Care Home: Lyncroft

What the care home does well The home continues to provide a comfortable and domestic scale environment for the people who live there, all of whom have mental health difficulties, including some needs that are complex. People living at the home told us that they liked living there and that they received a lot of support from staff. One person stated, "Staff are really OK". The home is working hard to motivate people to become more independent. The home has clear, detailed and up to date records and administrative systems that assist in meeting people`s needs effectively. What has improved since the last inspection? At the last key inspection six requirements were made and we were pleased to see that these had all been complied with. The required improvements made were in the following areas: to review care plans on a regular basis to make sure they reflected peoples current needs and aspirations; to provide further training for staff in the safe administration of medication, to help avoid mistakes when giving medication; to fit window restrictors or assess the risks of not doing so, to minimise the risk of accidents to residents; to replace or repair the floor in the laundry, to help control the spread of possible infections; to make sure that the home undertook the proper recruitment checks on staff when employed at the home, to help keep residents safe and for the manager of the home to be registered with the Commission, to verify his skills and competence to do his job. Four good practice recommendations were also made at the last inspection in the following areas: For key workers to write monthly reports on residents progress, to help when reviewing care plans; to seek written agreement from a G.P. for a resident that staff were helping to become more independent in looking after their medication and to obtain recently published safeguarding adults information from the local authority to complement the home`s own procedures. All of these recommendations had been effectively acted on. CARE HOME ADULTS 18-65 Lyncroft 11 Bushwood Leytonstone London E11 3AY Lead Inspector Peter Illes Key Unannounced Inspection 14th August 2008 10:00 Lyncroft DS0000007246.V369250.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lyncroft DS0000007246.V369250.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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. Lyncroft DS0000007246.V369250.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lyncroft Address 11 Bushwood Leytonstone London E11 3AY 020 8989 5933 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Ms Jenniffer M. E. Khan Abdu Raouf Nauyeck Care Home 12 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (12) of places Lyncroft DS0000007246.V369250.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Special category - to include one named person with learning disabilities 29th October 2007 Date of last inspection Brief Description of the Service: Lyncroft is a privately operated care home registered to provide care and support to twelve adults with mental health problems. The home is a large converted two storey residential property. The ground floor comprises: five residents bedrooms, lounge, dining room, kitchen and a conservatory that is a designated smoking area and leads out to a large attractive garden; there are six further bedrooms on the first floor, one of which is registered to accommodate two people. There are sufficient toilet and bathroom facilities on both floors and the home’s laundry facilities are in the basement. The area is well served by public transport with Leytonstone underground station and local bus stops within walking distance. Access to the M11 is close by at the Green Man roundabout, which makes road communication very accessible to various parts of London. There are many easily accessible facilities and amenities within the local community including various local shops, supermarkets, and G.P. surgery, opticians, library and public offices. A stated aim of the home is to provide people that live there with a secure, relaxed and homely environment in which their care, well-being and comfort are of prime importance. At the time of the inspection, the weekly fee was from £600 per week depending on the person’s assessed need. Information about the service, including inspection reports, is available on request from the registered manager and registered provider. Lyncroft DS0000007246.V369250.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced key inspection took approximately five and one half hours with the registered manager being present or available throughout; the registered provider was also present for the majority of the inspection. There were nine people living at the home. One of the home’s bedrooms is registered as a double room although is only occupied by one person. The registered manager stated that because of this the home had only two effective vacancies at the time. One new person had moved into the home from another of the provider organisation’s homes since the last inspection. The inspection was undertaken by the lead inspector although terms such as “we”, “our” and “us” are used where appropriate within this report to indicate that the inspection activity was undertaken on behalf of the Commission. The inspection activity included: meeting and speaking to the majority of the people living in the home and speaking to two of them independently; detailed discussion with the registered manager and the registered provider; independent discussion with the senior support worker and another support worker; independent discussion by telephone with a community psychiatric nurse from L.B. of Waltham Forest Community Mental Health Team and also with a social worker from L.B. of Newham, both of whom had recent contact with the home. Further information was obtained from a current Annual Quality Assurance Assessment (AQAA) submitted by the home, feedback questionnaires from five staff, a tour of the premises and documentation kept at the home. What the service does well: The home continues to provide a comfortable and domestic scale environment for the people who live there, all of whom have mental health difficulties, including some needs that are complex. People living at the home told us that they liked living there and that they received a lot of support from staff. One person stated, “Staff are really OK”. The home is working hard to motivate people to become more independent. The home has clear, detailed and up to date records and administrative systems that assist in meeting people’s needs effectively. Lyncroft DS0000007246.V369250.