Inspection on 24/08/06 for Lynwood Nursing Home

This inspection was carried out on 24th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Lynwood Nursing Home 27/08/08

Lynwood Nursing Home 26/10/05

Lynwood Nursing Home 20/06/05

Lynwood Nursing Home 06/12/04

Lynwood Nursing Home 30/07/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Lynwood Nursing Home Lynwood Rise Road Sunninghill Berkshire SL5 0AJ Lead Inspector Susan Cledwyn-Davies Unannounced Inspection 24th August 2006 09:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lynwood Nursing Home DS0000011005.V302158.R03.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 Nursing Home DS0000011005.V302158.R03.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lynwood Nursing Home Address Lynwood Rise Road Sunninghill Berkshire SL5 0AJ 01344 620191 01344 875062 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) BEN - Motor & Allied Trades Benevolent Fund Mrs Julie Kay Way Care Home 87 Category(ies) of Dementia (12), Old age, not falling within any registration, with number other category (75) of places Lynwood Nursing Home DS0000011005.V302158.R03.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users with complex nursing needs and who are between 60 and 65 years of age may be admitted to the home on condition that CSCI are informed on each occasion. 26th October 2005 Date of last inspection Brief Description of the Service: 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 service users; nursing care for up to thirty service users and dementia care for up to twelve service users. Accommodation is arranged in five units, the dementia care unit is on the ground floor of the main building, the first floor of the main building is for nursing care only and the top floor of the main building is for personal care. The remaining two units, providing personal care are situated in a separate building, accessed by a connecting corridor. The fees vary from residential care £410, residential extra care £510, nursing care £665 to nursing dementia care £730. Additional charges are made for hairdressing, newspapers, chiropody, personal toiletries, some activities e.g. trips out and bar expenses. Lynwood Nursing Home DS0000011005.V302158.R03.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection included receiving a preinspection questionnaire and 39 service user questionnaires received. There was a site visit to the home of 7.5 hours. During this visit time was spent in the nursing area, in the unit for people with dementia and in the residential area. There was discussion with 10 service users and 1 relative, with 10 staff and examination of records. Five care plans were case tracked during the site visit. What the service does well: What has improved since the last inspection? 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 Lynwood Nursing Home DS0000011005.V302158.R03.S.doc Version 5.2 Page 6 contacting your local CSCI office. Lynwood Nursing Home DS0000011005.V302158.R03.S.doc Version 5.2 Page 7 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 Outcomes Statutory Requirements Identified During the Inspection Lynwood Nursing Home DS0000011005.V302158.R03.S.doc Version 5.2 Page 8 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 the following standard(s): 1, 3 and 6 Good An outcome group judged as ‘Good’ has more strengths than areas for improvement. There are no significant weaknesses in areas relating to health and safety issues or management. The key NMS under this outcome heading are generally met but there may be some areas of improvement that we are confident the provider can manage. Where areas for improvement emerge the service recognises and manages them well. The statement of purpose and service users guide are kept updated. All service users are assessed prior to admission and information about the home given. EVIDENCE: The service users guide and statement of purpose were reviewed in July 2006. The information reflects the care given in the home. The questionnaires and one service user confirmed that sufficient information about the home is given prior to admission. All service users are assessed prior to admission. Assessments were seen and information was used within care plans. Service users and/or relatives are Lynwood Nursing Home DS0000011005.V302158.R03.S.doc Version 5.2 Page 9 encouraged to visit the home before admission. The manager advised that a new format for recording enquiries and the actions taken following this. There will then be a clear record of information given and visits either to the home or to the potential service user and will ensure that everyone receives all the support available. Intermediate care is not provided. Lynwood Nursing Home DS0000011005.V302158.R03.S.doc Version 5.2 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 the following standard(s): 7, 8, 9 and 10 Good An outcome group judged as ‘Good’ has more strengths than areas for improvement. There are no significant weaknesses in areas relating to health and safety issues or management. The key NMS under this outcome heading are generally met but there may be some areas of improvement that we are confident the provider can manage. Where areas for improvement emerge the service recognises and