Care Home: Lyndale

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What the care home does well Lyndale offers a secure and comfortable home to people living there. It is in a good place near shops and other facilities in Hereford, which they can walk to. Everyone living at the home has a plan showing their care needs, goals, likes and dislikes. Plans help staff know the support they need and how to give it. Residents are supported with various activities they like and to go out into the community. They are encouraged to develop their life skills and independence. People living at the home receive good support with their personal care. Staff make sure they have regular health checks and manage their medicines safely. The house is kept clean and in good condition. It is homely and well furnished and decorated. Residents` bedrooms are made nice and personal. One of them says "The home feels more settled and homely. The home is getting decorated with new furniture and I like that, so I do feel the home is a lovely place".Staff receive good training and support when they start work at the home and to help them keep the home safe. New staff have necessary checks taken up as part of making sure that they are suitable to work with vulnerable adults. What has improved since the last inspection? Residents now all have a health action plan. These plans should better ensure their good health and help those capable manage their own health care more. Work continues to make the home nicer and have better facilities for people living there. There is a new bed-sitting room so another resident can have the opportunity to be more independent and develop their daily living skills. Possible new staff have to tell Lyndale about all their previous jobs. The home then checks them out with their last employer to make sure they are suitable. Residents and their relatives are being asked what they think of the home by the owner. Their views will help the owner and manager plan how to improve the service as the residents want and/or for their benefit. What the care home could do better: Different ways, such as pictures and photographs, could be used to help some residents make more choices. Also if their plans are easier to understand they could decide what they want more, which would promote their independence. With more in-depth training on the special needs of people using the service staff should be able to understand and be able to help them better. CARE HOME ADULTS 18-65 Lyndale Lyndale 24 Southbank Close Hereford Herefordshire HR1 2TQ Lead Inspector Christina Lavelle DRAFT REPORT: Key Unannounced Inspection 28th April 2008 12.00- Lyndale DS0000055244.V362878.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 Lyndale DS0000055244.V362878.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. Lyndale DS0000055244.V362878.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lyndale Address Lyndale 24 Southbank Close Hereford Herefordshire HR1 2TQ 01432 378118 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) Lyndale (Hereford] Ltd Mrs Dinah Jane Chadwick Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Lyndale DS0000055244.V362878.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care and accommodation to services users of both sexes whose primary care needs on admission to the home are within the following categories:• Learning Disability (LD) - 10 The maximum number of service users to be accommodated is 10. 23rd August 2006 2. Date of last inspection Brief Description of the Service: A new manager Mrs Chadwick has been appointed since the last inspection and was registered in November 2007. Lyndale can now provide accommodation with personal care for up to ten adults (as an area on the lower ground floor was recently converted to another bed-sitting room). People using this service must require care primarily due to learning disabilities. They may also have an associated physical disability (including conditions such as epilepsy) and/or a mental health disorder. They may also use behaviours that could challenge a care service and so the people living at the home often have complex needs. The main stated aim of the service is to “provide a homely environment for people with learning disabilities in which continuous encouragement, education and stimulation are the core elements in the daily life of the service users”. The home is a large, detached Victorian house located in a quiet residential culde-sac. It is only a short walking distance from Hereford city centre and so shops, services, facilities and main transport links can be accessed easily. The home has parking spaces at the front and a large, private garden at the back. There is also a small, enclosed courtyard area, which can be reached from the kitchen. People living at the home have single bedrooms, six of which are on the first floor and two that have en-suite toilet and shower facilities. Another two are self-contained bed-sits (one is on the ground and the other the lower ground floor). The bedsits offer an opportunity for semi-independent living and have their own bathrooms, kitchen/sitting areas and separate bedrooms. The home also has two sitting rooms, a dining room, toilets and bathrooms on both floors for everyone to use, as well as a laundry, office and team leaders’ room. Information about the home is provided in a statement of purpose and service users guide, which are available from the home. The weekly fee for the service covers both the residential placement and a programme of daytime activities. Fee levels are assessed depending on the individual needs of people using the service and for staff supervision both when at home and out in the community, as agreed with their funding authorities. Additional costs include for personal clothes, toiletries, newspapers, dry-cleaning, taxis and holiday accommodation. Lyndale DS0000055244.V362878.