Care Home: Lyncroft

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What the care home does well The home ensures that the needs and wishes of people who use the service are paramount. There are many examples of good practice, which can be highlighted as evidence of this including when and what to eat. Staff are well trained, and generally have the knowledge and understanding to provide people who use the service with a good standard of care. People who use the service are at the heart of their ethos, and all activities are arranged with this in mind. Walsingham are committed to ensuring that their workforce has a solid foundation during their induction period; and that staff then undertake regular training in order to improve their knowledge and skills. This was evident as staff were all able to communicate effectively with people who use the service even though they had very different communication patterns. What has improved since the last inspection? Lyncroft has worked hard to ensure that all the requirements and recommendations made at the last inspection have been actioned. In particular, issues around the administration of medication have been rectified. What the care home could do better: The home has taken on a transitions role between long term institutional care and living in the community. In the event of this, the home needs to give even greater thought and consideration to new people moving into the service so that the transition can be as smooth as possible. Key inspection report Care homes for adults (18-65 years) Name: Address: Lyncroft 237 Banstead Road Banstead Surrey SM7 1RB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Rin Saimbi     Date: 1 6 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. that people have said are important to them: They reflect the things 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. Care Homes for Adults (18-65 years) Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Lyncroft 237 Banstead Road Banstead Surrey SM7 1RB 02087868381 02087868381 bansteadrd@walsingham.com www.walsingham.com Walsingham Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Lyanna Mesure Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 5 The Registered Person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD Date of last inspection Brief description of the care home Lyncroft is a residential care home that was first registered in January 1997 to provide care for people with learning disabilities. Over recent years there has been a period of uncertainty as the future of the home was unclear. The home has a clearer direction and focus now; it will be providing an interim home to people who have recently been discharged from long stay hospitals and preparing them for supported living accommodation in the community. Their stay will range from Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 5 Brief description of the care home twelve to eighteen months. This homes ethos is based on Christian philosophies. The home is one of four homes in the Croydon and Sutton area that are owned by `Walsingham, which is a registered charity. Lyncroft is a two storey detached property in keeping with the other houses in Banstead Road. The property lies between Banstead and Ewell; it cannot be accessed easily by public transport, with a train station ten minutes walk away and no bus links. The costings for the year 2009/10 range from £1,689 to £1,726 per week. The costings reflect the level of needs of the individuals placed into the home; placing authorities are advised to contact the home directly to get a full menu of costs. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection that started at 9.40 am and finished at 1.40 pm. Lyncroft has been in a state of flux for some time. It has recently been redesignated as an interim home for people with learning difficulties moving from long stay institutions into the community. When we inspected four people had moved into the home on the previous day, this impacted on the inspection and how it could be conducted. References to its impact are highlighted in the report. The inspection itself took the form of meeting with all the people who had recently moved into the home, we were able to talk to two people, and as two did not have any verbal communication, observe interaction between them and staff. When we asked one person, is it OK? they replied yes. We were also able to meet with a relative who was visiting on the day of the inspection. Care Homes for Adults (18-65 years) Page 6 of 28 There was a tour of the buildings communal areas and some of the bedrooms, which was only undertaken with permission of people who use the service. We looked through documentation, which related to people who use the service to make sure it was relevant, accurate and up to date. We checked documentation coming into the Commission, so that this report reflects the home over the year, rather than a snapshot of findings on the day of inspection. We received an Annual Quality Assurance Assessment, which is the homes own assessment of of how is functioning, this document was received in a timely manner. We would like to thank the people who use the service and staff for their time and cooperation during the inspection process. Care Homes for Adults (18-65 years) Page 7 of 28 What the care home does well: What has improved since the last inspection? 