Inspection on 24/11/08 for Lynwood House

This inspection was carried out on 24th November 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 6 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 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 30/01/2009.

Inspecting for better lives 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:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: David Smith     Date: 2 8 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. the things that people have said are important to them: They reflect 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 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): Type of registration: Number of places registered: Voyage Ltd 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 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 Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 14 Brief description of the care home 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 34 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: two star good 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: The last Key inspection of this service was on 10/05/07. This is a Key Inspection of this service. The first day of our visit was unannounced. We returned for a second day where we arranged to meet with the Acting Manager, view staffing records and to explain the outcomes of this inspection. The pre-inspection planning involved reviewing the report of the last Key Inspection carried out in May 2007, the Annual Service Review carried out in June 2008, the report of the Random Inspection in August 2008 and the service history, which details all other contact with the home. Care Homes for Adults (18-65 years) Page 6 of 34 We (the CSCI) provided the home with their Annual Quality Assurance Assessment (known as an AQAA). This is a self-assessment, which focuses on how well outcomes are being met for the people who live at Lynwood House. The home sent us their AQAA when we asked for it. It was clear and gave us all the information we asked for. We provided a number of surveys for service users, their relatives, health professionals and staff members to enable us to carry out the last Annual Service Review. Twenty surveys were completed and returned and the views of the people who wrote to us have also been included in this Key Inspection report. We spoke with two service users in private and time was spent informally observing interaction and communication between staff members and other people who live in the home. We spoke with staff who work in the home and the Acting Manager. We gathered additional information for this report by looking at a number of records within the home such as care plans and associated records, risk assessments, accident and incident reports, medication administration, staffing records and health and safety procedures. We also viewed all communal areas of the main house, the Annexe and several bedrooms used by the people who live here. What the care home does well: What has improved since the last inspection? What they could do better: The improvements in the recording of accidents must be sustained. This will promote the welfare and safety of people who live or work in the home. The improvements in the monthly review process must be sustained. This would ensure each persons health and safety is suitable monitored and they are provided with support which meets their current and changing needs. The home must provide an alternative to the one passenger lift to enable people to Care Homes for Adults (18-65 years) Page 8 of 34 safely transfer between floors if they are unable to use the lift. Each member of staff must be provided with regular supervision and a clear, signed record of each meeting must be maintained.This will ensure staff are supported to provide a good quality service to each person who lives in the home. The new Manager must start the registration process with us as soon as possible after they start work at Lynwood House. This will help to ensure a well run and accountable service for each person with an interest in the home. The organisation must carry out an audit of the home every month, and the reports must be available for inspection. This would help to ensure an accountable service for each person with an interest in Lynwood House. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and health care 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 34 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. Prospective service users are provided with information they need to make an informed choice of where to live and their needs are thoroughly assessed. Evidence: The homes Statement of Purpose contains comprehensive information about the services the home is able to offer. This is regularly updated. Each service user we spoke with, or who wrote to us, said they did have enough information about the home before they moved in and were asked if they wished to live here. The home has a thorough pre-admission procedure, which ensures each prospective service user has their care and support needs thoroughly assessed before they are given the opportunity to move into the home. Family members can be involved in this process if an individual wishes. Care Homes for Adults (18-65 years) Page 11 of 34 Care Homes for Adults (18-65 years) Page 12 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users know their needs and personal goals are reflected in their individual plan. They are supported to make decisions and take risks. Individuals are consulted on, and supported to participate in, all aspects of life in the home. Evidence: We looked at the care records of four people who live in the home. These have improved since our last Key inspection and each person now has a new individual support plan. Each of these plans is written in a person centred way and only includes the areas of support relevant to each person, such as personal care, hygiene, medication, how to communicate effectively, decision making and finances. Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: Formal reviews are held, which include service users, their families, Social Workers and Keyworkers. These are clearly recorded and the outcomes used to update individual care plans. The home tries to ensure that each care plan is kept up to date between formal reviews by asking Keyworkers to write a monthly summary for each person. These provide an overview of areas such as health and medication, behaviour, family contact or visits, contact with health care professionals and any areas of concern. Whilst these have improved significantly since our visit to the home in August 2008, where we found they were not being completed regularly, two people did not have a summary completed for every month of 2008 which has passed. It is important for these to be completed consistently by all staff as these summaries play an important role in ensuring changing needs are identified and care plans updated. The service users spoken with, and those who wrote to us, said staff listen to them and act on what they say. Interaction between staff and service users was observed at various times during our visits. These show staff have a good knowledge of the support needs of service users and how to communicate with them effectively. For some people who live in the home, it is difficult for them to clearly communicate their choices or wishes. Staff continue to use a number of methods to ensure each person is supported to make choices, such as observation of eye movement, behaviour or gestures as well as listening to the individuals who can express themselves through speech. A small group of people who live in the home (the Lynwood Action Group) continue to meet regularly, with staff support. One service user who attends this group said these meetings are very useful and they are able to discuss any issue they wish. Their discussions are always recorded and where they ask for improvements to be made, they feel this is acted upon. Each service user has a number of person centred Risk Assessments, which support them to take risks as part of their lifestyle. These form part of each persons care plan, are clearly written and are subject to regular review. Care Homes for Adults (18-65 years) Page 14 of 34 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. Each individual has opportunities and appropriate support to develop, access leisure and educational facilities both locally and in the wider community and to maintain relationships with their family and friends. Each persons rights and responsibilities are recognised in their daily lives. A healthy and balanced diet for each individual is promoted. Evidence: The people who live in the home are supported to access a range of education and leisure facilities, as well as planned activities which take place in the home each day. Since our last Key inspection, there have been occasional staff shortages, due to staff Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: leaving, and this has restricted opportunities for people at times although the home has worked hard to ensure individuals were affected as little as possible. The home has now recruited new staff and no longer has any vacancies within the team. The records we looked at show individuals are supported to attend hydrotherapy sessions, shopping trips, have meals out of the home and enjoy day trips with staff to places of interest. The service users we spoke with, and those who wrote to us, said they are generally able to do the things they wish during the week and also at weekends. One person we spoke with said they are enjoying their work placement with a local employer and they feel they are well supported at work. The home employs a member of staff in the role of an Activities Co-ordinator. They oversee the activities programme for each person who lives in the home and run many of the in-house sessions. During our visit a small group of service users were involved in making Christmas decorations, which they appeared to enjoy. People who live in the home also have use of a sensory room which is located in the Annexe. This is very well equipped and staff said this is well used by the people who live here. During our visit one individual was enjoying a relaxation session in this room, supported by one member of staff. Service users are supported to choose and go on holidays. On the second day of our visit, two individuals left the home for a holiday in Blackpool, supported by staff. The home works hard to organise other social events, such as the garden party held during the summer and also supports individuals to attend family functions away from the home. Many of the people who live here have regular contact with their families. Some regularly stay with their parents and some parents visit on specific days each week. Families have a wealth of knowledge about their son or daughter and this information is welcomed by and shared with the home. The family members who wrote to us said Lynwood House provides the care and support they expect and generally keeps them informed of important issues regarding their son or daughter. One relative said the care staff are committed to the provision of a high standard of care. Other comments include: our daughter is very happy in the home and seems very settled, the home offers variety, support and seeing to (our daughters needs) in a caring way and we are very pleased with our sons care. Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: Observation during our visit, comments from the people who wrote to us and discussions with staff show that each person who lives in the home continues to be treated with respect and dignity. Each person is seen as an individual and treated as such. The service users we spoke with and the records we looked at confirmed that the home provides a variety of meals and snacks, which are healthy and nutritious. Some individuals choose what they wish to eat while others have much more specific diets to ensure their health care needs are met. Where this is the case, this is reflected in their care plan and staff are provided with appropriate training and support. Care Homes for Adults (18-65 years) Page 17 of 34 Personal and health care 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are supported in their preferred manner and their personal and health care support needs are well met. The homes policy relating to administration of medication ensures each persons welfare and safety. Evidence: The care plans in place for service users provide clear guidance for staff on how they should support those living at the home with their personal and health care. Individuals are registered with a local GP, dentist and chiropodist. Other specialist services are accessed when an identified need arises. These are provided by the Community Learning Disability Team. Records show the Occupational Therapist, Psychiatrist, Physiotherapist and Speech and Language Therapist regularly support the home. Contact with these professionals is clearly recorded in each persons file and the outcomes acted upon. Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: Staff spoken with continue to have a good knowledge of each individuals support needs and are clear on the support and guidance they should provide. The record keeping in this area is good and can be easily tracked. This process ensures that each persons health care is very closely monitored and the support provided is subject to review. Several people who live in the home require support with intimate personal care and hoists are required as part of this process. The care plans and risk assessments in place ensure support is provided in a consistent and safe way. Discussions with the Acting Manager, and other staff members, show that health care needs for some individuals have changed and staff are now required to undertake more nursing type tasks. An example of this is the five people who now require the use of peg feeds. Staff are provided with appropriate training and those spoken with are confident in supporting individuals. The home has also recently accessed additional physiotherapy support for some of the people who live here and developed a good working relationship with the Community Matron who provides additional support and guidance in relation to health care. Relatives who wrote to us said the home does meet the differing needs of individuals and family members said they feel their relative is given the care and support they expect. One parent said the home cares for (our daughter) in all aspects. The health professionals who wrote to us said service users health care needs are well met, their privacy and dignity respected and the home seeks their advice and acts upon this to manage and improve individuals health care. One professional said Lynwood staff offer good care and support the needs of individuals. The home now uses the Boots Monitored Dosage System of medicine administration. The medication records show profiles of each service user, recent photograph, details of their medication, times of administration and manufactures notes on each of the prescribed medications administered within the home. The senior staff member who oversees medication administration within the home said they feel the Boots system is better than the system they used before. Medication is usually dispensed by managers or senior members of the team who have been trained. Storage remains good, with each person having their own named container for medicines which are not blister packed by the pharmacy. There are thorough audits on stock levels and any controlled drugs used in the home are stored and recorded appropriately. Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: Care Homes for Adults (18-65 years) Page 20 of 34 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. Service users are enabled to communicate their views and they can be confident that they will be listened to and their views acted on if necessary. Service users are protected from abuse, neglect and self-harm. Evidence: The home has a formal Complaints Policy, an Adult Protection Policy and a Whistle Blowing Policy, which staff can use in confidence to raise any issue or concern they have regarding the service. They also have letting us know what you think cards, available in a range of formats, to enable people to raise concerns. The service users we spoke with, and those who wrote to us, said they know who to speak to if they are unhappy and know how to complain. One individual we spoke with said they are unhappy with some aspects of their life in the home. They said they feel able to talk to staff about these issues and know how to use the formal complaints procedure should they feel they need to. The staff we spoke with remain clear on the important advocacy role they have. Due to the vulnerability of a number of people who live in the home, they would rely on staff to raise concerns on their behalf. Staff members are clear on the action they need to take if they witness or suspect abuse or if they have any other concerns. They Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: continue to use their daily interactions when supporting service users to alert them to any physical signs or changes in behaviour, which cause them concern. Relatives who wrote to us said they know how to make a complaint, should they need to and they feel the home has always responded appropriately if they have ever raised any concerns. The home has a system in place to record accidents and incidents which occur. When we visited the home last August we found significant failings in these records and said this must be immediately improved upon. We looked at a number of reports during this visit and note that, in general, staff are now following the homes reporting procedure and completing each report consistently. When an accident occurs, which may lead to an injury, staff complete a body chart (noting the type and location of any injury) and an accident form. They must advise the senior member of staff on duty of the incident and pass the relevant forms to them. These are then signed off by this senior staff member and reviewed by the Acting Manager. The selection of records we looked at show that body charts are now used to record only one injury (staff had been using one chart to record several injuries) and accident reports are usually completed when required. We did note that on two occasions, accident reports had not been completed when they should have been. The Acting Manager agreed these should have been done and that the improvements in this area must be sustained and built upon as this is important to each of the people who live