Care Home: Lyndhurst

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What the care home does well Each of the people living at the home that completed surveys stated that they had been given enough information about the home so they could decide if it was the right place for them to live. The home provides comfortable accommodation for people living there. They make sure that peoples` health is taken care of by seeing doctors and other health care workers when needed. Some of the comments made included; `the care home gives an assurance to the person and their relative that they are getting the best possible care that is needed`, `my family and I have a good relationship with the home`, `they do everything they can to care for her`, `very friendly`, `the home kept in contact with us when my mother was not well`. Staff were also positive about working at the home. Those spoken with and comments received from the surveys stated that; `the manager is very supportive`, ` the service provides well for people living at the home and promotes independence amongst other things`, `we put the residents first`, `all our residents are treated with the best care and respect`. In relation to staff support, one person commented that they had been fully supported when they started work at the home and communication between the team was very good. Comments included, `my induction covered everything I needed to know`, `we receive mandatory training as well as other courses such as pressure care and dementia` and `all information is documented and discussed between staff at handovers`. What has improved since the last inspection? The home continues to provide people with a lifestyle of their choosing with plenty of opportunities both in and away from the home. The brochure about the home has been updated to provide people with clear information about what the home offers and what you can expect if you lived there. Ongoing training and development is offered to staff with almost all of the team having completed or working towards the NVQ. What the care home could do better: CARE HOMES FOR OLDER PEOPLE Lyndhurst College Street Leigh Wigan Greater Manchester WN7 5QH Lead Inspector Lucy Burgess Unannounced Inspection 19th February 2008 09:30 X10015.doc Version 1.40 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 Lyndhurst DS0000005747.V359643.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lyndhurst DS0000005747.V359643.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lyndhurst Address College Street Leigh Wigan Greater Manchester WN7 5QH 01942 606319 01942 671246 jan.pickup@clsgroup.org.uk www.clsgroup.org.uk CLS Care Services Limited 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 Janice Pickup Care Home 40 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (40), of places Physical disability over 65 years of age (8) Lyndhurst DS0000005747.V359643.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 40 service users to include:• up to 40 service users in the category of OP (Older People) • up to 8 service users in the category of PD(E) (Adults with Physical Disability over 65 years) • up to 3 service users in the category of DE(E) (Adults with Dementia over 65 years) The service should employ a suitably qualified and experienced manager, who is registered with the Commission for Social Care Inspection. The Home’s Statement of Purpose must be altered to set out how the services and facilities offered by the Home will meet the needs of service users with dementia by 31 May 2005. The Registered Person must ensure that all staff working in the Home have dementia training awareness and dementia care training, which equips them to meet the assessed needs of the service users accommodated, as defined in the individual plan of care. The service must at all times employ suitably qualified and experienced members of staff, in sufficient numbers, to meet the assessed needs of the service users with dementia. 27th June 2006 2. 3. 4. 5. Date of last inspection Brief Description of the Service: Lyndhurst - part of the CLS group of homes - is situated close the centre of Leigh, near to shops and other essential services. A large three storey building, residents are accommodated on each floor. Throughout the building there are a number of lounges and seating areas, and there is a separate visitors’ lounge. The main dining room is located on the ground floor. Each of the 40 bedrooms is for single occupancy. There is limited outside space. However, the courtyard garden is secure, well maintained and attractive. There is limited car parking for visitors to the home; however, a pay and display car park is located within a few minutes’ walk. Lyndhurst offers accommodation to people aged 65 and over, who require assistance with Lyndhurst DS0000005747.V359643.R01.S.doc Version 5.2 Page 5 personal care. The fees at Lyndhurst are currently £395.00 per week, increasing to £420.00 in April. Additional charges may be made for residents’ personal spending, such as toiletries, clothing, etc. Further details can be found in the home’s Statement of Purpose. Lyndhurst DS0000005747.V359643.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This was a key inspection, which included a site visit and took place over one day, for a period of 10 hours. The service did not know that the inspector was to visit. During the inspection care and medication records were looked at as well as information about the staff and health and safety including how the home and the equipment were kept safe. The inspector also looked around the building to check if it was clean and well decorated. As part of the inspection process the provider’s are asked to complete a selfassessment survey information document (Annual Quality Assurance Assessment). This was sent to the home before the inspection and had been completed by the manager and returned to us prior to the site visit. Other information was gathered from the feedback surveys we sent out. We received completed surveys from 1 relative, 5 residents and 7 staff. Time was also spent during the visit speaking with staff and people who live at the home. Comments have been added to the report. Discussion and feedback was held with the Registered Manager. What the service does well: Each of the people living at the home that completed surveys stated that they had been given enough information about the home so they could decide if it was the right place for them to live. The home provides comfortable accommodation for people living there. They make sure that peoples’ health is taken