Inspection on 23/02/10 for Lynwood House

This inspection was carried out on 23rd February 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lynwood House 24/11/08

Lynwood House 10/05/07

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 29/06/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Lynwood House Lynwood Close Midsomer Norton Bath & N E Somerset BA3 2UA     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sarah Webb     Date: 2 6 0 2 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 36 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: Lynwood House Lynwood Close Midsomer Norton Bath & N E Somerset BA3 2UA 01761412026 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Voyagecare.com Voyage Ltd Name of registered manager (if applicable) Mrs Heather Frear Type of registration: Number of places registered: care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: May accommodate people who in addition to their learning disability have associated needs including autistic spectrum disorder. May accommodate up to 10 people in Lynwood House. May accommodate up to 4 people in Lynwood House Annexe May accommodate, in designated rooms within Lynwood House, up to 4 people who in addition to their learning disability are wheelchair dependant. May accommodate, in the ground floor bedroom within Lynwood House Annexe, 1 person who, in addition to their learning disability, is a wheelchair user Date of last inspection Brief description of the care home Voyage Limited, who are part of the Paragon Healthcare Group, operate Lynwood House. The home consists of two properties, which are very close to the town centre where there is a wide range of shops and other amenities. There are car parking Care Homes for Adults (18-65 years) Page 4 of 36 Over 65 0 14 2 8 1 1 2 0 0 8 Brief description of the care home spaces to the front of both properties and large gardens to the rear, which back onto 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 of these bedrooms are suitable for people who use a wheelchair and there is a passenger lift between floors. There are two communal lounge areas, a large dining area, an activity room with kitchen area and a separate domestic style kitchen. The other property is known as The Annexe and is a more modern building situated next door to the main house. This has four single bedrooms, each with en-suite facilities. One bedroom is on the ground floor and has been adapted to meet the needs of a person who uses a wheelchair. The communal facilities consist of a lounge, kitchen, dining room and well equipped sensory room, which all service users are free to use. The 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. Care Homes for Adults (18-65 years) Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection carried out over three days. This inspection was brought forward following the outcome of a review of the service in February 2010. The review showed us that although the Manager is working well with us to implement positive outcomes for the people living at the home, concerns were still being reported to us. The pre inspection planning involved reviewing the report from the last key inspection that was carried out on 28th November 2008, the annual service review of February 2010 and the service history that details all other contact with the home. We had received an Annual Quality Assurance Assessment (known as the AQAA) in October 2010. This is a self assessment that focuses on how well outcomes are being met for the people who live at Lynwood house. Care Homes for Adults (18-65 years) Page 6 of 36 We gathered additional information for this report by looking at a number of records in the home such as care plans, risk assessments, accident and incident reports, staffing records and health and safety procedures. A Pharmacy Inspector accompanied us on one day of the visit, looking at the administration of all medication. We also viewed all communal areas in the main house, the Annexe and several bedrooms used by the people living in the home. We sopke with the Manager, Operational Manager, a senior member of staff, four members of staff and a parent. Care Homes for Adults (18-65 years) Page 7 of 36 What the care home does well: What has improved since the last inspection? What they could do better: The individual care plans of the people living in the home must include agreed restrictions that reflect their best interests and their assessed mental capacity needs. This will make sure that people living in the home have their best interests and mental capacity needs met. Records must be kept of the use of all medicines in the home, including creams and ointments to demonstrate that these have been used effectively, as prescribed. Clear records must be made of the use of liquid feeds given via PEG tube. This will demonstrate that these are given correctly. The home must be run in the best interests of the people living at the home with staff maintaining good and professional relationships with the people living there, so that Care Homes for Adults (18-65 years) Page 8 of 36 they are supported in a safe and respectful manner. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 36 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care needs of prospective people wanting to live at Lynwood House are assessed before they move to the home. Improvements are being made in meeting the specialist needs of some people living at the home. Evidence: Pre admission procedures were seen to be followed for people wanting to move to the home. This helped in making a decision about whether peoples individual needs are met. We saw care files that contained both assessments and care plans carried out by the funding authority of the people living in the home. The Manager told us she also visits people after a referral is made and carries out her own initial assessment of their needs. This was seen in care files. From speaking with the Manager and a parent it was evident families are involved in their relatives care if they wish. Care Homes for Adults (18-65 years) Page 11 of 36 Evidence: Clinical reassessments of six peoples health needs have recently been carried out to determine whether their health care needs can be met at Lynwood House. This was due to a significant number of people admitted to hospital during 2009, changes in how their health care needs should be met and changes in the management of the home. The outcome of the reviews identified that staff needed training to further support peoples changing clinical needs, recognising the constraint that the home is registered as a care home, and not nursing. Improvements are being made, since concerns were originally raised in 2009, in the management of the home. This has in turn impacted on the majority of the staff team who continue to be trained in supporting people with their needs. We saw a positive response with most of the staff spoken with telling us they were happy with the training they had received in supporting those individuals with more complex needs. Care Homes for Adults (18-65 years) Page 12 of 36 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning of the people living in the home show how they should be supported with their personal goals. The best interests of the people living in the home is not always reflected in care planning. People living in the home are involved in making choices and decisions. People living in the home are supported to take risks safely. Some areas of risk assessing are in the process of being changed to show an individual approach is taken. Evidence: We saw five peoples care files. These contained Individual Support Plans (ISP) that provided appropriate and clear information for staff to follow. Each persons ISP had a record of their short term goals, long term goals, and how to deliver their support. The majority of staff spoken with confirmed they were given enough information about how people should be supported with their needs. We saw some areas of care planning relating to how people are supported with their behaviours, that would Care Homes for Adults (18-65 years) Page 13 of 36 Evidence: benefit from additional information being provided to staff. This was discussed with the Manager. The Manager is aware that care planning needs to be made accessible for the people living in the home in helping them to understand and to be involved in their care. The care of the people living in the home had been reviewed monthly. We saw monthly summary sheets that included information about appointments people had attended, health issues, the activities they had been involved with and their general wellbeing. Formal reviews of peoples care are held involving them, their families and their social worker and their keyworker. Review records showed if there had been changes to individuals care and had been dated. It is difficult for some people living in the home to communicate their preferences and choices. We saw peoples individual communication needs recorded. This included individual facial expression, body language, and eye point to indicate choices. Staff had a good understanding of when people were unhappy by changes in their sound. A member of staff has been identified to complete Total Communication training. We saw that a speech and language therapist has visited and had started working with staff in the development of a total Communication approach. We observed staff in their interaction with the people living in the home at various times during our visit. These showed a respectful attitude in their communication and a knowledge of how people should be supported. We saw some people being involved in making choices and decisions about what they wanted to do during the day. We saw individual risk assessments that helped people to take risks safely as part of their life style and were linked into specific areas of their need. The manager confirmed that there were some that were still in the process of being changed to an individual approach. We observed that there were restrictions in place for some people, but these had not been included in their ISP. We would expect to see risk assessments, and care planning to include restrictions in place, reflecting peoples best interests and their assessed mental capacity needs. This will show the decision making process and that these are transparent, recording who has been involved in the process. That consent has been obtained upon the best interests of the people living in the home, with consideration and evidence to show that mental capacity issues have also been taken into account. Care Homes for Adults (18-65 years) Page 14 of 36 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported to access leisure and educational activities and in maintaining regular contact with their family. The rights and responsibilities of the people living in the home are recognised in their daily lives. People living in the home are involved in making choices about their diet. A balanced and healthy diet is promoted. Evidence: The people in the home are supported in taking part in various activities. An activities coordinator is employed who organises structured day time activities. These included listening to music, music therapy, using the sensory room, fun physio, arts and craft, and kareoke. We saw some people involved in a cooking activity during the visit. Care Homes for Adults (18-65 years) Page 15 of 36 Evidence: We saw from the individual records of one person living in the home that they attended work placement and a day service. We were told by staff that another person was now involved in a college course and was being supported in looking for work in a dogs home. We saw records of peoples involvement in activities such as going to church, the pub, shopping, visual board activities, swimming, gym, food shopping and visits to