manages them well. Care plans are well maintained. It is good practice to ensure that good records are kept of unexplained bruises in all parts of the home. Key workers are allocated to support service users. One key worker in the residential wing needed to be more involved. Service users were positive about the care. Medication management is safe. EVIDENCE: Care plans were seen in each of the areas. They were detailed and easily accessed by staff. Care plans were well maintained and reviewed monthly. Care plans described the care to be given and included risk assessments. Annual reviews were held including service users and relatives if possible. By next April 2007 it is planned to have a computer and Internet access on each Lynwood Nursing Home DS0000011005.V302158.R03.S.doc Version 5.2 Page 11 unit and to start staff training to use this. Computerised Care systems are being investigated for possible use. In the residential wing was an exception. Care plans did not include sufficiently detailed records of unexplained bruises. These are important to make sure that injuries are followed up. Body maps were used in all other parts of the home. The manager advised that herself and the deputy manager checked care plans. In future they would alternate checking care plans in the nursing wings and in the residential areas to ensure consistency. Each service user has a key worker. In the nursing wing this is a qualified nurse and carer while in residential each service user has a carer. Within the residential unit discussion with a new service user showed that the key worker needed to be more involved in the daily routine especially in the evening. The head of the unit and the manager would be ensuring this. Service users were every positive about the care given. Comments included “satisfied with everything, receives the care and support needed” “Definitely receive the care and support needed, staff always listen and act on what said” Questionnaires were very positive about the medical care provided. One stated “the doctor comes every week and is very good”. Staff confirmed that the doctor reviews medication regularly. Staff training in the End of Life programme is starting soon and expected to be completed by the spring. One relative whose mother had recently died spoke of how good the care was and that she couldn’t have asked for better. Medication is administered by qualified staff in the nursing area or by carers in the residential wing. Medication storage and records were checked in one wing and were safely maintained. Staff are trained prior to administering medication. The previous inspection had found medication well managed. There is a medication procedure to guide staff. Lynwood Nursing Home DS0000011005.V302158.R03.S.doc Version 5.2 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 the following standard(s): 12, 13, 14 and 15 Good An outcome group judged as ‘Good’ has more strengths than areas for improvement. There are no significant weaknesses in areas relating to health and safety issues or management. The key NMS under this outcome heading are generally met but there may be some areas of improvement that we are confident the provider can manage. Where areas for improvement emerge the service recognises and manages them well. There are a wide variety of activities meeting many service users needs. Staff encourage contact with family and friends, communicating relevant important news. Service users views are respected. Catering is appreciated and provides good choice. There have been short periods when the quality has deteriorated. EVIDENCE: A wide variety of activities are prepared by the Therapy dept. In questionnaires most service users said there were usually enough activities to take part in. Activities arranged include outings, exercise groups, concerts, quizzes and crosswords and bingo. The league of Friends also provide a social calendar with up to 6 events organised a month. The bar is open at weekends for service users and family and church services take place. Lynwood Nursing Home DS0000011005.V302158.R03.S.doc Version 5.2 Page 13 Catering is generally good and feedback from service users was positive. This included in the questionnaires “I love my food and there is always a choice and plenty of it” and “If I don’t like it they will change it.” The meal seen on the day of the visit was tasty and well presented. Some feedback on the day was “that the meals have just been poor for 2 weeks but are now better”. The annual development plan includes a section on catering but this was not completed. (see Management and administration) The Matron and Assistant Matron eat meals with service users as part of their monitoring. Feedback from relatives both in questionnaires and on the day was positive. “They couldn’t have done more” and “Lynwood is a wonderful home and I have nothing but praise to say about the home. My Mother’s needs are taken care of with dignity”. Observation and in discussion with service users and staff the care practice is good and service users have choice and control over their lives. Lynwood Nursing Home DS0000011005.V302158.R03.S.doc Version 5.2 Page 14 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 the following standard(s): 16 and 18 Good