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Lyncroft DS0000007246.V369250.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lyncroft DS0000007246.V369250.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 5 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Up to date information is available to prospective residents and other interested people to make an informed choice about living in the home. People’s needs are regularly reviewed once they are living in the home to assist staff be aware of any changes in these needs. EVIDENCE: The home has a satisfactory statement of purpose and service user guide that was seen. The registered manager informed us that each person has a statement of the terms and conditions for living at the home that forms part of the service user guide. Those sampled were satisfactory and had been signed by the person and a representative from the home. In addition we were informed that the home has a contract for each person with their placing authority and those sampled were again seen to be satisfactory. One new person had been admitted to the home since the last inspection although that person had been admitted from another of the provider organisations home’s, which is situated a few doors away in the same road. Residents from both homes mix socially to the extent that they wish and the Lyncroft DS0000007246.V369250.R01.S.doc Version 5.2 Page 9 staff are familiar with residents in each of the homes. The person had moved at their own request, which they confirmed when spoken to independently. The files of four people living in the home, including that of the person who had moved from the nearby home, were inspected. They all showed that their needs were reviewed on a regular basis to allow staff to properly address their changing needs. This included evidence that enhanced care programme approach (CPA) meetings were taking place where appropriate. These are formal review meetings required by mental health legislation. A social worker from L.B of Newham was spoken to independently by telephone. She said that she had recently reviewed a person placed at the home by L.B. of Newham and was happy with the care the home was providing. Following a good practice recommendation made at the last inspection key workers now also undertake monthly reviews of people’s progress, with the information then being used to update the person’s care plan. It was noted on the records of key worker sessions sampled that the residents’ preferences are discussed as well as their more clinical needs regarding their mental health and included their preference about addressing their culture, religion and sexuality. A resident spoken to independently confirmed that they were involved in both their CPA and key worker meetings. Lyncroft DS0000007246.V369250.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are consulted when their needs are assessed and both people’s needs and preferences are recorded in their care plans to assist staff in meeting these. People are supported to maximise their independence by making as many decisions as possible for themselves. People are also supported and guided to take appropriate risks in their daily lives to assist them to safely achieve their aspirations. EVIDENCE: A requirement was made at the last inspection that all care plans are evaluated and reviewed at least every six months and more frequently if the person’s needs change. Evidence was seen that this requirement was being complied with. The care plans for four of the people living at the home were inspected. These were current, based on up to date assessment information, including from multidisciplinary meetings with health and social care professionals. The Lyncroft DS0000007246.V369250.R01.S.doc Version 5.2 Page 11 care plans had been signed by the resident involved and were being reviewed at least every six months. Care plans were focussed on people’s individual needs and preferences and included promoting their independence and in assisting them to keep well and safe. Care plans also recorded people’s needs and preferences regarding their culture, religion and sexuality. A copy of the Commission’s recently published key equality and diversity prompts was left with the registered provider to further assist the home in this area. Residents spoken to independently indicated that they were comfortable with the support that they received from staff. They also that they were involved in meetings with their key workers and in meetings with other health and social care professionals, including in reviewing their care plans. People living in the home continue to be encouraged and supported to make decisions about their day-to-day lives and to be involved in any meetings or discussions relating to them. The home holds regular residents meetings to discuss their wishes and preferences regarding the running of the home. Records of these meetings were sampled and showed individual feedback from each resident at the meeting. A recent entry included a record of discussions about outings during the summer and discussions about the ongoing decoration programme for the home. The home’s Annual Quality Assurance Assessment (AQAA) stated that all residents are risk assessed individually and this includes risks within the home and risks out in the community, e.g. travelling by public transport (bus, train), visits to the library, shops, relatives etc. The files inspected for four people contained up to date risk assessments that recorded identified risks that had been identified for that individual and evidenced the statement made in the AQAA. The risk assessments seen had been signed by the resident concerned and residents spoken to independently confirmed that they had been involved in the risk assessment process. Lyncroft DS0000007246.V369250.