Inspection on 27/08/08 for Lynwood Nursing Home

This inspection was carried out on 27th August 2008.

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

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 24/08/06

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 28/09/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Lynwood Nursing Home Lynwood Rise Road Sunninghill Berkshire SL5 0AJ     The quality rating for this care home is:   three star excellent 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: Helen Dickens     Date: 2 7 0 8 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 Older People 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 Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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 Older People Page 3 of 30 Information about the care home Name of care home: Address: Lynwood Nursing Home 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): Name of registered manager (if applicable): Type of registration: Number of places registered: BEN - Motor & Allied Trades Benevolent Fund Mrs Julie Kay Way care home 87 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 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. 12 0 Over 65 0 75 Date of last inspection Brief description of the care home 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. At present not all rooms have ensuite facilities. Communal facilites are good and there is a dedicated physiotherapy gym and a separate spacious activities room overlooking the garden. Care Homes for Older People Page 4 of 30 Care Homes for Older People Page 5 of 30 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection was unannounced and took place over 7 hours. The inspection was carried out by Mrs. Helen Dickens and Mrs. Julie Way, Matron and Registered Manager, represented the establishment. A partial tour of the premises took place and a number of files and documents, including three resident’s files and care plans, three staff training and recruitment files, quality assurance information, and the annual quality assurance assessment (AQAA) were examined as part of the inspection process. Questionnaires returned to CSCI regarding this service earlier in the year were also used in writing this report. The inspector saw and spoke with most residents who were in the main dining room at lunchtime and three more were interviewed in more detail on the day of the inspection. Care Homes for Older People Page 6 of 30 The inspector would like to thank the residents, staff and matron for their time, assistance and hospitality. What the care home does well: What has improved since the last inspection? The Annual Quality Assurance Assessment (AQAA) was completed to a very high standard by the manager, and noted a number of improvements since the last inspection in August 2006. These included reviewing of policies and procedures, improving the pre-assessment and care planning forms by adopting the Berkshire Care Association format, and introducing body maps into care plans in all areas of the home. A therapy activities photo album has been started and this was on display at the home on the day of the inspection. Complaints recording has also been improved and now meets the only Requirement made at the previous inspection. There are now better training arrangements in place with clearer training records. All the homes employees have now had safeguarding adults training, and training on the Mental Capacity Act has started. On the environment, furniture and plants have been added to the Treetops garden area for people with dementia, and their lounge is now more homely. Refurbishments have Care Homes for Older People Page 8 of 30 been carried out across various parts of the home including the first floor Claude Wallis Wing and first floor nursing wing. A new 42 inch wall mounted TV has been purchased for residents, and donated office furniture has improved the office areas. Four floors have been recarpeted and some individual bedrooms have been redecorated. A relatives support group has been set up since the last inspection, and the catering department has been restructured, creating the post of Head Chef. Several residents commented to the inspector that they had noticed improvements in relation to the food and menus. What they could do better: 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. Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements for assessing new residents are thorough and people who move into Lynwood can be confident their needs have been properly assessed. Evidence: Three residents files were sampled. Assessments prior to admission were found to be detailed and comprehensive. Information had been collected from other health and social care professionals including GPs and social workers. Each prospective resident is visited by a qualified person, usually the home manager, to carry out their assessment. The AQAA returned from this home states all potential residents and their families are invited to the home and a record is kept of how these visits went. One file sampled showed the resident had made a visit to the home and had enjoyed a prelunch sherry with other residents. Care Homes for Older People Page 11 of 30 The home is now using the new Berkshire Care Association format for residents initial assessments and these provide plenty of detail and a clear format. One form covers preferences in relation to daily routines and these were fully completed by the assessor. There was plenty of evidence that residents and their families had been consulted during these assessments. Risk assessments were on file in relation to nutrition, moving and handling, skin condition, and falls. Each file also contains a body map as recommended at the last inspection for residential residents, as opposed to just for nursing care residents as was previously the practice. This home has an excellent physiotherapy unit for use by the homes residents. All new residents are given a physiotherapy assessment on arrival. The four part time Chartered Physiotherapists work to their professional guidelines for assessing clients. Each resident is given a personalised programme of therapy to maintain their independence and improve their overall health. A recently admitted resident