CARE HOMES FOR OLDER PEOPLE
Lynwood Residential Care Home Limited 22/26 Grosvenor Road Paignton Devon TQ4 5DY Lead Inspector
Judy Hill Announced 26 October 2005
th 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 Residential Care Home Limited D54-D07 S63555 Lynwood V241983 261005 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Lynwood Residential Care Home Limited Address 22/26 Grosvenor Road, Paignton, Devon, TQ4 5DY 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) 01202 427780 01202 423913 Lynwood Residential Home Limited Mrs Hilda Teale Care Home 22 Category(ies) of Dementia (22), Old age, not falling within any registration, with number other category (22), Physical disability (22) of places Lynwood Residential Care Home Limited D54-D07 S63555 Lynwood V241983 261005 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Registered Manager must complete an NVQ at Level 4 by December 2005 The Home may accommodate a maximum of 22 service users in the registration categories of old age, dementia - over 65 years of age and physical disability - over 65 years of age. Date of last inspection 31st May 2005 Brief Description of the Service: Lynwood Residential Care Home is registered to provide accommodation and care for a maximum of twenty-two people who are over sixty-five years of age and who may have dementia and/or physical disabilities. The home is registered with Companies House as a limited company and a management consultant, Mrs Sue Heybourne, is the registered as the responsible individual. The registered manager is Mrs Hilda Teale. Lynwood is situated in a residential area of Paignton and is within walking distance of the town centre, the bus station and the railway station. The sea front is approximately half a mile away. Most of the bedrooms are single rooms and several have en-suite toilet facilities. There are two lounges and two dining rooms and a well used garden to the back of the house. Twentyfour hour care is provided and meals are home cooked on the premises. Lynwood Residential Care Home Limited D54-D07 S63555 Lynwood V241983 261005 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was announced and was carried out from 10am to 4pm on Wednesday 26th October 2005. The information contained in this report was gained in conversation with the registered manager, the responsible individual, care and catering staff and the residents of Lynwood. Additional information was gained from direct and indirect observation and from records including a completed pre-inspection questionnaire, needs and risk assessments, care plans, staff records, staff rotas, menu plans and records and a comprehensive risk assessment of the premises. What the service does well:
Very detailed needs assessments are being drawn up by the manager to identify prospective and current residents care needs. These are being used to identify individual risk and to produce risk management strategies and care plans for the staff to follow to ensure that each individual residents personal care needs are clearly identified and can be met by the care staff. The introduction of a key worker system has enabled the staff to form closer working relationships with and a better understanding of a small number of named residents. Service users medication is stored securely and is only administered by appropriately trained senior care staff. All of the staff help to monitor the physical and mental wellbeing of the residents on a regular daily basis and will bring any concerns that they have to the attention of the manager. The residents are treated with respect by the staff and are able to retain their privacy and dignity. The residents are encouraged to maintain contact with their families and friends and visitors are made welcome at any time. An extensive programme of refurbishment is currently taking place at Lynwood. To date the entrance hall, ground floor dining areas, ground floor lounge and several of the bedrooms have been finished to a very high standard. Further work is planned and when the refurbishments are completed Lynwood will be a very attractively presented home. Lynwood has an enclosed garden to the back of the house and this outdoor space is very well used. Although there are two bedrooms that are registered as double rooms, residents will not be required to share a room unless they choose to do so. The care staffing levels are maintained at a level that is high enough to meet the assessed needs of the current residents and additional staff are employed to carry out the bulk of the cleaning and to prepare meals. The manager has
Lynwood Residential Care Home Limited D54-D07 S63555 Lynwood V241983 261005 Stage 4.doc Version 1.40 Page 6 been very proactive in identifying suitable training courses for the staff and arranging for them to attend them. This training includes the statutory health and safety related training and specialist training in dementia care. The registered manager is competent and able to discharge her duties fully. She is well supported by the responsible individual and the homes owners. A detailed risk assessment has carried out on the premises and on all working practices. Regular servicing is carried out to ensure that the gas, electrical and fire fighting and mobility appliances are safe. What has improved since the last inspection? What they could do better:
The residents who are not taken out by their families are given very few opportunities to go out. More could be done to ensure that individual residents and groups of residents who wish to go out more are able to do so. Although in general the meals provided are very good, the manager must ensure that the catering staff fully understand the needs of individual residents who have specific dietary requirements and preferences and that they provide suitably meals for them.