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home are encouraged and supported to participate in a range of activities including within the wider community. They also enjoy contact with relatives and friends to the extent that they wish. People are supported to be as independent as possible and are supported to enjoy healthy and nutritious meals of their choice. EVIDENCE: The majority of people living at the home can and do travel independently and have freedom passes to assist with this. One person travels in the community with the support of staff because of their specific needs. People’s support needs when travelling in the community were appropriately recorded on the files sampled. At the time of this inspection one person was attending a local authority day service one day a week. The registered manager stated that staff Lyncroft DS0000007246.V369250.R01.S.doc Version 5.2 Page 13 and health and social care professionals try to encourage more residents to become involved in more structured day time activities outside of the home. However, most choose not to do so preferring to make their own arrangements, including travelling independently in the community and residents spoken to independently confirmed this. Evidence was seen of other activities coordinated by the home including involving people in shopping trips, outings to pubs, to the library, cinema, meals out, a BBQ and day trips, including a day trip to Margate, planned for the day following this inspection. One resident was asked if he was looking forward to the trip to Margate and stated, “ I may go depending on how I feel”. People living at the home are supported to attend places of worship according to their wishes. One staff member stated that the person she was key worker for, who had a visual impairment, did not want to attend church but did like listening to “Songs of Praise” on the television. That person was observed listening to church music in their room. The home’s Annual Quality Assurance Assessment (AQAA) stated that residents are encouraged to form their own personal lifestyle/ personal relationships, platonic and sexual, and that relationships have been formed by some residents outside of the home. Evidence to support this statement was gathered from files inspected and from residents and staff spoken to independently. The majority of people living at the home have contact with relatives and friends ranging from weekly to annual contact depending on the wishes of the individuals involved. Daily routines in the home assist to promote people’s independence and people spoken to independently confirmed that they could get up and go to bed when they wished. Staff were seen to interact positively and appropriately with people accommodated throughout the inspection. A community psychiatric nurse from L.B. of Waltham Forest Community Mental Health Team stated that in her experience staff treated residents with respect and had a good understanding of their needs, which assisted with this. People are also appropriately encouraged to undertake daily living tasks to assist develop their independence skills and this was documented in their files. This includes people being able to cook meals with an appropriate level of staff supervision. One resident told us that they felt that access to the kitchen was sometimes unacceptably restricted. However, when this was raised with the registered manager we were informed that access to the kitchen was only restricted when staff were cooking communal meals or when the kitchen was being cleaned. Staff and another resident spoken to independently confirmed this. The registered manager reinforced this to the resident concerned while we were present and the person appeared satisfied with this. We were told that each person living in the home has a key to their bedroom and residents spoken to confirmed this. Lyncroft DS0000007246.V369250.R01.S.doc Version 5.2 Page 14 The home has a weekly menu that is written after consultation with people living in the home. The current menu showed a range of healthy and nutritious meals with people being given the option of choosing an alternative of their choice if they did not want the meal on the menu. One person has a separate menu with a range of African meals that they have chosen and are supported by staff to cook these. Ingredients seen in the home to prepare these meals included fufu flour and palm fruits. The home had sufficient food that matched the menu and that was properly stored. All the people living at the home that were spoken to stated that they liked the food. Lyncroft DS0000007246.V369250.