demonstrated to the inspector the progress she had made whilst carrying out her therapeutic programme in the therapy department. All new residents get the Lynwood Handbook, and the home also has its own website. The inspector spoke by telephone with the daughter of one newly admitted resident. She confirmed that she was happy with assessment procedure at this home, and that her relative had settled in well. She said staff had identified that her relative was very sociable and had made sure there were plenty of opportunities to join in with activities. This residents file was checked and they were observed to be involved in at least three different activities during the day of the inspection. Care Homes for Older People Page 12 of 30 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit by having their health and personal care needs clearly documented in their care plans, and by the arrangements for promoting good health, including the excellent physiotherapy facility at Lynwood. Medication administration arrangements at this home protect residents. Residents privacy and dignity are respected by the staff at this home. Evidence: The three residents files checked all had comprehensive care plans in place. The AQAA states that All service users have a personalised Care Plan supporting individual person centred care, respecting choice, independence and privacy. The documents highlighted under the previous Standard (3), were used to inform residents care plans. All aspects are regularly reviewed with a monthly written summary of social activity by the key worker. There were additional risk assessments as necessary e.g. for bed rails, and all had a night care plan and daily and nightly notes were kept. Care Homes for Older People Page 13 of 30 There is a Family Tree on each file outlining the social history of each resident, some residents had chosen not to complete this. GP notes are kept, as are records of visits and appointments with profesisionals. Each care plan has written guidance to staff based on the Nursing and Midwifery Council guidance about record keeping. There was a training course for staff on day of inspection on records and record keeping. There is an advance care planning document on each file. Residents had clearly been involved in drawing up and reviewing their care plans and either they or their relatives had signed them. Residents spoken with on the day were complimentary about the care they received. Resident surveys earlier in the year noted a number of positive remarks including one who wrote I am clean and well fed, I have visitors when I want them, visitors are well looked after and given a cup of tea. I am very happy.. A relative who returned a survey to CSCI noted that Staff do their very best...they are very patient. Good health is promoted at this home in a number of ways. The local GP holds a surgery in each unit every week, and residents are assisted to access other health professionals for example at the local Heatherwood Hospital. One resident had been taken to the hospital by the Linwood physiotherapist on the morning of the inspection to collect specially made shoes. The physiotherapist told the inspector that the home had a good relationship with the other local health professionals. During the afternoon this resident was seen to be trying out the new shoes in the physiotherapy department by walking with the parallel bars for support, and being closely supervised by the physiotherapist. Risk assessments are in place in relation to pressure sores and skin care, and residents nutrition and weight are monitored. The chef demonstrated they have the ability to provide for special diets, and the soft diet served as an example on the day of the inspection was both colourful and tasty. The home are planning to use food moulds to make liquidised and soft diets look even more appetising. As mentioned earlier, all residents get a therapy assessment on arrival covering all aspects of their mobility etc. The physiotherapists enable residents to work on their posture, balance and mobility in the dedicated Therapy Unit, which is a large gym and exercise facility within the main house. Four Chartered Physiotherapists are employed on a part-time basis, assisted by two physiotherapy assistants and an activities coordinator. The activities and therapy are offered in a co-ordinated fashion for example chair aerobics which was being held in the garden room was being delivered by the physiotherapy assistants. The physiotherapists are currently training some care staff to give hand massage to residents. Care Homes for Older People Page 14 of 30 Medication administration is well organised at this home.The AQAA states that Medication policies and procedures are followed by all staff. Training is provided and medications are regularly audited. There are 6 monthly visits by the community pharmacist who looks at arrangements at the home in relation to administration, stock control and storage. The reports were available for inspection and the last one was looked at in some detail. The pharmacist had noticed improvements since the previous visit and made two minor recommendations. One related to the controlled drugs register which was falling apart and needed replacing. The other concerned monitoring the temperature in one of the medication fridges which was rather cold. On the day of the inspection the inspector noted many examples of staff respecting the privacy and dignity of residents. For example in the dining room staff were seen checking on residents who needed intermittent help. The home provides special equipment to encourage independence such as one resident who was using a plate with a raised edge to ensure food was not accidentally dropped. It was noted that personal care is delivered in privacy and staff were seen to knock on doors before entering. Residents only wear their own clothes and the laundry assistant said that all clothes are labelled to prevent mix ups. The manager said that on surveys returned by relatives this sometimes came up as a problem and the home were continuing to try and minimise the number of times that residents clothes got mixed up. There are hairdressers working at Lynwood on four days per week which ensures residents have every opportunity to look their best. The