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 that the people who use this service experience good quality outcomes. This is a key inspection of the service provided by Lyndale. This means all the Standards that can be most important to adults living in homes are assessed. This visit was made without telling staff or anyone who lives there beforehand. Time was spent with some current residents. Most people at home today have communication difficulties due to their disabilities but one person was able to talk in private about their lifestyle and the support they get from Lyndale. The way the home is run and any changes since the last inspection were discussed with the manager. Two other staff (including one new support worker) were spoken with about their role, training and the care of people using the service. Surveys were sent to the home for some residents, their relatives and staff, and ten surveys were returned. Feedback obtained is mentioned in this report. An annual quality assurance assessment (AQAA) was completed as part of this key inspection, as is now required. This asks managers to say what they think their home does well, could do better, what has improved in the last year and about their plans to improve the service. It includes information about people living there, staff and other aspects of the home. Some relevant records kept by the home were checked and parts of the house seen. All other information received by the Commission since the previous inspection is also considered. What the service does well: Lyndale offers a secure and comfortable home to people living there. It is in a good place near shops and other facilities in Hereford, which they can walk to. Everyone living at the home has a plan showing their care needs, goals, likes and dislikes. Plans help staff know the support they need and how to give it. Residents are supported with various activities they like and to go out into the community. They are encouraged to develop their life skills and independence. People living at the home receive good support with their personal care. Staff make sure they have regular health checks and manage their medicines safely. The house is kept clean and in good condition. It is homely and well furnished and decorated. Residents’ bedrooms are made nice and personal. One of them says “The home feels more settled and homely. The home is getting decorated with new furniture and I like that, so I do feel the home is a lovely place”. Lyndale DS0000055244.V362878.R01.S.doc Version 5.2 Page 6 Staff receive good training and support when they start work at the home and to help them keep the home safe. New staff have necessary checks taken up as part of making sure that they are suitable to work with vulnerable adults. 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. Lyndale DS0000055244.V362878.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 Lyndale DS0000055244.V362878.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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including this visit to the service. Good assessment and admission procedures are in place to help to ensure the home would suitably meet the needs and wishes of prospective service users. EVIDENCE: The home’s admission procedures state, and the manager confirmed, that a full assessment of the needs of potential service users would always be carried out before they move into the home. This includes visiting anyone referred for a placement at their current residence and, whenever feasible, inviting them to visit Lyndale several times, including to have an overnight and weekend stays. The admission of a new resident was discussed with the manager and their care records were checked. The home had obtained detailed information about them from their social worker and a copy of their community care assessment. Several meetings were also held with the relevant health care team. An initial care needs assessment was completed by the home with information about Things they do, Things they like, How they like to spend their day, their selfhelp skills, health, medication, leisure interests and aftercare arrangements. This person had made introductory visits to Lyndale, including an overnight and weekend stay when staff involved existing residents and/or observed their interactions with each other. During their trial stay care reviews had been held before the decision was made that Lyndale could provide appropriate support. Lyndale DS0000055244.V362878.R01.S.doc Version 5.2 Page 9 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 Quality in this outcome area is good. This judgement has been made using available evidence including this visit to the service. Everyone living at the home has a plan they help to make if they can showing their care needs, wishes, goals and support needed to meet them. Possible safety risks are also assessed so they can be minimised. Although residents can make some decisions in their daily lives their choices could