Lynwood Residential Care Home Limited D54-D07 S63555 Lynwood V241983 261005 Stage 4.doc Version 1.40 Page 7 It was observed that one resident who cannot manage the stairs unaided had been placed in a bedroom that is only accessible via a small flight of stairs. When allocating rooms, consideration must be given to the individual residents mobility and their ability to access the communal areas of the home. The laundry floor is not easily cleanable and should be recoated of covered to ensure that it can be easily cleaned. 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 Residential Care Home Limited D54-D07 S63555 Lynwood V241983 261005 Stage 4.doc Version 1.40 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 Residential Care Home Limited D54-D07 S63555 Lynwood V241983 261005 Stage 4.doc Version 1.40 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 & 4 The improvements to the assessment processes will enable the manager to give prospective residents and their representatives more reliable written confirmation about whether or not the home will be able to meet the needs of people considering moving in. EVIDENCE: A sample of the service users needs and risk assessments were seen and demonstrated that since the last inspection the registered manager has done a great deal of work to improve them. The result is that these documents are much more detailed than they have been on previous inspections and that the information gained is kept in a much more accessible format. Lynwood Residential Care Home Limited D54-D07 S63555 Lynwood V241983 261005 Stage 4.doc Version 1.40 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, 9, 10 & 11 The care planning system is good and provides the care staff with the information they need to meet the personal care needs of the residents. The residents can be confident that their medicine will be administered and handled safely by trained staff. The residents can be confident that they will be treated with respect. EVIDENCE: An inspection of a sample of the residents care plans demonstrated that the new system of care planning that was being introduced during the last inspection has now been completed. The care plans now provide the information that the care staff need to ensure that they know and can meet the personal care needs of the residents and that they can monitor their health and physical well-being. A key worker system has been introduced and is being used to enable each of the residents to have a named care worker who will work regularly with them on a one to one basis. The key workers are also developing personal histories with the residents to provide the staff with a better understanding of them. This is particularly useful when working with residents who have dementia. Lynwood Residential Care Home Limited D54-D07 S63555 Lynwood V241983 261005 Stage 4.doc Version 1.40 Page 11 Only the senior care staff handle the residents medication and they have received appropriate training to do so. The medication storage, administration and record systems were spot checked and found to be satisfactory. Although two of the residents bedrooms are registered as double rooms they are currently being used as single rooms and the manage said that residents would not be asked to share a room unless they chose to do so. This ensures that each of the residents has their own private room in which they can receive their visitors if they choose to do so. Locks have been fitted to the bedroom doors and, subject to a recorded risk assessment, the residents have the option of holding their own keys. The care staff knock when entering residents bedrooms and were observed to address the residents by their preferred names. The wishes of the residents in the event of their death are recorded and will be respected. There is a pay phone in the hall and residents may have a private telephone line installed at their own expense if they wish. It is however suggested that the provision of a cordless phone could provide a greater degree of privacy for residents who wish to make and receive calls in private. Lynwood Residential Care Home Limited D54-D07 S63555 Lynwood V241983 261005 Stage 4.doc Version 1.40 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) 12, 13, 14 & 15 Some in house social activities are provided and these are good but more could be done to ensure that the social and recreational needs of the residents are being met both within their home and outside in the community. The meals provided are well-cooked, well-balanced and appetising but the residents cannot be confident that their special dietary needs and preferences will be met. EVIDENCE: The religious, social, occupational and recreational interests of the residents are being identified as part of the assessment process, however the provision of social, occupational and recreational stimuli is an area that could be improved upon. The residents religious needs are being met by visiting clergy of three different denominations but consideration could be given to providing staff support to enable the residents who wish to attend church services in the community to do so. The care staff organise regular games, such as prize bingo and hangman for the residents and musical entertainers visit the home on a fairly regular basis. Most of the residents have been seen enjoying these activities. On the day of