ladies in particular were observed to have very well kept hair. No rooms at Lynwood are used as shared rooms. The home has regard to individuals needs and these are clearly documented e.g in relation to religion and disability. The home promotes independence and dignity by the facilities on offer e.g. there are fewer falls possibly due to the physiotherapists working on balance and mobility with residents. Staff addressed residents respectfully throughout the day and written assessments noted how each person wanted to be addressed. Comments from the last survey carried out by CSCI found no negative comments in relation to privacy and dignity. One resident wrote I have always been happy and made to feel welcome at Lynwood and I have found the staff to be courteous. Care Homes for Older People Page 15 of 30 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit by a full programme of activities and therapy, and by the home having close contacts with the local community. Residents are given opportunities to exercise choice and control over their lives, and they enjoy their mealtimes. Evidence: Activities and therapy are closely aligned at Lynwood and there is a full programme of both on offer. The garden room is used for sedentary and craft activities and was busy all day during the inspection. The Therapy Unit is a large gym used for the more therapeutic and rehabilitative activities on offer, the large room being full of equipment including parallel bars, exercise bikes, balls, and beds. Residents have input in relation to the variety of activities both from what is identified in their initial assessments, and from regular service user meetings. There is plenty of pictorial evidence of the activities around the home including recent visits to Ascot, Windsor Great Park and Runnymede. The home has its own League of Friends who arrange additional outings and entertainment, there was for example a jazz concert in the Care Homes for Older People Page 16 of 30 grounds during the summer. Another group, the Fete Committee, organises an annual fete and a vintage car rally. There are Individual therapy programmes for each resident who wants it and these are monitored by the physiotherapists. Therapy and activities staff meet weekly to discuss client issues and progress. Key workers monitor each residents involvement in social activities, and this is recorded on their file. When planning activities consideration is given to those residents with disabilities, for example chair aerobics. There are also craft competitions and categories include flower arranging, indoor plants, cookery, knitwear and handicrafts. The home has its own chapel for religious services and visiting clergy bring communion or hold services. The manager was knowledgeable on the religious preferences of residents who are mainly Christian at the moment. Other facilities include hairdressing which is available in the salon 4 days per week, and pleasant outdoor spaces including terraces and landscaped gardens. A number of volunteers assist with activities, usually having some past connection with the home such as having a relative there. On the afternoon of the inspection one such volunteer was running the bingo in the garden room. The activities were well attended and residents were observed to be enjoying themselves, one new resident who was interviewed during the bingo interval said they were very happy with the activities at this home adding If you want to go somewhere, they take you. That day this resident had been seen participating in the chair exercises, the afternoon bingo and had also been walking on the terrace with a member of staff. They told the inspector that they were looking forward to going out for a meal the following day. There is plenty of evidence that this home has good contacts with the local community including a number of volunteers who come in to spend time with visitors, including a League of Friends who organise outings and entertainment. Residents are taken out to local visitor attractions such as Royal Ascot, Windsor Great Park and Runnymede. Pub lunches are also arranged for residents. The home has a good relationship with local health services including the local hospital and of course local NHS physiotherapy services. Lynwood has open visiting for friends and relatives, and contact with local faith communities who visit the home. Residents are encouraged to make choices in their daily lives and good records are kept about residents preferences for example in relation to food, when they like to get up and go to bed, when they like to eat their meals, and whether they want a newspaper. All those rooms visited by the inspector had some personal possessions brought in by residents including photographs and ornaments. Residents views are sought on the variety of activities, the menus and the decor in the home. Residents Care Homes for Older People Page 17 of 30 spoken with in the dining room all said they would be offered an alternative if they didnt like what was on the menu. One who said they preferred healthy food that they could chew frequently opted for the salad and home cooked ham. This resident also preferred not to use the therapeutic services on offer as they said their preferred exercise was to go for walks in the extensive grounds at Lynwood. Lynwood offers a pleasant mealtime experience for residents. The inspector spoke to residents on every table in the main dining room before and after their lunch and all were satisfied with the food. Special diets are catered for, including soft diets. Nutritional risk assessments were on residents files and they are weighed regularly. On the day of the inspection there was an excellent roast pork lunch. The Inspector tasted one teaspoon of each item on the main course plate and found the food to be tasty and well prepared. Vegetables were neither under not over cooked, the meat, served with apple sauce, was tender, and the roast potatoes were, as one resident said Lovely. There is a cooked breakfast available daily with bacon and egg on Sundays. There is also the option to have porridge which the assistant chef said was popular. There are cooked suppers each evening plus a choice of soup or sandwiches. One care plan sampled noted a resident liked to have biscuits or a spare