be enhanced if more communication methods are used and their plans easier to understand. EVIDENCE: Care records of two people living at the home were checked. They include their photograph and information about their family and other relevant people. An initial assessment was made of their needs and wishes including objectives, resources and any actions needed to meet them with timescales. Their special needs and interests, likes and dislikes are also outlined e.g. activities, food and busy places. Each person has a care plan drawn up with a pen picture and life history showing their strengths, needs, short and long term goals. Staff also record any significant and daily events including their behaviour, mood, health and activities so providing useful information about their lifestyle and progress. Lyndale DS0000055244.V362878.R01.S.doc Version 5.2 Page 10 People living at Lyndale are involved in drawing up their own plans (and sign them when able to) and can also take part in their care reviews. Whilst care planning is “person centred” as it should be (i.e. focuses on individuals’ needs and wishes) the home’s AQAA says they plan to introduce a more user-friendly format for the plans, which should help residents understand them better and so would be a positive development. It is evident that people living at the home are afforded flexibility in their daily lives and routines and supported to make some decisions. Their involvement in choosing such as house décor and furnishings, menus, holiday, day-to day activities and events is encouraged and the bed-sitting rooms now also offer two residents an opportunity to have a semi-independent lifestyle. The home should consider however that some residents could possibly be enabled to make more choices and decisions about their lives through using communication aides such as photographs, pictures and objects of reference, which should then be specified in their plans. Care staff are allocated to particular residents as their keyworker. They spend time getting to know them better and confirm they take a lead role in ensuring they have enough clothes and toiletries, activities, supporting them to attend health care appointments and keeping in touch with their family. One resident understands the role and values their own keyworker’s input. Keyworkers are also involved in reviewing their allocated residents’ care. Relatives and social workers are also invited to participate in care reviews and for one resident with limited verbal communication their parent had agreed and signed their plan. The manager says the home has tried but been unable to obtain advocates for some residents who do not have close family links. Mrs Chadwick has also received training on the Mental Capacity Act and is aware of its implications for people using care services who may not be able to make decisions and/or give their informed consent. This should include restrictions made to their choices and freedom. It is good that the appropriate agency has been approached by the home to obtain an Independent Mental Capacity Advocate for one resident. Risk assessments are carried out in respect of general risk areas e.g. bathing road safety, moving and handling and residents holding their bedroom keys. Individual risks had also been assessed e.g. for one person who gulps food and consequently staff cut up their food and always supervise them at mealtimes to reduce choking risks. Behaviours that could be harmful to an individual and/or others are also assessed and when necessary management plans put in place if interventions could be necessary to protect them or other people from challenging or aggressive behaviours. This may include a physical intervention policy, although restraint of any kind must only ever be used as a last resort. Behavioural strategies and techniques e.g. diffusion and diversion are specified in one person’s plans to help staff minimise incidents as well as administering specific medication prescribed as and when required for anxiety or aggression. Behaviour monitoring and analysis forms are completed and the home records incidents of challenging behaviours with interventions and consequences. They should be used to review the management plans to ensure they are effective. Lyndale DS0000055244.V362878.R01.S.doc Version 5.2 Page 11 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, 14, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including this visit to the service. People living at the home are enabled to take part in activities they enjoy and go out in the community if they wish. Their individuality and daily choices are respected and contact with their families is supported. The home also ensures residents are offered a variety of healthy and suitable meals that they like. EVIDENCE: Each person living at Lyndale has a weekly activities plan that includes their interests and activities they enjoy. Care staff are deployed flexibly to facilitate these activities, although several staff mention in their survey that occasionally outings are affected by staffing levels. Residents’ daily records detail activities they have all actually taken part in and where they have been, as their daily activity plan can vary according to their mood and behaviours. Staff say they aim however to give everyone an opportunity to go out daily and one resident confirms he always makes decisions about what he does every day. The home notice board shows