in the home. Staff are provided with training in relation to the Protection of Vulnerable Adults and are subject to Criminal Record Bureau enhanced disclosures before they start work in the home. We are informed of any significant event which occurs in the home, which may affect an individuals welfare or safety. Care Homes for Adults (18-65 years) Page 22 of 34 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 and safe environment for people to live in. Evidence: Lynwood House 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 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 Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: 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. We viewed all communal areas of both properties, together with a number of bedrooms. All of these areas were clean and tidy. Each bedroom is furnished and decorated to a high standard and they contain many personal items, pictures and photographs which helps with the homely feel. This level of personalisation, with the involvement of the person themselves wherever possible, shows their individuality is respected and promoted. The bathroom areas have a similar degree of personalisation. There are ceiling track hoists in many rooms and mobile hoists are also used. The home has other specialist equipment to ensure the dignity and comfort of each person who lives here. The service users we spoke with, and those who wrote to us, said the home is kept fresh and clean. The relatives who wrote to us said they feel Lynwood House is a homely and safe place to live. One relative said they make everyone feel at home. During the last year the lounge, hall, dining area and kitchen have been redecorated. New flooring has also been laid in the kitchen. Some of the communal areas, in particular, corridors and skirting boards do show signs of wear and tear: this is understandable given the amount of use of wheelchairs, adapted seating and other equipment. There remains an ongoing programme of redecoration and renewal due to the needs and lifestyles of the people who live in the home. The issue of the people with bedrooms on the first floor having an alternative to the passenger lift, unfortunately, is still unresolved. The Acting Manager said that various equipment has been tried, so that people may use the stairs, but none has adequately met peoples needs. However, a member of staff within the organisation is actively trying to resolve this issue. The rear gardens for both properties are private areas. These are well maintained and there are plans to improve access to the Annexe garden, by adding a ramp. Care Homes for Adults (18-65 years) Page 24 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported by an effective, competent and well trained staff team. Individuals are supported and protected by the homes recruitment policy and practice. Evidence: A core of well-established staff continue to work in the home who have a good knowledge of the needs of people who live at Lynwood House. Although some staff have left the home, and this had led to difficulties with staffing numbers at times, new people have joined the team and the home now has a full compliment of staff. The staff we spoke with said that it has been stressful at times working in the home due to vacancies within the staff team. These vacancies were covered by existing staff working extra hours or by bank or agency staff. Each person said that things had very much improved during the last two or three months, since new staff joined the team. The service users spoken with said they like the staff and feel generally well supported by them. Those who wrote to us said staff treat them well, listen to them and act on what they say. Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: Relatives who wrote to us said they feel the staff have the right skills and experience to look after people properly. Comments from relatives include: they are always very polite and professional and the staff are extremely good. The staff who wrote to us said they are always provided with up to date information about the care needs of the people who live in the home. They feel they are provided with appropriate training and are well supported in their roles. Observation of their work practice show that they are approachable, communicate well and are comfortable with individuals living at Lynwood House who were seen to be at ease with them. It is evident staff have a clear understanding of the needs of each individual, their care plan and how to implement it. The staff team continues to meet regularly. The staff members spoken with said these meetings are usually well attended and most staff appear happy to discuss issues in an open and honest way. If staff are unable to attend meetings, they read the minutes to ensure they remain up to date. The home has a robust recruitment process. New staff have to complete an application form, attend a formal interview and provide documents proving their identity and eligibility to work in the UK, at least two satisfactory references and Enhanced Criminal Record Bureau Disclosure before they can start 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. Staff are provided with a variety of training opportunities. The records we looked at show that staff have attended the following sessions: first aid, fire safety, food hygiene, health and safety, how to move and handle people safely and protection of vulnerable adults. Other more specialist training is provided to enable staff to support service users appropriately and these include: epilepsy, infection control, medication administration, peg feeding, diabetes and loss and bereavement. The home wishes to formally supervise staff every six weeks. However, the records we looked at show that this level of supervision is not being provided to each member of the staff team. One member of staff has had three meetings this year and two others have only had one. One persons records were not filed, although they said their most recent supervision was last August. Staff said they welcome supervision and enjoy these meetings as it gives them a Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: chance to discuss their own performance and any issues they may have. The Acting Manager felt, in general, supervision had improved but did agree this needs to be improved further. Care Homes for Adults (18-65 years) Page 27 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is reasonably well run and individuals benefit from the ethos, leadership and management approach of the home. Each person is supported to express their views in relation to the review and development of the service. Each persons rights and best interests are promoted by the homes policies, procedures and record keeping and their health, safety and welfare is generally promoted and protected. Evidence: The last Registered Manager, Mrs Czerny, has not worked in the home since February 2008. She was initially covering another post within the organisation on a temporary basis, but this has now been made permanent. Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: The home has been managed during this time by the Deputy Manager, who is currently acting up. It is clear from discussions with them and other staff members that the home has been run as well as possible during this time, although it has been a difficult time for the service due to changing needs of some of the people who live in the home and the vacancies in the staff team, mentioned previously in this report. During the Random Inspection in August we noted that some of the checks, which would normally be carried out by members of the management or senior team, were not being completed properly. Examples we gave were insufficient checks on accident reports, daily records, monthly summaries and performance management of staff. This is perhaps understandable in view of the absence of the manager, the deputy manager acting up to fill this post and their own post effectively being vacant. When we visited last August we said the organisation must tell us their plans with regard to the ongoing management of the home. We have been advised that a new manager has now been recruited and will begin work in the home in the New Year. They will therefore need to start the process of registration with us as soon as possible after they start work at Lynwood House. The home continues to aim to support each person to achieve their maximum potential, live as independently as they can and continue to develop new interests and skills. They support this work by using a person centred approach in the provision of care and support each person receives. The views of individuals are sought through the review process and contact with their Keyworker. Relatives views are sought, as they often act as advocates for their son or daughter. The homes Action Group, mentioned earlier in this report, also plays a key role in ensuring each persons views are listened to and acted on. The home has a number of policies and procedures to ensure the safety of the people who live or work in the home. These are also used to ensure the home complies with the law and remains up to date with the good practice. Details were provided by the Acting Manager in the AQAA she completed for us. The record keeping in the home is generally good. The records we looked at were well presented and easy to follow. They are kept securely when not being used to ensure confidentiality is maintained. The registered providers representative visits the home each month to conduct an audit. They complete a report following their visit, which describes which records they have looked at and who they have spoken with. We could not locate the reports for Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: March, June and September 2008, although the Acting Manager said they have been carried out. There are systems in place to ensure the health and safety of the people who live or work in the home. The homes AQAA confirms that the safety checks on the homes electrical wiring, portable electrical appliances and heating system are all up to date. We looked at the homes fire log. The Fire Risk Assessment was last reviewed in May 2008 and the alarm system serviced last April. All staff members now take part in regular fire drills. Some service users know what to do if the fire alarm is activated, others would rely on staff to ensure their safety in the event of a fire in the home. There are a number of general risk assessments in place, which support safe working practices in the home. There are well written and are regularly reviewed. Care Homes for Adults (18-65 years) Page 30 of 34 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 31 of 34 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 The improvements in the 24/01/2009 monthly review process must be sustained. This would ensure each persons health and safety is suitable monitored and they are provided with support which meets their current and changing needs. The home must provide an alternative to the one passenger lift. This would ensure people would be able to transfer safely between floors if they are unable to use the lift. 24/02/2009 2 29 23 3 36 18 Each member of staff must be provided with regular supervision and a clear, signed record of each meeting must be maintained. This will ensure staff are supported to provide a good quality service to each person who lives in the 24/01/2009 Care Homes for Adults (18-65 years) Page 32 of 34 home. 4 37 9 The new Manager must start 24/02/2009 the registration process with us as soon as possible after they start work at Lynwood House. This will help to ensure a well run and accountable service for each person with an interest in the home. 5 42 17 The improvements in the recording of accidents must be sustained. This will promote the welfare and safety of people who live or work in the home. 6 43 26 The organisation must carry 24/12/2008 out an audit of the home every month, and the reports must be available for inspection. This would help to ensure an accountable service for each person with an interest in Lynwood House. 24/12/2008 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 Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: 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 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. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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