places of interest such as Chew valley. We were told people had been on holiday during 2009 to Devon and Blackpool. This was confirmed through individual records. We were told by some staff that activities had improved through better planning, and gave an example of a recent trip for some people living at the home that had incorporated a visit to a cats and dogs home, a meal out and shopping. We have received several complaints since the last inspection about staff shortages impacting on the people living in the home and restricting their opportunities in going out. The manager confirmed that there had been staffing shortages but that she is in the process of recruiting new staff. Staff also confirmed staffing levels had improved. Many of the people living in the home have regular contact with their families. Some regularly stay with their parents and some parents visit the home on specific days. This was confirmed by a parent who was visiting on the day of the visit. Since the last inspection we have received several complaints about staff not being respectful to the people living at the home. These have been investigated by the manager and not upheld. We saw during this visit that the people living in the home were respected and supported in being involved in the routines of the home. This was seen when we shared a midday meal with some people living in the home and observed staff interacting with and involving people in their conversations. We saw an individual being helped to clean their bedroom with the staff member involving them through a positive approach. We have received several complaints since the last inspection that there has not been enough food. This was confirmed by staff, but that this is now changing. Food shopping processes have been implemented with the people living in the home more involved in taking part in shopping to help choose what food they want. A set four week menu was seen that has been developed by the Manager showing a range of nutritious and healthy choices. We saw freezers in both the main home and the annexe with sufficient food supplies. Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: We were told by the Manager that staff on duty are entitled to meals. We saw food receipts over the previous year that evidenced food had been bought and it was of a high expenditure. The manager told us she has come in to the home randomly over weekends and seen staff cooking three separate meat joints and has found food hidden away in the cellar. Disappearance of food from the home has been reported to the police in January 2010 and the manager now monitoring food supplies, this has now stopped. It is evident that the home has not been run in the best interests of the people living there but that the Manager is making progress. However she is aware that further improvements must be made. Senior staff confirmed the two people living in the annexe were given choices to be involved in their weekly menu and shopping and were encouraged to carry out tasks to help their independence skills. This was also seen reflected in their support plan. Care Homes for Adults (18-65 years) Page 17 of 36 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although people living in the home are supported in the way they want and supported with their health care needs, improvements to some aspects of medicine handling in the home are needed to help protect peoples health. Evidence: Individual support plans provided clear guidance, specific interventions and actions for staff to follow in how they should support the people living in the home with their personal and health care. Several people living in the home are supported with their intimate personal care and require the use of hoists. We saw individual support plans and risk assessments to show support was being given in a safe and consistent way. It was evident that the health care needs of the people living at the home are monitored and reviewed on a regular basis. Specialist support is accessed when the need arises such as physiotherapist, speech and language therapist, and epilepsy nurse. This was seen through the health care records. Staff have also been trained in supporting people with their health care needs such as epilepsy, and with others who Care Homes for Adults (18-65 years) Page 18 of 36 Evidence: may require more clinical interventions such as PEG feeds. Healthcare professionals continue to work closely with staff and monitor the management of clinical risks for those people who have specific complex needs. A qualified nurse is being advertised to oversee and monitor the management of clinical procedures by staff. It is understood their role will also provide a link between health care professionals and in training staff. Both the Operational Manager and Manager are aware that they will be unable to carry out nursing tasks themselves. All the people living in the home are registered with a local doctors practice. Staff told us that the doctor visits every month to see people and reviews their medicines every six months, this helps to ensure that people always receive the appropriate medicines. We saw evidence of these reviews in care plans we looked at. Staff told us that prescriptions for peoples medicines are checked by staff before being sent to the pharmacy for dispensing. Records are kept of the medicines ordered. This helps to make sure that the correct medicines are available. The home has recently started receiving medicines in weekly trays with sealed, labelled pockets for each dose time. This month liquid medicines have also been supplied in the same way so that each dose is already measured out to reduce the risk of mistakes being made. Staff told us that this system also lets them take labelled doses of medicine out of the home if the person is going to be out when their medicine is due to be given. None of the people living in the home is able to look after their own