CARE HOMES FOR OLDER PEOPLE
LYNWOOD Rise Road Sunninghill Berkshire SL5 0AJ Lead Inspector
Marie Carvell Unannounced 20 June 2005 at 11.15am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. LYNWOOD H51-H01 11005 Lynwood V228723 210605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Lynwood Address Rise Road Sunninghill Berkshire SL5 0AJ 01344 620191 01344 875062 www.ben.org.uk BEN - Motor & Alllied Trades Benevolent Fund Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Julie Kay Way Care Home 87 Category(ies) of Older Person (OP) - 75 registration, with number Dementia (DE) - 12 of places LYNWOOD H51-H01 11005 Lynwood V228723 210605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 06/12/04 Brief Description of the Service: Taken from home philosphy of care statement. The objective of BEN care is to meet the holistic needs of individuals by identifying, planning,implementing and evaluating on a multi-disciplinary team basis a care programme specifically designed to meet their physical, social,spiritual, psychological and esteemic requirements. In order to provide effective care, staff must be receptive to changing needs and adopt a flexible attitude. Lynwood provides accommodation and care for up to eighty seven service users over the age of sixty five years of age. The home is registered to provide personal care for up to forty five, nursing care for up to thirty and dementia care for up to twelve. Accommodation is arranged in five units, the dementia care unit is on the ground floor of the main building, the first floor of the building is for nursing care only. The top floor of the main building is registered to provide personal care only and is named Fraser Durbin Unit. The remaining units Ben King Wing and Claude Wallis Wing are situated in a separate buiding, that is accessed by a connecting corridor. LYNWOOD H51-H01 11005 Lynwood V228723 210605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by one inspector from 11.15am until 5.30pm and was unannounced. Time was spent with the manager, care manager, who manages the three residential units, under the direction of the manager, housekeeping manager, maintenance manager, staff on duty, service users on the three residential units and a visiting General Practitioner. A tour of the three units and bedrooms were made and a sample of service user, staff and records required to be kept in the home were examined. Feedback was given to the manager and care manager at the end of the inspection. The nursing wing and dementia care unit were not inspected on this visit, therefore the contents of this report refers to the three residential units only. LYNWOOD H51-H01 11005 Lynwood V228723 210605 Stage 4.doc Version 1.30 Page 6 What the service does well: What has improved since the last inspection?
The catering manager introduced new menus in January 2005, and the home is currently using the summer menu. In January the home held a Relatives Meeting and undertook a Relatives Questionnaire. The refurbishment of the Fraser Durdin Unit is almost completed. The role of Team Leader has been introduced on the three residential units, which ensures that a senior member of staff is always on duty.
LYNWOOD H51-H01 11005 Lynwood V228723 210605 Stage 4.doc Version 1.30 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. LYNWOOD H51-H01 11005 Lynwood V228723 210605 Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection LYNWOOD H51-H01 11005 Lynwood V228723 210605 Stage 4.doc Version 1.30 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 5 The home undertakes a comprehensive pre-admission assessment of all service users to ensure that the home can effectively meet their needs. EVIDENCE: A full assessment is carried out by the care manager, which details information about the users health, welfare and social circumstances. Information provided at the pre-admission assessment forms the basis of the care plan. The care manager is currently reviewing pre-assessment documentation. Prospective service users and their relatives are given the opportunity to visit the home and to move in on a trial basis. Service users confirmed this. LYNWOOD H51-H01 11005 Lynwood V228723 210605 Stage 4.doc Version 1.30 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8 and 10 Service users are provided with care in a manner, which maintains their right to dignity, privacy and choice. EVIDENCE: Service users confirmed that the home is pro-active in meeting their health and personal care needs in a caring and dignified manner. Advice and support is sought from other health and social care professional as the need arises. Care documentation could be simplified, in order to produce a clearer and user-friendlier format. The manager and care manager are to review all care planning documentation. Service users were complementary about the standard of care provided, the facilities and staff. The inspector gained the impression of a good rapport between service users, senior staff members and care staff. One service user told the inspector “ You can’t fault the care here”. Another service user said, “Nothing is too much trouble for the staff, always a chat and a laugh”. LYNWOOD H51-H01 11005 Lynwood V228723 210605 Stage 4.doc Version 1.30 Page 11 Staff were observed to interact with service users in a respectful and appropriate manner. Service users were seen to be well groomed and appropriately dressed. LYNWOOD H51-H01 11005 Lynwood V228723 210605 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 15 Service users are provided with a varied, nutritious and well balanced diet, served in a pleasant, relaxed atmosphere. EVIDENCE: Examination of the menus demonstrated