care of by seeing doctors and other health care workers when needed. Some of the comments made included; ‘the care home gives an assurance to the person and their relative that they are getting the best possible care that is needed’, ‘my family and I have a good relationship with the home’, ‘they do everything they can to care for her’, ‘very friendly’, ‘the home kept in contact with us when my mother was not well’. Staff were also positive about working at the home. Those spoken with and comments received from the surveys stated that; ‘the manager is very supportive’, ‘ the service provides well for people living at the home and Lyndhurst DS0000005747.V359643.R01.S.doc Version 5.2 Page 7 promotes independence amongst other things’, ‘we put the residents first’, ‘all our residents are treated with the best care and respect’. In relation to staff support, one person commented that they had been fully supported when they started work at the home and communication between the team was very good. Comments included, ‘my induction covered everything I needed to know’, ‘we receive mandatory training as well as other courses such as pressure care and dementia’ and ‘all information is documented and discussed between staff at handovers’. What has improved since the last inspection? What they could do better: Some of the information in the care files had not been completed or updated to reflect the current and changing needs of people living at the home. This information is needed so that staff are aware of the support to be provided ensuring people are cared for properly and any areas of potential risk are minimised. Medication records need to clearly show that medication is being given as prescribed. This should include the date, time given and then signed by the relevant member of staff. This will ensure that people are not placed at risk. Mandatory training updates including adult protection need to be planned for the forthcoming year so that staff are aware of the procedures to follow ensuring people are safe. Information was not available during the visit to show that relevant up to date checks had been carried out on the gas supply and electric circuit. The manager is asked to follow this up and confirm that these have been done. The manager must make sure that the relevant guidance is followed with regards to the smoke room ensuring people at the home are safe. Water temperatures need to be monitored to ensure that they are maintained at 43°C for the comfort of people at the home. Lyndhurst DS0000005747.V359643.R01.S.doc Version 5.2 Page 8 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. Lyndhurst DS0000005747.V359643.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lyndhurst DS0000005747.V359643.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that only those people whose needs can be met are admitted to the home. EVIDENCE: People have access to a brochure called, ‘Your Guide to Living at Lyndhurst’, which tells them about what they can expect if they were to move into the home. This includes how they will be supported, what facilities the home provides, information about meals and activities, how to make a complaint and who’s who. Information is provided in a large font and is easy to read providing a good overview of the home. Five people living at the home completed surveys. Each stated that they had been given enough information about the home so they could decide if it was the right place for them to live. Other comments included; ‘the care home Lyndhurst DS0000005747.V359643.R01.S.doc Version 5.2 Page 11 gives an assurance to the person and their relative that they are getting the best possible care that is needed’. The assessment process is explained within the homes brochure. This explains that where possible they like to invite people to the home before they make any decision about moving in. This gives people an opportunity to meet with staff and other people living at the home. The home will also carry out an assessment to look at what support people would like with their care needs and daily routine. Additional information is also sought from the funding authority. An admissions checklist is completed when people move into the home and they are informed of whom their key worker will be. This person will be responsible for keeping the care plan up to date so that all staff are aware of the support the person would like and need. Should people be admitted to the home due to an emergency the home will endeavour to complete the necessary information within 48 hours. Standard 6 does not apply, as Lyndhurst does not provide Intermediate Care services. Lyndhurst DS0000005747.V359643.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of people are met however records need to clearly show what support is to be provided so that people are not placed at risk. EVIDENCE: Care files are in place for each person living a the home. Information was looked at for 4 people, which included someone who was new to the home as well as those with additional support needs. Individual files are held and are updated by the care team leader who has been identified as the key worker. The manager explained that as some of the care team leaders were new to post there had been changes in key worker roles. Information seen was orderly and included; personal information, an assessment, professional contacts, weight records, activities, care plan and risk assessments. Staff also complete daily records showing what support has Lyndhurst DS0000005747.V359643.R01.S.doc Version 5.2 Page 13 been offered. Some of the information seen was incomplete or had not had a recent review. This was said to be due to the recent changes in the team Information in the first plan looked at had recorded in the first person, such as, ‘staff have shown me how to use the call bell’, ‘I would like the staff to help me with my medication’ and ‘I have reviewed my plan and it remains the same’. Whilst this last comment had been recorded there was no evidence to show that this had been done. Where possible people should be encouraged to sign the plans however if this is not possible then a relative or appropriate person should do it on their behalf. Risk assessments for this person were incomplete. Some of the areas had not been scored and therefore did not fully reflect an accurate score. One person had move to Lyndhurst from another home. Whilst initially they had been unsettled and had lost weight this had now settled. The person was more comfortable and relaxed and had started to gain weight again. A care plan had been