medicines, they are all looked after and given by senior care staff. A medicine policy is available to help staff give medicines safely. Staff complete a computer based medicines training course and are assessed by the Manager or their deputy to ensure they are able to give medicines safely. Staff have also received training about treatment of epilepsy. We saw one persons medicines being prepared to be given at lunchtime. Medicines were taken to the person and the administration record sheet signed when they have been given. Taking the labelled pockets containing the medicines to the person means that staff can check they are giving the medicines to the right person. Staff showed us a comprehensive audit system which allows them to check that medicines have been given correctly, as recorded. The pharmacy provides printed medicines administration record sheets for staff to complete when they have given medicines. We saw that some improvements need to be made to these records. Some handwritten additions made by staff for medicines supplied part way through the month had not been signed or dated by the person making the entry and had not been checked by a second member of staff. This may increase the risk of mistakes Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: being made. Some medicines are prescribed with a variable dose. In some cases the amount given has not been recorded and action should be taken to address this. One of these medicines is prescribed to be given four times a day but records show that it is only given twice daily. There was no record to show why medication was not being given. If a medicine is prescribed to be given regularly a reason must be recorded for any missed doses. Records are not kept of the use of many creams and ointments. Two ointments prescribed to be used twice daily for one person had only been signed as being used at night. Staff told us that the preparations had been used but not recorded. Action must be taken to ensure that staff make a record all medicines they give or apply. Protocols are in place for medicines prescribed to be used when required. This is good practice to ensure these medicines are used consistently and appropriately. However we saw that some creams had no protocol for their use and it was not clear how staff would know which cream to use or where to apply it. We looked at three peoples care plan to see if they had information about medicines. One person was prescribed a medicine to be used when required and had a protocol for its use which guided staff to a care plan for more information. We looked at the care plan but it did not mention using this medicine and needs to be updated. Several people cannot take food by mouth and are prescribed feeds to be given by a tube directly into their stomach. We looked at one persons care plan and saw a protocol in place so staff would know what feed to give and how the tube should be looked after. However records were not kept of what feed is given, when it was started and by whom, or when it stopped. This means that staff cannot evidence that they are giving the correct feed to the correct person over the correct time. Staff told us that they would discuss this with the company that provided their training for giving these feeds, and take action to make sure that they keep the required records. Staff told us that several people have random tests for their blood sugar, to check it is in the correct range. These are done each week. Individuals did not have their own equipment for this. We looked at one persons care plan to see if there was clear information for staff about these tests. This person had a care plan in place which included regular, random blood tests. Staff said these are done if the person seems to be unwell. There was information about action to be taken if the test result was low but no information about any action to be taken if the result was high. It was not clear Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: if the tests and the protocol had been agreed with the persons doctor or the community nurse. This person did not have their own equipment for blood testing. Action should be taken to ensure that blood sugar testing of individuals has been agreed with the relevant healthcare professional. Staff must ensure that the correct equipment is available for this. All staff involved must receive appropriate training to protect the health of the people being tested and the staff doing the tests. Secure storage for medicines is available in the home, however staff must ensure that only those staff who look after medicines can access the room used for storing medicines. All medicines, including those awaiting return to the pharmacy, should be stored in a locked cupboard within the room. No controlled drugs, which need additional secure storage, are in use at present. We recommended that staff check whether any of the medicine cupboards they have are of the required standard for storing controlled drugs, in case they have need for this in the future. Arrangements have been made to ensure that a medicine used in emergency treatment for epilepsy is kept safely. Keys for all the medicine cupboards must be kept securely. Records are kept of the receipt of medicines into the home and of the disposal of unwanted medicines. Care Homes for Adults (18-65 years) Page 21 of 36 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home are supported to communicate their views, are listened to, and action is taken if needed. The people living in the home have not always been protected from abuse. The manager has responded robustly to reports of suspected abuse so that people are kept safe. Evidence: The complaints procedure has been made available to both the people living at the home and their families. Families and the staff advocate for the majority of the people living in the home due to their vulnerability. We were told families have the opportunity