Lynwood Residential Care Home Limited D54-D07 S63555 Lynwood V241983 261005 Stage 4.doc Version 1.40 Page 13 the inspection a masseuse was at the home giving hand and foot massages and ‘Chi’ therapy, which the residents enjoyed. A professional hairdresser visits the home regularly, which also provides a social function. The garden to the back of the home provides a much used outdoor area for the residents when the weather is fine. The manager had taken three of the residents out for a drive the day before the inspection and one of the residents spoken with said how much she had enjoyed the outing. Such outings are not provided on a regular basis and more could be done to ensure that all of the residents who wish to go out are able to do so. There are no restrictions on visitors and the residents may receive their guests in the privacy of their own rooms or in one of the communal lounges. Residents who require help to manage their personal finances are encouraged to seek help from their families or a legal representative and this is recognised as an example of good practice. Lockable facilities will be provided for the residents to enable them to store their valuables securely. Lunch was seen being served during the inspection. The meal was homemade steak and kidney pie with roast potatoes, cabbage, green beans and gravy. Pudding was syrup sponge and custard. It was observed that alternatives were served to residents who did not want the set meal. The meal looked very well cooked and the portions were good. A record is kept of food provided. Although a record is kept of the residents who have special dietary needs because they are diabetic, no records appear to be kept in the kitchen of the residents who need to have their food pureed. This was evidence through an observation of two meals being sent back to the kitchen so that they could be properly prepared for two of the residents. The cook on duty said that one of the residents, who is not a strict vegetarian but prefers to eat vegetarian meals, is sometimes given meat and told that it is a ‘Linda McCarthy’ meat substitute. This is not acceptable. Lynwood Residential Care Home Limited D54-D07 S63555 Lynwood V241983 261005 Stage 4.doc Version 1.40 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 standard(s) 0 EVIDENCE: Standards 16 and 18 were assessed as met at the last inspection and were not inspected on this occasion. Lynwood Residential Care Home Limited D54-D07 S63555 Lynwood V241983 261005 Stage 4.doc Version 1.40 Page 15 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) 19, 20, 22, 24 & 26 An extensive programme of refurbishment is currently taking place and the rooms that have been completed provide a very attractive home environment for the residents. EVIDENCE: The home is very conveniently located, being within walking distance of the town centre, bus and train stations. Since the last inspection a major programme of refurbishment has been started. The entrance hall has been redecorated and a new laminate flooring been laid. This area is now light, bright and inviting. The improvements have been carried through to the two dining areas on the ground floor and the ground floor lounge, which are also very attractively presented. Several of the residents were spoken with about the homes refurbishment and commented very favourably about the changes. New chairs have been ordered for the first floor lounge and there are plans to refurbish this room and the adjoining dining room in the very near future. Lynwood Residential Care Home Limited D54-D07 S63555 Lynwood V241983 261005 Stage 4.doc Version 1.40 Page 16 The ground floor bathroom is in the process of being refurbished and a new Jacuzzi bath that is suitable for use by people with physical disabilities has been ordered. Consideration is being given to providing a ramp to the front door but wheelchair accesses is facilitated through a side entrance. New hoists are available for staff to use to assist the residents who require lifting. Ideally people who cannot manage the stairs without assistance should be placed in bedrooms on the ground floor but the home has a passenger lift and stair lifts to aid the resident’s mobility between floors. Some of the bedrooms are only accessible via stairs and should not be used by people who cannot manage the stairs as they will not be able to access the communal rooms unaided. Some of the bedrooms have been redecorated and provided with new lighting, flooring, furniture and bedding and there are plans to refurbish other bedrooms to the same high standard. The residents’ bedrooms have been fitted with locks and signed records are being kept of residents who do not wish to hold their own keys. The service users are provided with lockable facilities in which to store their money and other valuables. The laundry facilities are in an outbuilding. There is a washing machine with sluicing facilities and this is capable of washing soiled linen and a suitable high temperature to ensure that it is thoroughly cleaned. The laundry floor needs attention as it is impermeable and is difficult to keep clean. Lynwood Residential Care Home Limited D54-D07 S63555 Lynwood V241983 261005 Stage 4.doc Version 1.40 Page 17 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) 27, 28, 29 & 30 Safe recruitment processes are being carried out and the residents can be confident that they will be cared for by suitable and well trained staff. EVIDENCE: The staff rotas were seen and show that since the last inspection the care staffing levels have been increased and a cleaner has been employed. There is a minimum of two care workers on duty from 6.30am to 10.30pm, one of which is a senior care worker. In addition to this a student is employed on a full-time basis to assist with the provision of care and work under the supervision of the more experienced staff. Overnight care (10.30pm to 6.30am) is provided by one care worker on waking duty and one sleeping in and on-call. The registered manager works at the home on a full time basis. Ancillary support is provided by a part-time cleaner (21 hours a week), a chef, a cook and a kitchen assistant. Since the last inspection the manager has been very proactive in identifying suitable training courses for her staff and arranging training for them. Two of the staff have (overseas) nursing qualifications, one has completed an NVQ in Care at Level 3 and three have completed their NVQ in Care at Level 2. All of the care staff have attended certificated training courses in dementia care, lifting and handling, fire safety, and abuse. Arrangements are in place for the staff to attend a training course on Basic Food Hygiene. The senior staff have received training on medication administration.