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home receive appropriate personal support in accordance with their needs. They are also supported in meeting their physical, mental and emotional healthcare needs, including by accessing relevant health care professionals. The medication administration procedures within the home safeguard people living there. EVIDENCE: The majority of people living at the home are independent regarding their personal care although may need some verbal prompting on occasion. One person needs more direct support from staff in this area and this is appropriately recorded. Staff spoken to independently were able to describe how they provided direct personal care in a sensitive way and in keeping with the individual’s preferences. Residents spoken to independently indicated that staff were sensitive to any specific support needs they may have and during Lyncroft DS0000007246.V369250.R01.S.doc Version 5.2 Page 16 the inspection residents spoken to were appropriately dressed and presented in styles of their choice. The registered manager stated that some specialist mental health staff from the community based service who knew the residents and home had left and this did not help continuity of specialist support for residents. Evidence was seen from files inspected that the home continues to work hard to build and develop good working relationships with mental health services and this assists in keeping people well. The home’s Annual Quality Assurance Assessment (AQAA) stated that all residents are registered with a GP and are supported to attend medical appointments. Evidence of this was on files inspected. Each file inspected had a summary of appointments made with health and social care professionals and a separate record of the outcome of that appointment, including any action required. The records showed evidence of appointments with mental health specialists, general hospital outpatient departments, chiropodist, dentist and optician. At the last inspection a requirement was made that all staff that administer medication receive further training as a priority in the system of administering medication that the home was then using. This requirement was made as, at that time, the home had recently changed the dispensing pharmacist it was using and was unable to properly demonstrate that medication was being administered safely. Since the last inspection an in-house management review of medication procedures was undertaken and satisfactory records of this were seen at this inspection. We were told that the home had continued to remain dissatisfied with the service it received from the dispensing pharmacist and had changed pharmacists again. At this inspection evidence was seen that all staff were taking part in a detailed training course in safe administration of medication run by Lloyds Pharmacy in conjunction with Keele University. The training programme started in April 2008 and is due to be completed in September 2008. The home had a basic but satisfactory medication policy that the registered provider had reviewed in 2007. The home also had descriptions of medications prescribed to individual residents, what it was prescribed for and also had more detailed reference guides giving information on different medications. Medication was being safely stored and satisfactory records were seen of medication received into the home and medication disposed of. The medication and medication administration record (MAR) charts for two residents were sampled. These were accurate, indicating medication was being given as prescribed with no evidence of mishandling or missed doses. The home also encourages residents to take responsibility for administering their own medication where this is assessed as being appropriate. At the last inspection a good practice recommendation was made that the home should seek written agreement from the prescribing doctor for an individual resident, that they are in agreement for staff to work towards self-administration of medication for this person. This recommendation had been acted on. We were pleased to see that the registered persons had taken robust action since the Lyncroft DS0000007246.V369250.R01.S.doc Version 5.2 Page 17 last inspection to improve the home’s systems for safely administering medication. Lyncroft DS0000007246.V369250.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home are able to express their views and concerns and have these acted on appropriately. The home’s safeguarding adults policy and procedures assist in protecting people from abuse. EVIDENCE: The home had a satisfactory complaints procedure that was seen in individual service user guides and included all the elements specified in the national minimum standards. At the last inspection a good practice recommendation was made that the home should display a copy of its complaints procedure in a communal area of the home to make it more accessible to people living there and to other people who may visit. This recommendation had been acted on with a copy of the procedure displayed. People living at the home indicated that they knew how to raise concerns when they wanted to and that these were acted on when raised. Three complaints had been recorded since the last inspection. A relative of one of the residents made two of these and evidence was seen that these had been appropriately acted upon in accordance with the home’s procedure. The third complaint was a general one made to the L.B. of Waltham Forest by local residents in the community regarding alleged antisocial behaviour by people with mental health difficulties within the local area. This had been communicated to us by L.B. of Waltham Forest for information. We in turn referred this to a number of residential homes in the area to ask Lyncroft DS0000007246.V369250.R01.S.doc Version 5.2 Page 19 them to be aware of the complaint and to ask them to look into the matters raised in case it concerned their particular residents. The registered provider of Lyncroft had responded to us in a timely way that she could find no evidence that the complaint related to the residents at the home. No complaints directly relating to Lyncroft have been made to the Commission since the last inspection. At the last inspection a good practice recommendation had been made that the home should obtain a copy of the L.B. of Waltham