sandwich in their room in the evening. Residents can choose whether to eat in the dining room or their own room, and the dementia unit has their own very pleasant dining area. Most residents, when asked, gave 10 out of 10 for food, a few said 8 out 10 though one of these added But, nobody seems to leave very much. Other comments included New chef is a big improvement, Always served nicely, and Every dinner is nice The home cooks their own ham which is popular with residents, and there is a daily choice of salad which changes every day, or an omelette. One resident who chose the omelette as they felt like something light said it was Very good. The assistant chef was in charge and was interviewed. He went through the daily menus and demonstrated that there was a good variety of nutritious food for residents. One new resident who was of Mediterranean origins said the Food is lovely. They had a note on their care plan that they liked pasta and, when spoken with, confirmed they had had pasta twice so far. Care Homes for Older People Page 18 of 30 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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. Residents can be confident their complaints would be taken seriously, and they are protected from abuse. Evidence: There is a complaints policy in place at this home though the outcome format has changed to meet a Requirement made at the previous inspection. The policy is available within the home for residents. The complaints record was checked and three complaints had been received by the home in the last 12 months. One issue is being monitored to ensure a satisfactory outcome, and the other two are now resolved. Residents can also raise concerns at regular residents meetings, or during the providers Regulation 26 visits. There have been no complaints directly to CSCI. One relative has complimented the home in a telephone call made to CSCI. The home has recently introduced a short survey which is available in reception, asking visitors how they rated the home on a number of outcomes during their current visit. The manager said it was always better to pick up on any shortfalls before they led to complaints being made. The home has a Safeguarding Adults Policy in place and has the latest Local Authority policy on this subject. They can now offer in-house training as the assistant matron Care Homes for Older People Page 19 of 30 has completed the train the trainer award on this subject. All staff have now had this training and the training plan identifies when refresher courses are due. No safeguarding matters have been reported in relation to Lynwood since the last inspection. The manager was asked to review their in-house policy to ensure the wording reflected the local authority position in relation to investigation, and to consider a shorter version for day to day use by staff. Care Homes for Older People Page 20 of 30 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, 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. 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. Residents live in a homely and well maintained environment which is clean, pleasant and hygienic throughout. Evidence: A partial tour of the premises took place. Lynwood, despite the age and layout of the building, offers a homely environment which is kept clean and fresh throughout. The inspector visited most communal areas. Three residents bedrooms were also visited. As Lynwood is in an old building there is ongoing refurbishment and renewal. Since the last inspection this has included providing a smoking room for residents, improving the fire alarm system, refurbishing first floor Claude Wallis wing and the first floor nursing wing, redecorating Treetops Lounge and recarpeting in four wings plus the reception area. A platform lift has been installed to the nursing wing as a back up if the shaft lift is ever out of order. A new non slip flooring has been fitted in the Therapy Unit, and bedding has been replaced in Treetops unit. The AQAA states that the home complies with requirements from the fire service. Adaptations are available as required for example grab rails and hoists. Hygiene and the control of infection are well managed at this home. Staff all have infection control training and there are good hand washing facilities throughout. There Care Homes for Older People Page 21 of 30 were no unpleasant odours in any part of the home. There are good laundry facilities, including three commercial washers with sluicing facilities and tumble driers. The home has introduced the ozone laundry system which further minimises the risk of infection. The manager was asked to review the floor covering in the laundry which is currently not impermeable and therefore may be difficult to keep clean. Care Homes for Older People Page 22 of 30 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are met by the numbers and skill mix of staff, and the home exceeds the National Minimum Standards in relation to the qualifications of care staff. Recruitment arrangements protect service users and training arrangements ensure there is a well trained and competent workforce at this home. Evidence: The homes AQAA states that there are High staffing levels 24 hours a day. We have a higher ratio of staff in the mornings to recognise the higher activity. The inspector observed that there were sufficient care staff plus therapists, reception staff, domestic staff, and kitchen staff available. On the dementia unit there are three care staff and an RGN each morning - the inspector noted that two staff on the dementia care unit were sitting talking to residents in the period before lunch. In the main dining room there were plenty of staff on hand at lunchtime and those who needed assistance were supported adequately. The inspector noted one resident who may have needed more help and the manager said she would monitor this. There are written staff rotas in place and a staff whereabouts log to show where senior staff will be on each day of the week. Care Homes for Older People Page 23 of 30 Residents are in safe hands at Lynwood as, in addition to their ongoing training programme, more than 50 of their care staff have at least the NVQ Level 2 qualification in care. Recruitment files are well kept and there are