activities, local events and outings and meetings planned. Lyndale DS0000055244.V362878.R01.S.doc Version 5.2 Page 12 Staff enable people living at the home to access a wide range of local leisure facilities such as restaurants, pubs, cinema, bowling, horse riding and to use shops and other facilities. This includes accessing the community by walking into town or using the home’s vehicles or public transport. One aspect of the keyworker role is supporting residents to choose and take part in activities, which they arrange and also support them shopping, on day trips and holidays. Whilst some residents would not be able to attend college or have work related placements due to their complex needs the home’s statement of purpose and AQAA describes how developmental opportunities are sought for individuals if and when appropriate. Disability and behaviours can also affect the extent to which some people may want (and are able) to interact well with other people and/or integrate in the community. Personal skills development is considered in care planning for some residents in respect of their self-care, budgeting, laundry, cleaning and cooking, as part of promoting an independent lifestyle. The manager says that visitors to Lyndale are always made welcome and can be seen in private by the people living there. The home also provides support and transport to a suitable venue or to residents’ relatives homes if necessary so that contact can be maintained with them. One resident confirms that he receives regular calls from a relative and Lyndale are also supporting his wish to move back nearer his family. This could involve the manager taking him to visit other possible placements when they are suggested by his social worker. Regarding food provided by the home monthly menus are drawn up, which are reviewed regularly and discussed during monthly meetings when the residents’ views and ideas are sought. Staff say they aim to promote healthier eating and lifestyles and are aware of one person’s special dietary needs. It is good that some residents are on the waiting lift for a fitness course at a local gym. Food stocks seen included such as porridge, various cereals and fresh fruit and vegetables. One staff member comments there is a “Varied diet and menus to meet needs” although two other staff say in their surveys there is too much emphasis on healthy eating and residents are not often allowed cakes, biscuits and puddings. Some residents are involved in shopping and preparing meals when they are able and/or want to develop their life skills. One person attends a cookery class. The lunchtime meal was seen to be a flexible, relaxed and social occasion, although individuals can choose to eat alone if they wish. Lyndale DS0000055244.V362878.R01.S.doc Version 5.2 Page 13 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 Quality in this outcome area is good. This judgement has been made using available evidence including this visit to the service. People living at the home are supported to meet their personal and health care needs. Their medicines are also managed safely by the home on their behalf. EVIDENCE: Residents’ plans outline the personal and physical health support they require, including for their emotional needs. Their individual support preferences and daily routines are also shown in relation to such as bathing. Plans include encouraging self-care in respect of their personal hygiene and for one person with very limited self-care skills their personal care needs are shown in detail. Their plan covers how staff can recognise when they are in pain, monitor and maintain their appetite and weight and a continence management programme. Everyone living at the home now has a health action plan (HAP). HAPs contain information on all relevant aspects of health including mental health, eye care, dental care, gender related care, mobility and any special needs e.g. epilepsy and diabetes. Relevant sections are completed and detail particular problems; staff and any other support needed; routine and specialist health care input required and appointments attended. The manager says staff do try to involve Lyndale DS0000055244.V362878.R01.S.doc Version 5.2 Page 14 residents in drawing up and maintaining their own HAPs to the extent they are able. This is good as they should be encouraged to manage their own health care and to lead a healthy lifestyle as part of developing their independence. The home employs the services of a Consultant Psychiatrist who has specialist knowledge of learning disabilities and is on call to respond to any emergencies. Clinical sessions are held monthly at the home for residents needing any input. Records are also kept by staff of any physical checks they routinely undertake to monitor individuals’ health care related issues e.g. weight and sugar levels. Risk assessments are carried out covering generic areas i.e. mobility, moving and handling, bathing, and nutrition as well as special areas such as diabetes. Medicines prescribed for residents are stored securely in the home and only designated staff who have completed accredited safe handling of medicines training administer and/or deal with them. It was previously confirmed that an appropriate policy and procedures are provided in relation to medication. The AQAA states that within their individual capabilities service users will be given an opportunity to administer their own medication or other