Forest’s revised safeguarding adults policy and review its own safeguarding adults policy and procedures as a result of this. This recommendation had been acted upon. At this inspection the home has a satisfactory safeguarding adults policy and also a copy of the revised L.B. of Waltham Forest’s policy. There have been no allegations or disclosures of abuse made to the home or to the Commission since the last inspection. Evidence was seen that staff had undertaken training in safeguarding adults and staff spoken to were able to describe what action needs to be taken should an allegation or disclosure of abuse be made to them. We were informed that the home was not the appointee for any of the residents’ finances. The home does hold personal allowances for residents and the personal allowance and records relating to this were inspected for one person. These were satisfactory with the cash being held in an individual purse that was securely stored and the cash matched the record seen. Lyncroft DS0000007246.V369250.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27 & 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a home that is comfortable, well decorated, well maintained and that meets their current needs. People who live in the home, staff and visitors benefit from the building being kept clean and tidy. EVIDENCE: The home is a large converted two storey residential property. The ground floor comprises: five residents bedrooms, lounge, dining room, kitchen and a conservatory that is a designated smoking area and leads out to a large attractive garden; there are six further bedrooms on the first floor. There are sufficient toilet and bathroom facilities on both floors and the home’s laundry facilities are in the basement. The home is suitably decorated and furnished. Lyncroft DS0000007246.V369250.R01.S.doc Version 5.2 Page 21 People living in the home stated that they liked their bedrooms and those seen during a tour of the premises had been personalised to varying degrees by the person that occupied them. People spoken to also stated that when rooms were decorated they were consulted about their preferences regarding this. The registered manager confirmed that although one room was registered as a double room it was occupied by one person and as a result of this the maximum number of people the home could currently accommodate was eleven. The home’s Annual Quality Assurance Assessment (AQAA) stated that the home maintains a monthly quality assurance monitoring system and any areas of concerns or defects (about the building) are addressed with immediate effect. Evidence of this monitoring was seen as well as reports from the registered provider’s monthly visits to the home that identify any shortfalls in the building. At the last inspection a requirement was made that window restrictors are fitted to all first floor windows unless a specific risk assessment has been undertaken for each person regarding risk in this area. This requirement had been complied with and it was noted that all the windows to the front of the home have been replaced with double glazed units that include having restrictors fitted. The home’s Annual Quality Assurance Assessment (AQAA) also stated that plans for the next twelve months include re-tiling of all toilet and bathroom areas; painting and decorating of all communal areas, further window replacement and new carpets. Evidence was seen at this inspection that this work has commenced with new carpets in place and a new floor having been laid in the kitchen and laundry. The home was clean, tidy and free from unpleasant smells during the inspection and the registered manager stated that people living in the home were encouraged and supported by staff in keeping their rooms clean. The home has suitable laundry facilities that meet the needs of the current residents. A requirement had been made at the last inspection that the laundry floor is replaced or repaired to make it non-porous to maximise infection control protection in this area. As stated above, this requirement was seen to have been complied with. Lyncroft DS0000007246.V369250.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. A staff team with a range of qualifications and competencies, in sufficient numbers, support people living in the home. The home’s recruitment policy assists in protecting people living in the home. People are supported by staff who have access to a range of appropriate training. Staff also receive formal supervision to assist in further meeting the needs of people living in the home and in their own personal development. EVIDENCE: At the time of this inspection the home was employing a registered manager, one senior support worker, ten support workers and one bank support worker. Two support staff work the morning shift, two support staff work the afternoon/ evening shift and two waking support staff work at night. The registered manager confirmed his hours are in addition to this. The registered manager also confirmed that he usually worked during office hours although also worked some shifts to help him be aware of what happened in the home on different shifts. Care staff work double shifts from 8am to 8pm and the Lyncroft DS0000007246.V369250.R01.S.doc Version 5.2 Page 23 night staff work from 8pm to 8am. Staff spoken to independently stated that working long shifts suited them and felt that it also worked to the home’s benefit by maintaining more continuity of care throughout the day. A copy of the rota was seen and accurately recorded the staff on duty during the day. The staffing ratio at the home was judged to be satisfactory to meet the current needs of the residents. All the staff have either achieved or are working towards qualifications that will assist them to further enhance the lives of residents and to further their own career development. Eight of the