Inspection on 10/05/07 for Lynwood House

This inspection was carried out on 10th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lynwood House 23/02/10

Lynwood House 24/11/08

Lynwood House 25/04/06

Lynwood House 17/10/05

Lynwood House 23/05/05

Lynwood House 03/02/05

Lynwood House 27/07/04

Lynwood House 06/02/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Lynwood House Lynwood Close Midsomer Norton Bath & N E Somerset BA3 2UA Lead Inspector David Smith Key Unannounced Inspection 10th May 2007 09:30 Lynwood House DS0000052026.V334703.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 House DS0000052026.V334703.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 House DS0000052026.V334703.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lynwood House Address Lynwood Close Midsomer Norton Bath & N E Somerset BA3 2UA 01761 412026 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) Voyage Ltd Mrs Angela Czerny Care Home 14 Category(ies) of Learning disability (14) registration, with number of places Lynwood House DS0000052026.V334703.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. May accommodate up to 10 people in Lynwood House. May accommodate people who in addition to their learning disability have associated needs including autistic spectrum disorder. May accommodate, in designated rooms within Lynwood House, up to 4 people who in addition to their learning disability are wheelchair dependant. May accommodate up to 4 people in Lynwood House Annexe May accommodate, in the ground floor bedroom within Lynwood House Annexe, 1 person who, in addition to their learning disability, is a wheelchair user 25th April 2006 Date of last inspection Brief Description of the Service: Voyage Limited, who are part of the Paragon Healthcare Group, operate Lynwood House. Lynwood House is a spacious detached property situated in a quiet residential cul de sac in Midsomer Norton. A neighbouring property also forms part of the service and is known as ‘The Annexe’. The service is near to local shops and facilities in the town of Midsomer Norton. Bath city centre is nine miles away. The house and the annexe are set within their own grounds backing onto school playing fields. Lynwood Houses ethos is transitional care in the sense of young adults moving from specialised educational settings or from parental homes to a setting where their needs can be met on as long-term a basis as their healthcare conditions allow. The current fees for this service range from £1300.00 to £1900.00 per week depending on the individual support needs of each person. Lynwood House DS0000052026.V334703.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 visit as part of a Key Inspection of this service. I gathered information through discussions with residents, the Registered Manager, Deputy Managers and Support Workers. Interaction and communication between staff and residents was also observed during the course of my visit. Care plans and associated records were examined together with medication administration, Risk Assessments, accident/incident reports, complaints log, staffing and health and safety records. I was also provided with a tour of the home. Other sources of evidence have been used as part of the Key Inspection process. These include the home’s action plan in response to the last CSCI inspection, the providers own monthly auditing of the service and notifications of significant events which have occurred within the home. The Commission also provided the home with a Pre-inspection Questionnaire, Residents’ Survey Forms and a range of Surveys for other stakeholders prior to this visit. The Pre-inspection Questionnaire was completed and returned together with two Resident’s Surveys. Nine other Surveys were also returned. The people who live in the home wish to be described as ‘residents’ and this has therefore replaced the term ‘service user’ in this report. What the service does well: Each resident spoken with and those who responded by survey said they were treated well and able to choose how they spent their day. Each relative who responded by survey said the home met each person’s need and supported them to live the life they chose. The service continues to maximise each residents quality of life and this is recognised by those who advocate for each resident, be they parents, social care professionals or health professionals. A wide range of professional expertise is actively used in order to support and maintain residents’ health and well-being. The expertise of families is also acknowledged and there remains openness in this partnership. Lynwood House DS0000052026.V334703.R01.S.doc Version 5.2 Page 6 Pre-admission assessment procedures are thorough, well applied and comprehensive transitional planning is centred on each resident’s individual needs. Staff continue to support residents to participate in their local community and to develop their potential through the use of a range of community facilities and through experiencing events and places of interest. The sensory room is a particular strength. Lynwood House offers clean, pleasant and homely accommodation with good quality furniture, fixtures and fittings. Despite the amount of equipment necessary to meet health needs in many of the bedrooms and bathrooms, these rooms remain personalised to an impressive degree. There is a strong core of committed staff who are focussed on their responsibilities and well supported by a manager who is dedicated and able. This helps to ensure residents are provided consistent care and support. What has improved since the last inspection? What they could do better: All staff must take part in regular fire drills and a clear record of each one needs to be maintined. An alternative means to the passenger lift for transferring between the ground and first floors is needed. This will promote the welfare and safety of residents and staff. The home should consider if communication between them and residents’ families and friends could be further improved upon. This would help to promote relatives involvement in residents’ care. Internal redecoration of communal areas in the main house should continue to be kept on a rolling programme in anticipation of the inevitably high levels of wear and tear. This would help to maintain a homely environment for each resident. Lynwood House DS0000052026.V334703.R01.S.doc Version 5.2 Page 7 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 House DS0000052026.V334703.