to raise concerns about the care of their relative and any other aspect of the running of the home during meetings, visits to the home and through the formal process of the complaints procedure. The people living in the home are supported by other professionals involved in their care who would also raise issues. We saw the record of complaints logged in the home since the last inspection. Complaints were seen to have been investigated with a record of action taken. We saw that two complaints were in the process of being investigated. We have received five complaints since the last inspection and they have been referred to in the text of the appropriate standard in this report. Investigations have Care Homes for Adults (18-65 years) Page 22 of 36 Evidence: been undertaken robustly by both the Operational Manager and the Manager. We referred one of these complaints to the local authority under safeguarding protocols. Staff have received training in whistleblowing and it was evident from speaking to staff that they know the procedures for raising concerns and what action to take if they witness or suspect abuse. Policies and procedures in safeguarding the people living in the home are discussed and made available to staff during their induction. All staff have to complete training in the safeguarding of vulnerable adults within their six month induction period and then are updated two yearly. This is completed on line through a computer programme with different units being completed. We saw through the training matrix that there were several staff who needed to update this training with three newer staff who had not completed their initial training. We were informed that staff are in the process of both updating and completing this training. The Manager told us the she is looking for a fuller external training in the safeguarding of vulnerable adults to follow on from the on line course. It is evident that since the last inspection the people living in the home have not always been protected from abuse. We have been told by the organisation about a previous financial abuse of some people living in the home. We subsequently referred this to the local authority under safeguarding. Appropriate action was taken by the organisation with the incident reported to the police. Action has been taken in response to this abuse with improved financial procedures and monitoring now in place. We have also been told that some staff have not always been respectful to the people living at the home with some peoples property being damaged maliciously. The manager has also taken appropriate action and reported this incident to the police. Staff are subject to Criminal Record Bureau enhanced checks before they start work in the home. This was seen through individual staffing records. A requirement has been met to sustain the recording of any accidents and incidents of the people living in the home . The accident records we looked at showed these had been completed consistently. We saw individual body charts that recorded where an injury had occurred during an accident. We are informed of any significant event that occurs in the home that may affect the health, welfare and safety of the people living there. Care Homes for Adults (18-65 years) Page 23 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Lynwood House provides a homely, comfortable, clean and safe environment for the people to live in. The bedrooms and bathrooms of the people living in the home are personalised and suitable to meet their individual needs. Evidence: Lynwood House consists of two properties close to the town centre where there is a range of shops and other amenities. Both properties have large gardens to the rear that back onto school playing fields. The main house, known as Lynwood House, is a large and spacious Victorian building that has ten single bedrooms. There are three bedrooms on the ground floor and seven on the first floor, all having en-suite facilities. Four of these bedrooms are suitable for people who use a wheelchair with a passenger lift between floors. There are two communal lounges, a large dining area, an activity room with kitchen area and a separate domestic style kitchen where the meals are prepared and cooked. The second property is known as The Annexe and is a more modern building situated next door to the main building. This property has four single bedrooms all with enCare Homes for Adults (18-65 years) Page 24 of 36 Evidence: suite facilities. One bedroom on the ground floor has been adapted to meet the needs of a person using a wheelchair. Communal facilities consist of a lounge, kitchen, dining room and sensory room that is also available for those people living in the main house to use. We saw all the communal areas of both properties and a number of bedrooms. Bedrooms were seen to be furnished and decorated to a high standard, and with homely feel, containing personal items, pictures and photographs. Ceiling track hoists were seen in bedrooms and bathrooms, and other specialist equipment to support people safely and respectfully. We saw records of when equipment had been repaired and maintained. All of these areas were very clean and tidy and a recent complaint about some areas of the home being unclean was not found. The majority of bedroom doors and communal doors such as kitchens have key pads in place. We were told key pads were in use for both the kitchens in the main house and the annexe restricting access to the people living in the home. We did not see risk assessments relating to these restrictions or to any individual. A requirement for an alternative to the lift for those people on the first floor has been removed. It is evident this issue has been looked at in detail with everything being done short of providing a new lift, which would involve significant building work. Investigations have taken place and alternative methods of safely transfering the