ten support workers have achieved the national vocational qualification (NVQ) level 2 in care and two are due to complete this qualification later in August 2008. Two of the support workers are now working towards NVQ level 3 in care. The senior support worker has achieved NVQ level 2 in care and is also working towards level 3. The registered manager is a registered mental health nurse. At the last inspection a requirement was made that no new staff, at any level, start work at the home until the provider organisation has received a new and satisfactory criminal records bureau (CRB) clearance and protection of vulnerable adults (POVA) check, or, in exceptional circumstances, a POVA First check while waiting for the full CRB. In the latter circumstances the staff member must be supervised at all times until the full CRB is obtained. This requirement is being complied with. No new staff have been employed since the last inspection although one member of support staff had transferred from another of the provider organisation’s homes. This member of staff had a CRB and POVA undertaken by the provider organisation when first employed although the registered provider had obtained new clearances when the member of staff transferred to Lyncroft. Documentary evidence of the current clearances was seen at this inspection. An overall staff-training matrix for the home was seen and documentary evidence of individual staff training records were sampled; these evidenced that the provider organisation was committed to staff training. Training undertaken in the past twelve months included breakaway training, safe administration of medication, safeguarding adults, fire safety, moving and handling, and food hygiene. Staff spoken to independently confirmed that they received regular training. The home has also committed to an Investors in People assessment, which is due to start in October 2008. Staff receive individual supervision at least every two months and this was evidenced by documentation seen in the home and from staff spoken to. The registered manager stated that he asks people to look at identified policies and procedures at one supervision session and then checks this at the next. Staff spoken to confirmed this. Lyncroft DS0000007246.V369250.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from the effective management systems used in the home and their views are sought regarding the quality of life they experience. Health and safety procedures assist in protecting people living at the home, staff and visitors. EVIDENCE: At the last inspection the registered manager had only been in post a few weeks. A requirement was made at that inspection that an application for registration is made to the Commission in respect of a suitable manager for the home. This was to comply with legislation and to verify to the Commission that the appointed manager is qualified, competent and experienced to run the Lyncroft DS0000007246.V369250.R01.S.doc Version 5.2 Page 25 home. This requirement had been complied with. The registered manager is a registered mental health nurse, holds a postgraduate certificate in management and a certificate in counselling. He presents as being knowledgeable about the needs of the residents and was observed relating to them well during the inspection. Feedback from staff spoken to independently was positive and also confirmed that the registered manager has made supervision more structured. This has included reinforcing the home’s policies and procedures as outlined in the Staffing section of this report. Both the community psychiatric nurse from L.B. of Waltham Forest and the social worker from L.B. of Newham, that were spoken to independently, indicated that they felt that the home was being properly managed and that the registered manager and his staff were cooperative and acted upon any advice given by them. The home has a number of ways of monitoring the ongoing quality of the service offered to residents. An effective key worker system is in operation with clear records of monthly key worker sessions, which were sampled. The home also holds regular residents meetings and records of meetings sampled showed that residents were consulted and discussions took place on a range of areas that affected their every day life. The home also seeks more formal feedback from residents through annual satisfaction questionnaires. Feedback from these is then collated into a report. Both satisfaction surveys returned in September 2007 and the report in relation to these were sampled and provided positive feedback about the home. The home has also introduced a satisfaction survey for staff and a report dated March 2008 was seen that also provided positive feedback. The registered provider stated that she visits the home most days and also undertakes formal monthly monitoring visits; reports of these were also sampled to evidence this. At this inspection a range of satisfactory health and safety documentation was seen. This included: a gas safety certificate, electrical installation certificate and portable appliance test. The home’s fire log was inspected and showed that the fire fighting equipment had been serviced, weekly safety checks on fire equipment were being carried, that regular fire drills were being undertaken every three months and the home had a current fire plan and fire risk assessment. Lyncroft DS0000007246.V369250.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Lyncroft DS0000007246.V369250.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Lyncroft DS0000007246.V369250.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: 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 © 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 Lyncroft DS0000007246.V369250.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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