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lynwood House DS0000052026.V334703.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There continues to be a thorough and tailored process of information sharing, assessment and visiting which enables the home and each prospective resident and their families to make an informed decision about the placement. EVIDENCE: The Statement of Purpose for the home was updated in February 2007. Together with the Residents’ Guide, it provides clear information about the service for each resident, their family and the placing authority. Both residents spoken with and those who responded by Survey said they were asked if they wanted to move to this home and felt they had been given enough information to enable them to decide if this was the right place for them to live. The home has admitted two new residents since the last inspection. The care records for both residents were therefore examined. Lynwood House DS0000052026.V334703.R01.S.doc Version 5.2 Page 10 These records showed that comprehensive assessments were carried out by the home and were used in conjunction the Funding Authority’s Care Plan/Assessment of Needs. Information from families and previous placements had also been sourced, where this helped the assessment process. There were also records of assessment from other Health Care Professionals, such as Speech and Language Therapy and Occupational Therapy Assessments. All of the available information had been used to determine whether a good quality service could be provided. Each resident had been formally offered a placement in the home. Each transitional plan was centred on the resident concerned. One person had visited the home during the day and also had weekend stays as this was felt to be the best approach. The initial care plans are regularly reviewed and placement meetings are usually held for each resident after they have lived in the home for three months, although this can vary depending on the needs of each person. Lynwood House DS0000052026.V334703.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures that the service provided to each resident takes into account their personal preferences, supported by written information in care plans, which are subject to ongoing review. The risk assessment process supports each resident to take risks as part of their lifestyle. EVIDENCE: I examined the care records of four people who live in the home. Each file contained an individual care plan, which contained information on the residents’ health, medication, mobility, finances, activities and communication needs. These care plans were detailed and informative and set out action that needed to be taken by staff in order to meet the individual’s needs. Lynwood House DS0000052026.V334703.R01.S.doc Version 5.2 Page 12 Each care plan is reviewed regularly. When formal review meetings are held, these are attended by residents, parents, Social Workers, staff from the home and relevant Health Care Professionals such as Occupational Therapists, Speech and Language Therapists and Physiotherapists. The home ensures each care plan is kept up to date between these formal reviews by maintaining ‘monthly summaries’ by residents’ key workers. This provides an overview of areas such as health and medication, behaviour, contact with families and health care professionals and notes any concerns. This summary is then used to review and update care plans when necessary. A monthly record is kept in each persons file and a note is made when any section of the care plan is amended. This is good practice. Whilst in general the care planning and reviewing practices are very good, it was not clear in one care plan how the last review had taken place or who was involved. Whilst the care plan itself was clearly up to date, the home must ensure a clear record of every review is maintained. Interactions between people who live in the home and staff were observed during the course of my visit. These were conducted in a sensitive and respectful manner. Individual support needs and methods of communication are clearly known and acknowledged by staff. Due to the nature of the disabilities of some of the people who live in the home it can be difficult for them to clearly communicate choices/wishes. Staff continue to use a number of methods to ensure people are supported to make choices and decisions. For example staff use observation of eye movements, body language, behaviours or gestures of individuals as indicators of choice/wishes as well as residents being able to express themselves verbally. The home has also now developed the ‘Lynwood Residents Action Group’. The residents involved in this group meet regularly to discuss the general running of the home, what they would like to change or improve, new things they would like in the home or new places to visit. One resident told me they were involved in this group and said recent meetings had led to a new Barbeque being purchased as well as equipment and games to be used in the garden to enable them to play basketball, net ball and ‘swingball’. They really liked this group and thought it was a very good idea. There are person centred Risk Assessments in place, which are clear and concise. These support residents to take risks as part of an independent lifestyle and are reviewed regularly. Lynwood House DS0000052026.V334703.R01.S.doc Version 5.2 Page 13 Lynwood House DS0000052026.V334703.R01.S.doc Version 5.2 Page 14 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 