An outcome group judged as ‘Good’ has more strengths than areas for improvement. There are no significant weaknesses in areas relating to health and safety issues or management. The key NMS under this outcome heading are generally met but there may be some areas of improvement that we are confident the provider can manage. Where areas for improvement emerge the service recognises and manages them well. Complaints are taken seriously and action taken. Recording of complaints to conclusions and any possible actions needs to be improved. Service users are protected from abuse. EVIDENCE: Service users in questionnaires confirmed that they knew to whom to complain. The complaints record was seen and showed that service users complaints and concerns are recorded and taken seriously. The complaints record does not clearly show the full action taken and the conclusion. It was required that a format be used to record/log complaints to ensure that there was an investigation, conclusion and any actions noted. Adult protection in the service is taken seriously. All staff receive POVA training and there is an in-house trainer. There is an adult protection policy available for all staff. Service users confirmed that “staff always listen and act on what said” “staff listen and act most of the time”. A relative confirmed, “that my mothers needs are taken care with dignity”. Lynwood Nursing Home DS0000011005.V302158.R03.S.doc Version 5.2 Page 15 There has been one referral to the adult protection officer involving residents and this was investigated and managed. Lynwood Nursing Home DS0000011005.V302158.R03.S.doc Version 5.2 Page 16 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 the following standard(s): 19 and 26 Good An outcome group judged as ‘Good’ has more strengths than areas for improvement. There are no significant weaknesses in areas relating to health and safety issues or management. The key NMS under this outcome heading are generally met but there may be some areas of improvement that we are confident the provider can manage. Where areas for improvement emerge the service recognises and manages them well. The environment is well managed and service users appreciate the good housekeeping. One room was found needing extra cleaning and this was completed quickly. EVIDENCE: The home is well maintained and there is a continuous improvement programme both for furniture and equipment and decoration. Service users in the questionnaire were all positive about the accommodation stating “the standards are very high at Lynwood” “cleaning all day long”. “I am happy. I have no complaints. Washing is done well and put away for me.” Lynwood Nursing Home DS0000011005.V302158.R03.S.doc Version 5.2 Page 17 The upper floor for residents who are quite independent has been upgraded and decorated, providing a very attractive space. In the nursing wing the lounge has been expanded and new decoration, curtains and furniture provided. Each of the different units have separate accommodation. The residential area in particular, though purpose built some time ago, is now more old fashioned in design. The communal space is large with alternative lounges and a bar for service users to use but the bedrooms are not en suite and some corridors have stairs. Service users themselves spoke of being happy in their rooms and enjoying the space. There is a committee set up to consider future developments in the service and how future service users needs can be met. A new maintenance manager has been appointed to ensure good maintenance and safety standards. While going round the home the inspector found the home clean and fresh smelling. The exception was one room in the nursing wing. The sister on duty arranged for the carpet to be cleaned and subsequently the inspector was advised that specialist cleaning fluids had been obtained and had improved the room. There will be further monitoring of this room. Lynwood Nursing Home DS0000011005.V302158.R03.S.doc Version 5.2 Page 18 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Excellent An outcome group judged as ‘Excellent’ has substantial strengths and a sustained track record of delivering good performance and managing improvement. Where areas for improvement emerge the service recognises and manages them well. We would expect to see the essential elements found in an outcome judged as good with further additional strengths. The performance does not have to be perfect to be excellent in an outcome area. The key NMS under this outcome heading are met. The examples are illustrations only and should not be regarded as a tick box. There is a good level of staffing and very few vacancies. Staff are enthusiastic and dedicated. Staff training is encouraged and over 50 of staff have NVQ 2 training. Skills for care audits are being completed. Recruitment records were safe. Service users are happy with the care given. EVIDENCE: The staff numbers and skill mix are appropriate to the needs of the service users. There is some use of agency staff to cover peak vacancies. More staff have been recruited and there is now less need for agency workers. One agency member of staff said that she had received an induction and was very impressed with the service; she would try to work