treatments. One person’s plan assesses they are unable to self-medicate. Whenever necessary protocols are in place for staff to administer medication prescribed for use as and when required (or for one resident on request to control their anxiety and agitation). Weekly audits of medicines are carried out by the home and relevant records were checked and are being maintained appropriately. Lyndale DS0000055244.V362878.R01.S.doc Version 5.2 Page 15 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 Quality in this outcome area is good. This judgement has been made using available evidence including this visit to the service. People living at the home are enabled to express their views and a complaints procedure is operated to deal with service users’ and other people’s concerns. Appropriate steps are taken by the home to promote protection of residents. EVIDENCE: Lyndale provides a complaints procedure that is available in a suitable format for people with learning disabilities. Records are kept of any complaints made with information about actions taken and outcomes. It is good that staff have recently supported two residents to make serious complaints. Relevant other agencies (including the Commission) were notified by the home about these and/or are involved in the investigations. Two residents who can express their views verbally confirm they know what to do if they have concerns. One says he would speak to the manager or team leaders and also carers always listen. Staff confirm in their surveys they also know what to do if concerns are raised or complaints are made to them. Although two mentioned that one resident is being intimidated by other residents, which was subsequently referred back to the provider for investigation and/or action. Staff understand that part of their keyworker role is to advocate for residents with communication difficulties. Since the last inspection two anonymous complaints have been made to the Commission. The subject of one of these complaints was also reported to the Police and the local authority. This matter was subsequently referred under multi-agency Safeguarding procedures for vulnerable adults. The provider and manager were fully aware of the issues and have taken appropriate steps to Lyndale DS0000055244.V362878.R01.S.doc Version 5.2 Page 16 deal with them. The provider is currently investigating the other issues raised, which may have implications for team working and the management approach at Lyndale. The Commission will be informed of the outcome in due course. The manager has appropriately made Safeguarding referrals directly in relation to an incident at the home and allegations made by one resident (which did not involve Lyndale). It is apparent that Mrs Chadwick understands and knows how to use these procedures and is open to reporting incidents that could affect the safety and welfare of residents, staff and other people. The home provides policies and procedures on abuse, protection of vulnerable adults, for management of challenging behaviours and whistle blowing. These topics are covered in the induction programme for new staff, ongoing training and are re-visited in supervision and meetings. Some staff did also attend a training session taken by Herefordshire’s Adult Protection co-ordinator. Staff are expected to complete an abuse or concerns checklist after each shift, which the manager says provides an additional monitoring system within the home. Lyndale DS0000055244.V362878.R01.S.doc Version 5.2 Page 17 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including this visit to the service. Lyndale provides people living there with accommodation that suitably meets their needs and offers them a secure and comfortable home. Arrangements are in place to keep the house safe, clean and in a good state of repair and décor. EVIDENCE: Lyndale is located in a quiet cul-de-sac in a residential area of Hereford close to the city centre. It is within easy walking distance of its shops, services and facilities. Public transport links are accessible and the home also provides two vehicles for shopping, outings and holidays. The overall impression of the house is homely and comfortable. Some areas had flooring or carpets replaced and a new cooker fitted since the last inspection. Plans are now in hand to buy new furniture and redecorate the sitting rooms. The manager intends to try to speed up the home’s maintenance and upgrading programme and it is good they now have their own decorator. One resident comments in their survey “The home feels more settled and homely. The home is getting decorated with new furniture and I like that, so I do feel the home is a lovely place”. Lyndale DS0000055244.V362878.R01.S.doc Version 5.2 Page 18 The home has two sitting rooms, a separate dining room, a large enclosed garden and internal courtyard for all the residents to use. Laundry facilities have been moved since the last inspection into a larger and more suitable place on the lower ground floor. It is made accessible to people who wish and are able to do their own laundry with any necessary risk assessments in place and/or support from staff. Although there are key coded locks to access the kitchen and laundry areas it was confirmed with management that any resident wishing and able to use the facilities in these areas is enabled to do so. Residents help choose the colour scheme and furniture in the home and can personalise their own