people from the first floor have been sought. The outcome being that in the event of an emergency Albac mats are to be used to assist non mobile people to exit the home. The gardens of both properties are private areas and had been well maintained. At the previous inspection it was found there were plans to improve access to the rear garden of the Annexe. We found this has not been happened. This area is the meeting point in the event of a fire for people and an accessible route is needed from the back exit of the Annexe to this point. Care Homes for Adults (18-65 years) Page 25 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have a good understanding of their role and responsibilities. Some staff have not always put this into practice. Although new staff are now being recruited, with existing staff trained and now supervised, the people living in the home have not always been supported with an effective staff team and with sufficient numbers of staff to meet their needs. The people living in the home are supported and protected by robust recruitment practice. Evidence: We spoke with a senior member of staff, four care staff and a parent. Staff spoken with had a good understanding of their role and gave examples of how they supported the people living in the home. A newer member of staff explained how they had shadowed staff when they first started working in the home helping them to understand and learn how to support peoples individual needs. Some staff said there was sometimes a lack of consistency in working practice. This was also evidenced through an individual support plan showing how the individual should be supported in maintaining their independence skills, but some staff told us Care Homes for Adults (18-65 years) Page 26 of 36 Evidence: they did not follow this practice. This was passed on to the Manager. It was evident that staff have not been happy working in the home and that they felt it has been stressful at times. Staff told us they were still angry about the previous financial abuse suffered by some of the people in the home. They felt that there had been a succession of Managers in a short space of time and that at times they have had to make decisions without a Manager being in place. They also said they felt that they had not been communicated with in the past about changes and to talk about the things that have happened. Although we observed staff in their interaction with the people living in the home and that these showed a respectful attitude in their communication and a knowledge of how people should be supported we have been told that some staff have not always been respectful to people. This was seen through the malicious damage found to some peoples property and from complaints of when staff were seen to be disrespectful. This is unacceptable behaviour and disrespectful to the people living at the home. This practice also does not evidence that all staff are putting into practice their knowledge of their role and the understanding and promotion of the homes aims and values. Since the last inspection there have been staff vacancies that have contributed to a low morale amongst staff. These vacancies were sometimes being covered by existing staff, bank or agency staff. We have received complaints about staff shortages and the impact on some of the people living in the home who required 1:1 support. Staff shortages had also impacted on some people not always going out especially those people who need a greater level of support. Staffing rosters seen showed there had been periods over some weekends when staffing levels were below those expected. At this visit we were told three new staff had been recruited recently, leaving four staff vacancies with interview dates set. Five bank staff had also been recruited. Staff spoken to confirmed staffing levels had improved. We have been told since the visit that the four vacancies have been filled. However a period of stability is needed with new staff in place to assess whether the people living in the home are being supported by an effective staff team. This will be followed up at the next inspection. The manager told us that the main shift pattern for staff was being reviewed as there is not enough flexibility for evening activities to take place. We saw a robust recruitment process was being followed. New staff had completed an Care Homes for Adults (18-65 years) Page 27 of 36 Evidence: application form, attended a formal interview and provided documents proving their identity and eligibility to work in the UK, two satisfactory references and Enhanced Criminal Record Bureau Disclosure before they had started working in the home. One newer member of staff spoke highly of their induction into the home and felt this covered the things they needed to know. All staff spoken to confirmed the recruitment process. Staff complete their mandatory training, over a six month period through a computer programme. These include completing units on medication awareness, first aid awareness, infection control, food hygiene, health and safety, and safeguarding. The Manager is a qualified trainer in manual handling and trains the staff. A senior member of staff is a trainer in Non Violent Physical Crisis Intervention that includes knowledge about working with people who may challenge the service. Staff confirmed they had also received training in PEG feeds, fire, epilepsy (including how to administer epilepsy medication), and loss and bereavement. The Manager told us an external trainer was booked in March to train staff in reporting and record keeping. Eleven staff have a National Vocational Qualification (36 of the staff team) with a further six staff who are registered to complete the qualification. A requirement has been met for staff to receive regular supervision with a signed record of the meeting. We saw nine staff records that showed those staff had been supervised within the last three