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each resident has sufficient opportunities and appropriate support to develop, access leisure and educational facilities both locally and in the wider community including holidays, day trips and visits to family and friends. Staff continue to enable and support family contact. The views of family members have been acknowledged and accommodated where practicable. A healthy and balanced diet for each individual is promoted. EVIDENCE: The home’s activities schedule and observation during my visit show that residents continue to be supported to enjoy a range of activities, which include both social and educational opportunities. Lynwood House DS0000052026.V334703.R01.S.doc Version 5.2 Page 15 A number of residents continue to attend local colleges to pursue a wide range of interests, such as horticulture. Individual or small groups of residents are regularly supported to enjoy trampolining, hydrotherapy, swimming, horse riding, going shopping, having meals out and enjoying day trips with staff members to places of interest. Residents who responded by Survey said they made decisions about what they would like to do each day and that they felt they could do the things they wanted to. One resident I spoke with spoke said they decided how to spend their day and discussed their college course, which they enjoyed and hoped might lead to employment. The home employs an Activities Co-ordinator, who oversees the activities programme for each resident. The home also has its own sensory room in the annexe, which is very well equipped and used by all of the residents. Residents are supported to choose and attend holidays, as well as day trips. Discussions with staff and residents and records examined show that individuals have been on recent holidays to Breen and Disneyland Paris. Other social events have been organised by the home, such as Birthday Parties or staff have supported residents to attend family functions away from the home. I did note that the home had a recent compliment from one family for organising their relatives 21st Birthday Party. Most of the residents have regular contact with their families. Some residents regularly go to stay with their parents for weekends and some residents’ parents visit the home on specific days each week. Parents have a wealth of knowledge about their son or daughter to bring to the provision of their care and support. This information is sought and welcomed by the home. Relatives who responded by Survey said they felt generally the home did meet the needs of their relative, supported them to live the life they chose, helped them keep in touch and updated them on important issues. One said “They take professional but homely care of my relative” and another said “We are very happy with the level of support and care provided to our relative”. However some relatives felt communication could be improved further, for example one said they would like “ Regular communication” or “More social activities where we can get to meet the staff”, another felt that “The Keyworkers could take a more pro-active role in home communication”. I discussed this issue with the Manager, who explained that the home made every effort to maintain regular contact with relatives, although the home will continue to look at ways of improving contact with relatives and friends. Lynwood House DS0000052026.V334703.R01.S.doc Version 5.2 Page 16 I examined the menu records for four people who live in the home. These showed that the home is providing a variety of meals and snacks, which are healthy and nutritious. Residents are generally given a choice, though some have much more specific diets to ensure the health care needs are met. Where this is the case, this is clearly reflected in their care plan and is regularly reviewed. Lynwood House DS0000052026.V334703.R01.S.doc Version 5.2 Page 17 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 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported in their preferred manner, their personal and healthcare support needs are met and the policy relating to administration of medication ensures their welfare and safety. Experienced staff have a good knowledge of each resident and how to provide appropriate levels of support. EVIDENCE: The health needs of residents are very well met with evidence of good multi agency working taking place on a regular basis. All of those living at the home are registered with a general practitioner; they are also supported with other healthcare needs such as dentistry and chiropody. The care documentation in place for residents provided clear guidance for staff on how they should support each person with their personal care. There is Lynwood House DS0000052026.V334703.R01.S.doc Version 5.2 Page 18 clear information relating to each person’s health care needs and specialists have helped to develop each plan. These specialist services are accessed when an identified need arises. These are generally provided by Bridges Community Learning Disability Team, although other specialists do support the home. Care records show the home is regularly supported by the Consultant Psychiatrist, Physiotherapists, Speech and Language Therapists, Occupational Therapists and other relevant health care professionals. Contact with each professional is recorded and forms part of each persons care plan. Each resident’s health is closely monitored. The care plans I examined showed that residents are weighed regularly and supported by staff to attend a number of health review meetings with professional such as Neurologists, Gastroenterologist and Epilepsy Specialists. I note the home continues to have an extremely close working relationship with both Bridges CLDT and the local GP practice. These provide valuable resources to assist the home in planning and providing a specialist service for residents with extremely complex healthcare needs. The needs of several residents dictate that support is required with intimate personal care and hoists are used as part