bedrooms. Their rooms are furnished and equipped to meet any special needs and those able to manage them have a lockable piece of furniture and keys and can lock their bedroom and use them as their private space if they wish. The home now has two bed-sitting rooms (one having only been fitted and registered recently), which can offer the opportunity for semiindependent living and have their own kitchen, en-suite facilities and separate entrances from the internal courtyard. Two bedrooms in the main home also have en-suite facilities and other bedrooms have a bathroom close by. Those areas of the premises seen during this visit were clean, tidy and fresh and there are cleaning schedules in place to maintain this. People living at the home are encouraged to help out with household tasks and to keep their own bedrooms tidy etc. to the extent they can. Policies and procedures are in place relating to infection control, which are covered in the induction programme for new staff and some staff also completed specific training. Disposable gloves and aprons are provided and appropriate arrangements made for soiled waste. Lyndale DS0000055244.V362878.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area is good. This judgement has been made using available evidence including this visit to the service. Residents are supported by enough staff who receive relevant training. Whilst this training helps staff to maintain safety in the home they should understand and know how to manage the special needs of people using the service better with more in-depth training. Thorough recruitment procedures help to make sure only suitable staff support people living at the home, for their protection. EVIDENCE: Lyndale has a staff team of thirty support workers, which includes eight men. There is a new manager and six other care staff left during the last year. Mrs Chadwick feels however that the staffing situation is more settled. Rotas show there is always a minimum of five support staff rostered on duty throughout the daytime and evenings (six or seven if possible) including a team leader, with two waking staff at night. Extra staffing is arranged as needed and a member of the management team is designated on call at all times. Most staff comment there is usually enough staff on duty, although staffing levels can occasionally affect the support available for the residents to go out when they wish. Staffing levels seem appropriate to meet the personal needs of people living at Lyndale and they are also deployed flexibility to facilitate activities. Lyndale DS0000055244.V362878.R01.S.doc Version 5.2 Page 20 Regarding recruitment the manager, the home’s AQAA and the records of two recently appointed support workers confirm satisfactory processes are being followed. Staff in their surveys also say that necessary checks were taken up before they started work at the home. Both of the new staff had enhanced criminal record checks (CRBs) and two written references taken up as part of their selection and recruitment. There is also proof of their identities, a full employment history and a health declaration. One recently appointed support worker said that they attended an interview and did not work with anyone who lives at the home until their checks had been received. New staff also have to complete a probationary period before their appointment is confirmed. The provider requires all new staff to complete their comprehensive induction programme before moving onto LDQ (Learning Disabilities Qualification), which is an accredited course for staff working in care with people who have learning disabilities. Most staff say in their surveys that their induction mostly covered everything and they receive relevant training that covers all mandatory health and safety topics. The new worker says they had a full one-week introduction to the home with the deputy manager, which they found to be very helpful. This person is now completing the induction pack and has covered all the core health and safety topics as well as training on abuse, whistle blowing and in relation to challenging behaviours. Staff are also expected to move onto NVQ training in social care and although only twelve of the staff team have achieved this qualification another three are doing the course and others are to follow. Most staff had attended training sessions on epilepsy and autism and the home also arranges instruction regarding the management of challenging behaviours. Whilst most staff confirm they receive relevant training several comment that this is rather basic in respect of the specialist needs of people with learning disabilities and who also have mental health difficulties. They feel that more in depth knowledge would help them understand some of the residents and their needs better. Clearly they do need to be aware of the implications for their health and welfare and how best to manage their support. The manager plans to provide some in-house instruction on mental health and this and other such training opportunities should be prioritised. In respect of training the manager also plans to set up a training matrix to show when any refreshers are needs and training shortfalls in the team, which would be positive developments. In respect of communication within the staff team shift handovers are carried out when a team leader goes through all the residents to discuss their mood, behaviour, activities, health issues and any diary