months by the new Manager. The majority of staff spoken to also confirmed supervision was more regular than during the previous year and with more regular staff meetings taking place. The Manager told us a team building day is being planned. Care Homes for Adults (18-65 years) Page 28 of 36 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is beginning to be run in the best interests of the people living at the home, and is beginning to benefit from a new management approach. The views of the people living in the home are sought to help further develop the service. The health and safety of the people living in the home is promoted. Evidence: The new Manager, Mrs Heather Frear, started working in the home during August 2009. Since our visit Mrs Frear has undergone an interview process with us and is now registered as the Manager. It is evident that Mrs Frear has begun to make changes in the way the home has been run previously, communicating a sense of direction and leadership. This process has involved making changes to the culture of the home, that was not always run in the best interests of the people living there. Care Homes for Adults (18-65 years) Page 29 of 36 Evidence: The majority of the staff spoken with confirmed their view that the Manager has improved things, that they were happy with the changes, including the redecoration and refurbishment of some areas of the home, more regular supervision and staff meetings. Recent recruitment is now improving staffing levels and we were told communication is beginning to improve. There had been complaints about communication in the home and messages not getting through to staff. A new system is now in place to make a record of all telephone calls and staff are informed at handover of any significant information. The views of the people living in the home are sought through the review process, and contact with the families of the people living in the home and the staff also supporting them. A recent reception held for to restart a parents group that used to be running has recently been held. We were told this had been well represented by parents. It is evident that generally record keeping has improved since the two previous inspections. This was seen through various records relating to the people living in the home and has previously been recorded in the text of the appropriate standards. Records were kept secure when not in use ensuring confidentiality was maintained. A requirement has been met for audits to be carried out monthly by a representative from the organisation and for these to be available for inspection. We saw full audits for the past year with action plans setting out what needed to be done. We saw systems in place to ensure the health and safety of the people at the home was being maintained. We saw the service and maintenance records of the hoists and the fire equipment and fire procedures had been set out for individuals. Records showed staff had attended recent fire training. We saw an area of the fire risk assessment that had not been completed with correct information by the previous manager. This was amended with the correct information during the inspection. Records were being kept of refridgerator and freezer temperatures and food probe. There were general risk assessments in place, that had been reviewed, and which helped to support safe working practices in the home. The management approach of the home is slowly beginning to impact on the way the home is being run with changes to the culture and ethos of the home, and better outcomes for the people living there. There now needs to be period of stability with staff vacancies now filled and the aims and purpose of the home being understood and Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: put into practices. Care Homes for Adults (18-65 years) Page 31 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 32 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 Individual care plans must 30/04/2010 include agreed restrictions that reflect peoples best interests and their assessed mental capacity needs. This will make sure that people living in the home have their best interests and mental capacity needs met. 2 20 13 Action must be taken to 30/04/2010 ensure that guidance is obtained from a relevant healthcare professional about testing peoples blood sugar. Appropriate equipment must be available for each person. Staff must receive appropriate training. To protect the health of people living in the home and of staff. Care Homes for Adults (18-65 years) Page 33 of 36 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 20 13 The registered manager must make sure that clear records are made of the use of liquid feeds given via PEG tube. To demonstrate that these are given correctly. 09/04/2010 4 20 13 The registered manager must ensure that records are kept of the use of all medicines in the home, including creams and ointments. To demonstrate that these have been used effectively, as prescribed. 09/04/2010 5 32 12 The home must be run in the best interests of the people living there. To ensure staff maintain good and professional relationships with the people living in the home and that they are supported in a safe and respectful manner. 09/04/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 Develop accessible information for people living in the home to help them understand and be involved in their care. Care Homes for Adults (18-65 years) Page 34 of 36 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 2 20 It is recommended that the registered manager checks that suitable storage for controlled drugs is available in the home, in case one of this group of medicines is prescribed. Improve access to the rear garden of the Annexe so that the people living there have easy access to the fire meeting point. 3 24 Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. 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