of this process. The care plans are detailed in this respect and Risk Assessments in relation to all manual-handling tasks are in place and are regularly updated. It was evident at this inspection that the management and staff spoken with are sensitive to the healthcare and emotional needs of those living at the home and through observation and discussion demonstrated respect to the wishes of individuals living at the home. Staff commented they felt the team had an extremely good knowledge of each resident’s health care needs and this would alert them to any changes in a resident’s health. Relatives who responded by survey said the home does meet the different needs of residents and that their relative was given the care they expected and agreed. One relative said “ The personal care provided is always of a high standard” and another said “every care is given to each individual”. One health care professional who responded by survey said the home ‘always’ seeks and acts upon their advice to manage and improve individual health care and felt each persons needs were met. They added the home is “prompt at responding to concerns” and that the staff team are “kind and considerate to each individual”. The home uses a monitored dosage system of medication administration, which is operated by the local GP practice. Medication is only dispensed by the home’s Manager, Deputy Managers or Senior Support Workers who receive Lynwood House DS0000052026.V334703.R01.S.doc Version 5.2 Page 19 appropriate training. Storage is very good, with each resident having their own named container locked in the medicine cabinet. The records I examined show that all medication dispensed in the home is clearly recorded, has manufactures profiles in place and stock levels are clearly monitored and recorded. Each resident’s medication is reviewed regularly. A Psychiatrist from Bridges CLDT and the GP support this process. The records I examined show that some individuals are currently having their medication reduced or changed. The monitoring and record keeping in relation to such changes is of a high standard. Lynwood House DS0000052026.V334703.R01.S.doc Version 5.2 Page 20 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 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to communicate their views and they can be confident that they will be listened to and their views acted on if necessary. Clear policies and procedures are in place in order to protect residents from the likelihood of abuse, neglect and self-harm. EVIDENCE: The organisation operates a ‘Comments, Suggestions and Complaints Procedure’ entitled ‘Letting Us Know What You Think’, which is available in a range of formats. This explains three ways people are able to raise concerns or make a formal complaint and breaks down in stage of the formal procedure. I examined this log and found there had been no formal complaints made since the last inspection. A relative had raised one concern and this had been taken seriously, responded to in accordance with the policy and the outcome clearly recorded. Staff spoken with remain clear about the advocacy role they have. Due to the vulnerability of residents, many of them would rely on staff raising concerns on their behalf. Staff spoken with demonstrated a good knowledge of the action they would take if they suspected or witnessed abuse or had any other Lynwood House DS0000052026.V334703.R01.S.doc Version 5.2 Page 21 concerns. They also use their daily interactions and observations when supporting each resident to help alert them to any physical signs or changes in behaviour, which may cause them concern. They also confirmed that they had received appropriate training, such as Protection of Vulnerable Adults and are subject to Enhanced Criminal Record Bureau checks before starting work in the home. One resident spoken with who is able to communicate verbally, and residents who responded by survey, said they knew who to speak to if they were unhappy and also knew how to make a complaint. Residents observed who are unable to communicate verbally or manually appeared relaxed and happy in the company of staff. One resident said “I am happy that I am treated as an individual and my feelings are always taken into consideration” and another that the staff are “approachable and trustworthy”. Relatives who responded by survey said they knew who to speak to if raising a concern or complaint, however two were unsure of the formal process. Relatives who had used this process in the past said the home had responded appropriately to their concerns. Clear records of all accidents and incidents are maintained. The CSCI is informed of any significant event in the home, which may affect residents’ welfare or safety. Details of all financial transactions are clearly recorded and kept as part of each residents care plan. Any money coming in to the home and being spent by residents is recorded on a monthly sheet, with receipts provided for all expenditure. Staff members are required to sign each time they support a resident with a financial transaction. Lynwood House DS0000052026.V334703.R01.S.doc Version 5.2 Page 22 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Lynwood House is a homely, comfortable and safe environment for residents to live in. It has been adapted to ensure each person can maximise their independence and suit their lifestyle. EVIDENCE: The service known as Lynwood House consists of two properties, which are very close to the town centre. There are car parking spaces to the front of both properties and large gardens to the rear, which back on to school playing fields. The main house, known as ‘Lynwood House’, is a large and spacious Victorian building that has ten single bedrooms, three on the ground floor and seven on the first floor, all of which have en-suite facilities. Four bedrooms are suitable for residents who use a wheelchair. There is a passenger lift between the two Lynwood House DS0000052026.V334703.R01.S.doc Version 5.2 Page 23 floors. There