events for the day. Most staff feel that they are usually given enough information and seem to be clear about their roles and responsibilities. Individual supervision and staff meetings are arranged, which the manager also plans to develop to improve team work. Lyndale DS0000055244.V362878.R01.S.doc Version 5.2 Page 21 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 Quality in this outcome area is good. This judgement has been made using available evidence including this visit to the service. Residents of Lyndale benefit from a home that is well run. There are processes in place to monitor the quality of the service so it continues to develop and provide individualised support that meets their needs and goals. Appropriate procedures and practice help promote safety in the home to protect residents. EVIDENCE: A new manager (Dinah Chadwick) has been appointed since the last inspection and was registered by the Commission in November 2007. Mrs Chadwick is a qualified Mental Health Nurse (RMN) and has also achieved other qualifications including the Registered Managers Award and Diploma in Alternative Therapy. Mrs Chadwick has previously managed nursing homes that specialise in mental health, general nursing and the care of older people and so has extensive experience in a management position and in residential care home settings. Lyndale DS0000055244.V362878.R01.S.doc Version 5.2 Page 22 Management arrangements at the home include a deputy manager and team leaders and the manager’s role and responsibilities are strategic rather than day-to-day oversight of direct care and staff. Almost inevitably when there is a new manager there has been changes to the management approach. Several staff reflect this in their surveys commenting that there is now less management support available and opportunity to discuss their work, also only limited contact with residents and their relatives. However other staff feel they regularly or sometimes receive support from the manager. This feedback has been brought to the attention of the provider and manager and could be discussed in supervision and staff meetings so that team work is not affected. The AQAA completed by the manager demonstrate clarity about the aims and ethos of the service to promote a person centred approach to care delivery. Having been appointed recently it is understandable however that the focus on planning future improvements and how they will be achieved could be more detailed. However the manager is clearly aware that the views and needs of service users should be sought and be foremost in plans to improve the home and the service provided. Plans include to evaluate all responses received; to respond more quickly to action plans and make them available to residents in a more suitable format, all of which would be positive. The manager and deputy manager feel they and Lyndale are well supported by the provider. A representative of the provider makes required monthly visits to check the home’s conduct, which includes carrying out quality audits of all relevant aspects of the service. Action plans are produced to address any shortfalls identified and plan improvements and a new format introduced to record audit results. Quality assurance posters are displayed in the dining room and bedrooms and questionnaires sent to residents’ relatives to obtain their input and feedback about changes they think would improve the service. Regarding health and safety all the relevant policies and procedures are in place to promote the health, safety and welfare of people in the home and that should inform working practices. Staff have training in the core areas e.g. fire safety, first aid, food hygiene and infection control. Risk assessments relating to the environment are also carried out including for hazardous substances (COSHH). The AQAA confirms necessary checks and servicing are arranged and/or carried out by staff such as the fire safety system and equipment, electrical appliances, heating and gas installations and vehicles. Accident and incident records are also kept and have been notified appropriately. Lyndale DS0000055244.V362878.R01.S.doc Version 5.2 Page 23 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 X 2 3 3 X 4 X 5 X 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 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 X X 2 X 3 X X 3 X Lyndale DS0000055244.V362878.R01.S.doc Version 5.2 Page 24 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 persons meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered provider 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 to consider carrying out. No. 1 Refer to Standard YA7 Good Practice Recommendations The home should introduce care plans that are easier to understand and consider using more communication aides such as photographs, pictures and objects of reference. This could enable people living at the home to make more decisions and so promote their choices and independence. More in depth training should be arranged in relation to the specialist needs of people using the service. This would give staff more knowledge to help them understand and be able to deal with residents’ needs better. 2 YA35 Lyndale DS0000055244.V362878.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Lyndale DS0000055244.V362878.R01.S.doc Version 5.2 Page 26 - 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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