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is gathered about any potential new people coming into the service. Therefore all staff have a full picture of the individual and their needs, and is only providing a service to those whose needs it can meet. Evidence: Lyncroft has been in a period of flux of some considerable time concerning the group of individuals it would accommodate. This has finally been agreed, so that Lyncroft accommodates people who have been in long term institutions with a view to making them more independent so that they can live in the community. To this end people are accommodated for between twelve and eighteen months. On the day that we inspected four people new people had moved into the house on the previous day. The process for introductory visits has changed little since the previous inspection. The manager stated that Social Services had sent them basic information. Once they had identified the home as a possible placement, the manager visited people where they Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: lived on two or three occasions. There had also been a moving in party where staff from the existing establishment had come to Lyncroft with the people that were moving in. This was particularly important as two people moving in had no verbal communication. We case-tracked two people who had moved in (case-tracking means looking at all the information held about people who use the service). In both cases there was a comprehensive assessment and care plans from Social Services, and information from the previous place that they had lived. The manager was able to provide notes of information that she had gathered for the homes own assessment, which was yet to be formally written up. The registered provider had ensured that the specialist needs of one individual would be catered for prior to moving into the home, this included the installation of grab rails and moving furniture around so that the person could navigate the home. Whilst acknowledging the homes attempts to make the move as smooth as possible, greater thought to detail should be given. Two issues that arose during the inspection, firstly one person using the service could not remember where their room was, this could easily be rectified with a photograph on the bedroom door. Secondly, on the first night there were no additional staff on duty which impacted on what meal could be prepared. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have care plans written by the previous placement. Information has been gathered in order to compile their own assessments in a timely fashion. Evidence: We case-tracked two people who use the service and although full assessments had not yet been written, there was evidence that information had been gathered. This information was detailed and included notes on how someone put on their deodorant and what order they got dressed. There was plenty of information from other professionals which was available, this included risk assessments, activity plans and health needs. As people had moved in less than twenty four hours ago, and as there is nothing to suggest that all paperwork will not be completed in a timely fashion, the Commission will not be taking issue regarding this matter. Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: Walsingham have a confidentiality policy which is discussed with new staff during their induction period. Staff were able to confirm their understanding of the policy during discussions. Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service will be offered the opportunity to participate in a range of activities, dependent upon preferences. Dietary needs are catered for with meals based on peoples choice of likes and dislikes, providing them with daily variation and healthy eating options. Evidence: People who use the service each have their own existing activity which is based around a day center; this activity will be honored during an interim period and then reviewed in a month. The manager is in the process of resourcing activities in the community, these include a cookery club, sensory room, cinema, meals out and sports. One person has expressed his wish to attend church, this will be arranged. There is also some Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: consideration to where people will go on holiday. On their first full day at Lyncorft, people were observed to be getting used their surroundings, asking for drinks and one person was going to the supermarket with a member of staff. With regard to meals, in the past the home have attempted to use pictorial images to allow people to make choices about what they want to eat. We observed during the inspection that people were given a choice of what they wanted to eat at lunchtime. One person had already expressed his preference for peanut butter which was being supplied. Three people have some contact with their familys. During the inspection we were able to meet and talk to one relative visiting the home. The home has an open visitors policy to ensure that friendships and family links are maintained. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal care is carried out in a way that people who use the service have their dignity and choice maintained. Evidence: The way in which people who use the service prefer to receive their personal care is recorded. The designation of a key worker should allow for consistency and continuity of care. Staff were asked about issues of privacy and dignity and their responses indicated that they had an appropriate awareness and understanding. There were no current health records to examine. Though there has previously always been a number of professionals involved in the care of the people who use the service. The home stores all medication in a locked metal cabinet in the office. The home receives much of its medication from the pharmacist in dossette packs on a monthly basis. There is an annual audit by a pharmacist, and an annual internal audit. Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: We checked some records relating to the administration of medication and found no errors. A previous requirement surrounding recording of medication has therefore been withdrawn. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is complaints policy and procedure, which facilitates good access to the complaints system for people who use the service, their family or their representatives. This should ensure that people feel that their views are listened to. The home has the appropriate policies in place to ensure the protection of vulnerable adults. Evidence: The complaints procedure was clear and contained all of the elements required to meet standard 22 including a minimum response time of less than 28 days. The complaints procedure is also in picture format and clearly displayed in a number of places within the home. The home has a complaints log; within the last year there were three entrys, two of which were not complaints. The other issue had been dealt with in a timely fashion. There have been three vulnerable adult referrals and in all cases there have been dealt with in an appropriate manner. Staff are up to date with training regarding vulnerable adults; they have also received training about the Deprivation of Liberty Act. Staff were given a scenario regarding vulnerable adults and both were able to give an appropriate response. Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: Care Homes for Adults (18-65 years) Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In general the decor of the home is good, providing a comfortable environment for people who use the service to live in. Evidence: The home is a detached house on a residential road. It is close to Banstead train station, but local amenities can only be accessed via car. The homes premises are in keeping with the local community and are suitable for their purpose with adaptations being made for some people who use the service. On the ground floor there is a large communal lounge with access to an integral garage; the access to the garage is kept locked. Additionally, on the ground floor, there is a dining room, kitchen, laundry room, two bedrooms and one bathroom. On the first floor there are a further three bedrooms, two bathrooms, a sleeping in room and an office. It was noted that all windows have been fitted with restrictors this is in line with a previous requirement. To the rear of the property, there is a mature garden, which can be accessed via Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: French doors from the lounge. Arrangements are being made to install a ramp to ensure that everyone in the home has access. There are separate laundry room with facilities that can wash clothes at a temperature which would control the risk of infection. The premises were generally clean, bright and airy. It was noted however, that the ground floor bathrooms was in need of a deep clean. In addition the flooring in one particular area, had come away. Therefore it could potentially be an unhygienic area, with some risk of tripping. A recommendation is therefore being made, that the registered provider ensures that the area is maintain and kept hygienic. Each person using the home has a single room, which has been decorated to reflect their individual taste. The furniture is domestic in style and of good quality. Care Homes for Adults (18-65 years) Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff team at the home have a range of skills and abilities, which enable them to meet the needs of people who use the service. Staff receive levels of training and support through supervision so that the calibre of staff remains. Evidence: The arrangements for staffing are determined by the number of people living at the home; currently there are four living at the home which equates to three members of staff on the morning shift and three in the evening. At night there is one waking night and one sleeping in. Staff rotas were checked at random to ascertain the staffing levels at any given time; the rotas confirmed the level of staffing. Technically the home is fully staffed, however, there are four members staff who are currently absent for varying reasons. The manager stated that any absences are covered by regular agency staff. It was noted that in one week, eight shifts were covered by agency staff. This level of agency staff could compromise the dignity of people who use the service, as they have different staff members providing intimate Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: personal care. The registered provider should be mindful of this situation. Walsingham offers ample training opportunities to staff at all levels. New members of staff complete an induction programme covering various subjects including health and safety, fire drills, and introductions to people who use the service. The induction programmes are signed, dated and kept on staff files. Records of training are kept both within the home and centrally. Records were checked and showed that staff had completed the requisite number of days training. This information was recorded on database which indicated when staff needed refresher courses. Recruitment records are all held centrally by Walsingham, these are checked by CQC on a regular basis. Supervision of staff occurs on a four to six weekly basis; this was confirmed by records of supervision and staff that we talked to during the inspection. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In general, the home has adequate arrangements for ensuring the health and safety of people who use the service and of the staff. Evidence: The homes current manager has been post since November 2008; Ms Lyanna Mesure will be undertaking her registration with the Commission within the next week. The Walsingham group have a legal responsibility to complete Regulation 26 visits every month and have copies available for inspection purposes. The regulation 26 visits are an internal audit by a person not directly responsible for running the home, as a way of ensuring quality; Copies of the regulation visits were available for the recent months. We looked at the first aid boxes, all items contained within them were up to date. Therefore a previous requirement about the removal of out of date items has been withdrawn. Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: Fridge and freezer checks were examined, they showed that checks were undertaken on a daily basis. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 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 1 2 4 30 The registered provider should ensure that greater thought is given to the intial period of someone new moving in. The registered provider should make good the flooring in the bathroom and ensure that it is kept clean at all times. Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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