are two communal lounge areas, two adjoining dining areas, an activity room with kitchenette and a domestic style kitchen. The other property is known as ‘The Annexe’ and is a more modern building that is situated next door to the main house. This has four single bedrooms, all of which have en-suite facilities. One bedroom is on the ground floor and has been adapted for a wheelchair user. In addition there is a well-equipped sensory room available in the annexe, which all residents are able to use. I was provided with a tour of both the main house and the annexe and viewed several resident’s bedrooms. All of these areas were clean and tidy during my visit. The Manager told me that several areas of the home had been redecorated since the last inspection. These include the main lounges, halls, stairways and landings, kitchens and dining rooms. The bedrooms of three residents had also been repainted and new flooring laid in some rooms. Each bedroom remains furnished and decorated to a high standard and personalised through photographs and other personal possessions. This level of personalisation, with the evident involvement of the person themselves where possible, showed that their individuality is respected and promoted. Almost all of the bathrooms had had a similar degree of personalisation. There are ceiling track hoists in many rooms and mobile hoists are also available. The home also has other specialist equipment to ensure the dignity and comfort is maintained for each person who lives in the home. Residents who responded by survey said the home was ‘always’ clean and fresh. One relative who responded by survey said “the physical environment of the home is of a high standard” and another said the home provided “a lovely bright modern environment”. Some communal areas in the main house, notably corridors and skirting boards, continue to show signs of wear and tear: this is understandable given the amount of use of wheelchairs and other equipment. The Manager told me that there remains a rolling programme of redecoration and renewal due to the needs and the lifestyle of residents who live in the home. The issue of residents on the first floor having an alternative to the shaft lift remains unresolved. The manager told me that discussions were ongoing in relation to this issue. One relative who responded by survey said they feel “the lift is inadequate”. The back gardens for both houses are private areas; the plan to develop the back gardens of both properties is now in progress. I spoke with the member of staff who is leading this project who told me that some residents are actively involved and this relates well to the horticulture college course some residents attend. Lynwood House DS0000052026.V334703.R01.S.doc Version 5.2 Page 24 So far new plants have been added to gardens together with hanging baskets and potted plants on patios. A new vegetable patch has been developed which residents help to maintain. The gardens will continue to be developed as the summer months progress. Lynwood House DS0000052026.V334703.R01.S.doc Version 5.2 Page 25 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 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s recruitment policy promotes both resident’s rights and their safety. Each person that lives in the home is supported by a cohesive staff team that is committed to providing a good service. The clarity of staff roles and responsibilities along with staff training and supervision helps to provide a consistent approach to the support of staff and residents. EVIDENCE: Lynwood House DS0000052026.V334703.R01.S.doc Version 5.2 Page 26 There remains a core of well-established staff with varying abilities who are skilled and experienced to meet the needs of those living in the home. During the last few months several new staff have also joined the team, as new residents have moved into the home. Staff members spoken with were able to demonstrate a clear understanding of their role and responsibilities within the team and their own personal role and accountability. Discussions with staff members and observation of their work practice demonstrated that they are approachable, communicate well and were comfortable with the residents living at the home who were at ease with them. Staff members I spoke with said that the staff team continues to be open, honest and supportive. Each commented on how nice it is to work in the home. They felt well supported by the management team and were able to discuss issues in an open and honest way. Residents spoken with and those who responded by survey said staff ‘always’ treated them well and listened to them and acted on what they said. Relatives who responded by survey said they felt staff generally had the right skills and experience to look after residents properly and meet their different needs. One relative said “The staff truly care for the residents” and another said “Staff are competent and dedicated to the people they are caring for”. The staff team meets regularly and appropriate issues are discussed. Staff told me that if they cannot attend the meeting they would read the minutes to ensure they kept themselves up to date. The home operates a robust recruitment process and the records I examined included application forms, job descriptions, two satisfactory references, documents confirming proof of identity, induction checklists and Enhanced Criminal Record Bureau Disclosures. I examined the training records for staff. These showed that staff are provided with a variety of training opportunities including both mandatory and more specialist training. These include First Aid, Manual Handling, Health and Safety, Food Hygiene, Protection of Vulnerable Adults, Infection Control, Epilepsy, Positive Positioning, Peg Feeding and Medication. Some staff have also completed their Learning Disability Award Framework (known as ‘LDAF’). Lynwood House DS0000052026.V334703.R01.S.doc Version 5.2 Page 27 The home is also piloting a new induction-training programme