Lynwood Residential Care Home Limited D54-D07 S63555 Lynwood V241983 261005 Stage 4.doc Version 1.40 Page 18 The manager has delegated some additional responsibilities to the staff by appointing one as the fire, health and safety officer and another as an accident analyst. In addition to this the staff have been given key worker responsibilities for named residents to enable them to form a closer working relationship with them and understanding of them and their individual needs. The staff all have new uniforms and a dress code has been introduced to ensure that the staff are always suitably and smartly presented. Staff recruitment records were seen and demonstrated that safe procedures are being used to recruit new staff. Lynwood Residential Care Home Limited D54-D07 S63555 Lynwood V241983 261005 Stage 4.doc Version 1.40 Page 19 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) 31 & 38 The registered manager is very able and caring and is well supported by the responsible individual and the homes owners so the residents can be confident that the service is well managed. EVIDENCE: The registered manager is relatively new to the post but has had many years experience in the provision of care. She is working towards gaining her NVQ in Care at Level 4 and her Registered Managers Award and hopes to gain these qualifications by December 2005. She has attended numerous training courses to update her skills and has been very proactive in identifying suitable training courses for her staff. The management of the home is overseen by the registered Responsible Individual, Mrs Sue Heybourne and although the home owners are no longer directly involved in the day to day running of the home, they continue to play a supportive role and have been actively involved in the programme of refurbishment. Lynwood Residential Care Home Limited D54-D07 S63555 Lynwood V241983 261005 Stage 4.doc Version 1.40 Page 20 Records of staff training demonstrate that the manager is arranging for her staff to attend suitable training courses in health and safety related topics and that a system is in place to identify when training updates are needed. A very detailed assessment was seen which demonstrates that working practices and the safety of the home environment have been comprehensively risk assessed. Records are kept of regular checks on services and appliances. Accidents are recorded and are being analysed to identify the cause of the accident. Lynwood Residential Care Home Limited D54-D07 S63555 Lynwood V241983 261005 Stage 4.doc Version 1.40 Page 21 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 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2
COMPLAINTS AND PROTECTION 3 3 x 2 x 3 x 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 x x x x x x 3 Lynwood Residential Care Home Limited D54-D07 S63555 Lynwood V241983 261005 Stage 4.doc Version 1.40 Page 22 Yes 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 12 Regulation 16 Requirement Timescale for action 26/11/05 2. 15 16 Arrangements must be made to enable the residents who wish to do so to engage in social activities outside their home environment to do so. The manager must ensure that 26/11/05 the catering staff fully understand the needs of individual residents who have specific dietary requirements and preferences and that they provide suitable meals for them. Previous timescale 31/6/05 not met. Arrangements must be made to ensure that residents with physical disabilities are given suitably positioned bedrooms so that they can access the communal rooms as and when they wish to do so. The laundry floor must be recoated or covered to ensure that it can be thoroughly cleaned. 3. 22 23 26/1/06 4. 26 13 26/12/05 Lynwood Residential Care Home Limited D54-D07 S63555 Lynwood V241983 261005 Stage 4.doc Version 1.40 Page 23 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 Good Practice Recommendations Lynwood Residential Care Home Limited D54-D07 S63555 Lynwood V241983 261005 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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