clear recruitment procedures in place. Recruitment is a joint process with the HR department. Three recruitment files were sampled. All had completed application forms and references, and proper criminal records checks had been made. One new staff member had yet to complete a full employment history as required by the Regulations and the manager agreed to follow this up and to confirm to CSCI when this is received. There was a good record of interview notes on file for each candidate, as well as equal opportunities monitoring forms. Excellent arrangements are in place for staff training and development at Linwood. Both in-house and external training courses are available and several senior staff have train the trainer qualifications. All staff have training delivered to them in working hours. Eight members of staff attended a record keeping course held at the home on the day of the inspection. Some care staff are currently receiving training in hand massage from the homes physiotherapy department. Three staff files were sampled and records of training and certificates were on each file. There were good records of each workers induction training. There is a central staff training matrix which enables the manager to see at a glance which staff have done which courses and when refresher courses are due. Care Homes for Older People Page 24 of 30 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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. This home is well managed and run in the best interests of residents. Financial procedures at Lynwood protect residents, and their health, safety and welfare are promoted. Evidence: The Matron is the Registered Manager, and is a qualified nurse and has an NVQ Level 4 in management. She has 23 years experience in care settings, including seven in management. She holds the NVQ Assessors qualification and the SLICE(Supporting Learners in a Clinical Environment) award. She keeps up her own level of knowledge and since the last inspection has done training in the following subjects: cross cultural Care Homes for Older People Page 25 of 30 communication, fire, diabetes, infection control, mental capacity, and she has also booked on the train the trainer course for First Aid in the New Year. There are clear lines of accoutability at Lynwood. The manager is supported in her role by the assistant matron who is an RGN and has the assessors award for NVQs. She also has the train the trainer award for Safeguarding Adults. There are two unit managers, a facilities manger, a hotel services manager and administrative support. The Director of Care supervises the manager and carries out the Regulation 26 visits. Arrangements for quality assurance are good and have been based on the CSCI Key Lines of Regulatory Assessment (KLORA). There are guidelines for staff on all care plans regarding good record keeping and evidence that residents have had input into their care plans, which are reviewed every month. Residents also get involved in choosing menus and one resident spoke about how residents were asked about food during residents meetings. There are also staff meetings and monthly Regulation 26 visits by the provider. The local pharmacist visits 6 monthly to monitor medication arrangements. The Charity reviews policiess and procedures. Staff training needs are monitored and a central staff training matrix is kept up dated. The manager ensures the home is using the latest best practice for example the new assessment and care planning formats drawn up by the Berkshire Care Association. Other regular auditing includes falls records which are kept and monitored, and complaints are properly recorded and monitored. The manager and deputy are currently incorporating the above into an annual development plan and this work is in progress. Some residents choose to have small amounts of money kept by the home for day to day personal use and all sign (or their relatives with legal permission can sign) to say that all monies are kept in one account and any interest accrued is ploughed back into the charity. In the past these small amounts of interest have been used towards additional activities for residents. Proper records are kept and the charitys accounts department monitor incoming and outgoing monies. Lynwoods Facilities Manager is the designated health and safety officer and the health and safety Committee meets regularly to look at current issues. There is a report from each unit and Miinutes and actions are recorded. The recent Environmental Health Officers report highlighted a number of requirements and all but one have now been completed. There is staff training on relevant issues e.g. infection control, fire, health and safety and food hygiene. Risk assessments are in place e.g. for the use of cot sides, bathing and nutrition. The hazardous substances (COSHH) cupboard was locked. The inspector and manager discussed the terrace outside Treetops, the dementia unit, and the manager agreed to draw up an additional risk assessment regarding the outer perimeter of this area. She was also asked to check with the Facilities Manager that in house arrangements for legionella fitted with HSE guidance Care Homes for Older People Page 26 of 30 for prevention of legionella in care homes. Care Homes for Older People Page 27 of 30 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 Older People Page 28 of 30 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 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 12 18 The Lynwood policy on safeguarding adults should be reviewed, as discussed during the inspection, to ensure the wording fits more closely with the local authority policy. The manager may consider a shortened version for day to day use by staff. The manager was asked to review the floor covering in the laundry which is currently not impermeable and therefore may be difficult to keep clean. Arrangements for the prevention of legionella should be reviewed to ensure they fit with the Health and safety Executive guidance on the prevention of legionella in care homes. 13 26 14 38 Care Homes for Older People Page 29 of 30 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 © (2008) 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. 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