known as ‘El Box’. One of the Deputy Managers showed me examples of this system, which is computer based and uses a number of training modules which staff can complete at their own pace when they have the time to do so. Once staff have completed a module they receive a certificate showing they have been deemed competent in this area. This information is then added to the training matrix used within the home. The home continues to support staff to attain a National Vocational Qualification (NVQ). Two senior staff members are currently working towards their A1/A2 NVQ Assessors Award, acting as assessors for care staff. Due to changes within the team the home now only has 10 staff (27 ) of its team who are either qualified or working towards an NVQ. The Manager told that the organisation has recently recruited an NVQ Assessor who will work to support staff with both their NVQs and NVQ Assessor Awards. Staff are provided with regular, formal supervision. Staff spoken with told me they are supervised approximately every four to six weeks and also have an annual appraisal meeting. They find these sessions helpful and supportive. Lynwood House DS0000052026.V334703.R01.S.doc Version 5.2 Page 28 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, 38, 39, 41, 42 and 43. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is very well managed ensuring that resident’s interests and rights are promoted and protected. The manager promotes a person centred approach and this is clearly communicated throughout the service. There are systems in place designed to promote and protect the health & safety of both individuals and staff. Some areas require minor improvement to promote welfare and safety. EVIDENCE: Lynwood House DS0000052026.V334703.R01.S.doc Version 5.2 Page 29 The Registered Manger, Mrs Czerny, has worked at Lynwood House since 2003 and has a good understanding of the diverse range of needs of those living at the home. She holds a Diploma in Care Services, City and Guilds Advanced Management in Care Certificate and has completed NVQ Level 4 Registered Managers Award. She is also a qualified NVQ Assessor and Verifier. The management approach remains open and positive, with a clear sense of direction and leadership. Staff spoken with said their views are listened to, and that they are well supported by the manager. One resident said they “have the highest regard for the Manager”. The philosophy of the home is to support residents to ‘achieve their maximum potential in social skills and everyday living skills so they may live as independent life as possible’ and ‘develop interests and skills both within the home and by using facilities in the surrounding area’. The home continues to use a person centred approach in the provision of care and support of each resident. The staff I spoke with felt that each resident was seen as an individual and that their individual needs and wishes are respected. The views of residents are sought both through the review process and contact with their Keyworker. The home’s Resident Action Group, focused on earlier in this report, also plays a key part in ensuring residents’ views are listened to and acted upon. The record keeping in the home is of a good standard. Staff easily located all of the records I required during my visit and all are stored securely in the home. In general, the recording systems in place to support the maintenance of health and safety in the home are being used consistently. I examined the fire log, which showed that the alarm system and emergency lighting is checked weekly. Fire extinguishers are serviced annually and the home has a Fire Risk Assessment, which is regularly reviewed. Each resident now has a personal emergency evacuation plan, each of these being completed in January 2007. Although the home does conduct regular fire drills, some staff do not appear to have taken part in a recent drill. The Manager was unsure if these records were correct or whether more recent drills have not been recorded. The home maintains records relating to portable electrical appliance testing, lift servicing, hoist servicing, sling safety checks, electrical wiring, water temperatures, gas safety, hazardous products used within the home and Lynwood House DS0000052026.V334703.R01.S.doc Version 5.2 Page 30 clinical waste disposal. All of these records were in order and checks were up to date. The home has a number of generic Risk Assessments in place, which were last reviewed in March 2007. Lynwood House DS0000052026.V334703.R01.S.doc Version 5.2 Page 31 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 3 2 3 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 4 26 3 27 3 28 3 29 2 30 3 STAFFING Standard No Score 31 3 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 4 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 X 4 3 3 X 3 2 3 Lynwood House DS0000052026.V334703.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA29 Regulation 23(2n) Requirement Provide an alternative means to the passenger lift of transferring between the ground and first floors. (This requirement is repeated from the last inspection report). 1. YA42 23(4) Ensure all staff members take part in regular fire drills and maintain a clear record of each drill. Timescale for action 10/08/07 10/05/07 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. 2. Refer to Standard YA15 YA24 Good Practice Recommendations The home should consider ways of further improving communication between them and resident’s families and friends. Maintain a rolling programme of internal re-decoration of communal areas in the main house. DS0000052026.V334703.R01.S.doc Version 5.2 Page 33 Lynwood House 3. YA35 The home should consider developing a revised plan to ensure staff are supported to gain an NVQ qualification. Lynwood House DS0000052026.V334703.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 House DS0000052026.V334703.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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