that a wide range of wholesome and nutritious meals are provided. The catering manager introduced new menus in January and currently the summer menu is being served. Menus offer service users a number of choices for each meal. A cooked breakfast is served each morning and is popular with all service users. Meals are attractively presented and served the attractive dining room, with views over the grounds. Alternatively meals can be served in the service users room if requested. Staff were observed assisting service users in a discrete manner. Relatives and friends are able to join service users for a meal for a nominal cost and the home is able to provide a private room for service user birthday celebrations etc. LYNWOOD H51-H01 11005 Lynwood V228723 210605 Stage 4.doc Version 1.30 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Complaints are taken seriously by the management of the home, are fully investigated with written outcomes being provided to complainants. EVIDENCE: There is a robust complaints procedure. Service users were aware of the complaints procedure and were confident that concerns or complaints would be dealt with appropriately. LYNWOOD H51-H01 11005 Lynwood V228723 210605 Stage 4.doc Version 1.30 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 21,22 and 26 There is insufficient accessible toilet and bathing facilities in two of the residential units to meet the needs of the service users. The units were clean, pleasant and hygienic. EVIDENCE: Fraser Durdin unit is currently being refurbished. All service users’ bedrooms have been completed to a high standard. The main bathroom/wc is nearing completion by Lynwood’s maintenance team. Toilet and bathing facilities will be fitted with appropriate aids and adaptations to meet the needs of the service users. Claude Wallace and Ben King units urgently need to be refurbished to meet the needs of the current service users. Only three of the five bathrooms can be used as two bathrooms are without appropriate aids and adaptations. Some areas of the home including a toilet are inaccessible to service users with mobility difficulties due to steps. Two toilets on one floor are so compact that service users are unable to enter the confined space with walking aids. Many
LYNWOOD H51-H01 11005 Lynwood V228723 210605 Stage 4.doc Version 1.30 Page 15 service users have to rely on the use of commodes. This is clearly unacceptable. In July 2003 the premises were assessed by an Occupational Therapist. Not all recommendations made have been actioned. These issues are to be addressed as part of an ongoing programme of work, following recommendations made by the Occupational Therapist. The housekeeping staff work hard to keep the units clean, pleasant and hygienic. LYNWOOD H51-H01 11005 Lynwood V228723 210605 Stage 4.doc Version 1.30 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 30 Service users are provided with care by well-trained, professional and knowledgeable staff. EVIDENCE: There is a well organised staff training and development programme in place. All new staff receive induction training that meets TOPSS standards and a wide range of both in house and external training courses are available to all levels of staff. LYNWOOD H51-H01 11005 Lynwood V228723 210605 Stage 4.doc Version 1.30 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 and 38 The home regularly seeks the views of service users and reviews its performance through a planned programme of reviews and audits. The reviews include seeking the views of service users, relatives, staff and professionals involved in the home. Service users live in a safe home where their health and safety are considered a high priority. EVIDENCE: The views of service users are sought in regular service user meetings and spending time with individual service users. There is an annual relatives meeting and a pre meeting questionnaire is sent out. The catering manager spends time with service users, who are involved in menu planning. There is an annual review of individual service users needs undertaken. LYNWOOD H51-H01 11005 Lynwood V228723 210605 Stage 4.doc Version 1.30 Page 18 Regular audits are undertaken on all relevant issues including menus, medication, accidents, complaints and care plans. Recommendations made recently following a Fire Officer inspection have been completed. Records relating to health, safety and fire are maintained to a high standard. LYNWOOD H51-H01 11005 Lynwood V228723 210605 Stage 4.doc Version 1.30 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3
COMPLAINTS AND PROTECTION x x 2 2 x x x 3 STAFFING Standard No Score 27 x 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x 3 x x x x 3 LYNWOOD H51-H01 11005 Lynwood V228723 210605 Stage 4.doc Version 1.30 Page 20 N/A Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 21 Regulation 23 Requirement That the responsible individual advises the CSCI of what action is to be taken with timescales, to provide toilet and bathing facilities that meet the needs of the current service users. That the responsible individual advises the CSCI of the action with timescales, to meet the recommendations made following an assessment of the premises and facilities in July 2003 by an occupational therapist.l Timescale for action 20/09/05 2. 22 23 20/09/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard None made Good Practice Recommendations LYNWOOD H51-H01 11005 Lynwood V228723 210605 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection 2nd Floor 1015 Arlington Business Park Theale Reading RG7 4SA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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