiler and central heating system under contract by member of Council of Registered Gas Installers (CORGI) is arranged to ensure the safety of residents. 15/12/07 10 YA42 16 23 Lynwood DS0000068972.V354992.R01.S.doc Version 5.2 Page 29 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 information and documents such as the Statement of Purpose, the contract of terms and the complaints procedure 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 complaints book is considered to be used to record complaints made by people who use the service and not staff. It is recommended that that there is additional guidance for staff on how to record incidents of abuse, using body charts, preserving evidence, and provide residents with a picture guide to identify the types of abuse. 2 YA22 3. YA23 Lynwood DS0000068972.V354992.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 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. Extracts may not be used or reproduced without the express permission of CSCI Lynwood DS0000068972.V354992.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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