there again. Unit managers advised that the same agencies are used and familiar carers are used if possible. Service users commented in questionnaires that “staff are usually available” “I’m quite satisfied with the care and attention receive”. Staff commented that there is enough staff. Lynwood Nursing Home DS0000011005.V302158.R03.S.doc Version 5.2 Page 19 The inspector observed staff to be caring, helpful and friendly. There is an active NVQ training programme. Over 50 of staff have achieved NVQ 2. In discussion care staff said they were supported to complete the course, given study time and a mentor to help. Staff are also able to work towards NVQ 3. Staff training is seen as important and encouraged. Induction training is given to all new staff. New training is also brought in. Training from the End of Life Care programme is being started. The gold standard training from this programme is being introduced. All staff should complete this training by next spring. Skills for Care audits have just been completed for all staff and the results should be back shortly. Recruitment records seen were good. The last 4 recruited members of staff had all checks completed including CRB. Contracts had been issued and initial training started. There only three vacancies now, for kitchen staff and a maintenance person. Lynwood Nursing Home DS0000011005.V302158.R03.S.doc Version 5.2 Page 20 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Good An outcome group judged as ‘Good’ has more strengths than areas for improvement. There are no significant weaknesses in areas relating to health and safety issues or management. The key NMS under this outcome heading are generally met but there may be some areas of improvement that we are confident the provider can manage. Where areas for improvement emerge the service recognises and manages them well. The manager is experienced and qualified. Quality assurance is improving, service users are asked for their view of the service. Service users finances are safely managed and health and safety is promoted. EVIDENCE: The manager has a lot of experience of providing care for older people plus she has completed NVQ4 in care and management. The Director of Care, who Lynwood Nursing Home DS0000011005.V302158.R03.S.doc Version 5.2 Page 21 visits at least monthly, supervises the manager. Service users spoke of the support given and staff noted enjoying working in Lynwood. The manager has started a quality assurance file. This file contains a variety of records including the minutes of meetings by the manager and other senior staff of the organisation to develop the practice of the home. They are using the KLORA work and aiming to use this to improve the care. The first areas looked at are admission to the home and medication practice. Each service user has the care plan reviewed with themselves and relatives annually. Additionally the manager and deputy spend time with each service user. The aim is to talk individually with everyone at least once a year. This conversation is recorded. An annual development plan is prepared and this included continuing annual relatives meetings with pre-meeting questionnaires and continuing matron and assistant matrons resident days which including having a meal with residents. The annual development plan seen included some work completed already. The plan though did not include any timescales and was incomplete. (no catering section) Completing the development plan is recommended. Service users money is kept by the service for their use. This system was checked in the previous inspection and found satisfactory. The manager confirmed that the system remains the same. The accounts are audited internally regularly; there is a visit to the service every two months by accounts staff. The health and safety of service users is promoted. The pre inspection questionnaire demonstrated that all routine servicing and checks were maintained. Staff were observed making checks during the visit. Risk assessments for individuals are carried out and reviewed. Lynwood Nursing Home DS0000011005.V302158.R03.S.doc Version 5.2 Page 22 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 4 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Lynwood Nursing Home DS0000011005.V302158.R03.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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 OP16 Regulation 22(3) Requirement It is required that the Manager ensures there is a complete complaint record, including the investigation and outcome. Timescale for action 01/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP33 Good Practice Recommendations It is recommended that the manager ensure that body maps are used to record bruising especially unexplained. It is recommended that the manager complete the annual development plan, include timescales and demonstrate work achieved. Lynwood Nursing Home DS0000011005.V302158.R03.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Berkshire Office 2nd Floor 1015 Arlington Business Park Theale, Berks RG7 4SA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Lynwood Nursing Home DS0000011005.V302158.R03.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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