completed and was dated December 2007 however the mental health assessment and moving and handling assessment had not been completed. Due to this persons level of dementia and support required in relation to mobility both assessments need to be updated. Action had been taken to address concerns identified around mobility. The physiotherapist had carried out an assessment and a wheelchair had been ordered. A review had also been held in September 2007 with the psychiatrist. On another file the person had only moved into the home the day prior to the visit. Work had started on developing the plan and some of the risk assessments had been completed on the specific areas identified. Discussion was held with the manager about the plans and completion of risk assessments. The manager stated that staff were perhaps unsure what to record and had therefore left it blank. This was to be discussed with the care team leaders at their next meeting. Documents were being introduced called ‘My Life Profile’. Staff had started to complete these with people. The booklet looked at people’s family and friends, life history, memories, hobbies and interests and health background. Once completed these will provide a personal overview about the lives of each person living at the home and what is important to them. In relation to the health care needs of people, the home actively seeks the support and advice of health care professionals. This may include the continence advisor, district nurse team, physiotherapists, GP’s, chiropody and dieticians. Records showed where additional support was required this had been sought and the outcome ensuring the health and well being of people was maintained. Lyndhurst DS0000005747.V359643.R01.S.doc Version 5.2 Page 14 The administration of medication is only done by senior members of the team who have been suitably trained to do so. Medicines were stored securely and most were recorded accurately. It was found on some of the MAR sheets that information was not always clear. Those sheets which had been completed by hand had not been counter signed to evidence that information recorded was correct with the prescription, nor had the start dates been detailed to show what dates the medication was being administered, some sheets had gaps where they had not been signed following administration of medication. It was also noted on one recorded that medication was being signed for at 8.30 when in discussion with the team leader it was said to be given out between 9 and 9.30. The manager must ensure that records accurately reflect the person’s current medication, the times in which it is to be administered and the time when it is given. This will ensure that the system is safe and people are not placed at risk. Through discussion with the care team leader and on inspection of the stocks it was agreed some people were on large amounts of medication, which at times made it difficult to manage. The team leader stated that contact had been made with the community matron to visit the home and look at the system and stocks held to see if this could be reviewed. Additional records were held in relation to stock brought into the home and those items returned to the supplying pharmacist. Suitable arrangements were in place for the management of controlled drugs and items that need to be refrigerated. The medication room was clean and organised. Separate storage was made available for the district nurses. People living at the home appeared relaxed and well cared for. The inspector spent time sitting and chatting with people. Some of the comments received included; ‘It’s nice here’, ‘they are really good to you’, ‘I can do what I want’, ‘I’m not on my own here’ and ‘they’re all very nice’. Interactions with staff were warm and friendly. Care and attention had been given in relation to people’s appearance as well as being considerate when assisting with personal tasks. Staff were seen to knock on doors before entering people’s rooms. Lyndhurst DS0000005747.V359643.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a variety of opportunities to meet peoples social, emotional and recreational needs enabling them to have a lifestyle of their choosing. EVIDENCE: People living at the home follow routines of their own choosing. People rise in a morning at a time, which suits them. The home employs an activity organiser who provides activities both in and away from the home. A weekly timetable is displayed in the reception area however arrangements are flexible depending on requests made by people joining in. Records are maintained to show what people have taken part in. Time was spent talking with the organiser looking at what choices are offered to people. Activities include flower arranging, handicrafts, baking days, dominoes, board games, exercise to music, film shows and skittles. There is also a 1940’s lounge where people also enjoy reminiscence. Outside entertainers also visit including the ‘silver tappers’ a tap dancing group, singers and a ladies and male choir. Lyndhurst DS0000005747.V359643.R01.S.doc Version 5.2 Page 16 Hot pot suppers, wine and cheese evenings and tombolas are also held. The home receives a lot of support from relatives and people who live locally who support fund raising events. Donations are also received from companies within the local community. The activity worker is also organising an exhibition, this will be an open event for people to visit the home and look at some of the crafts/arrangements that have been made by people living at the home. There are also outings to the local garden centre for lunch, meals and a show at Rivington Barn and canal trips. Over the Christmas period 2 trips were made to Smithles Coaching House for Christmas dinner and a visit was made to the home by local school children that sang for people. The religious needs of people are also considered with a regular church service held at the home each Friday morning. Arrangements are made for the delivery of newspapers if these are requested. The home also has a hairdresser who visits the home twice a week. Monthly residents meetings are held with the activities organiser to discuss events within home, meals served etc. One person described the organiser as ‘lovely’, another person said, ‘she’s a nice person all together’. People are also encouraged to maintain contact with both friends and family with visits taking place in and away from the home. One relative commented, ‘my family and I have a good relationship with the home’ and described the staff as ‘very friendly’. In relation to meals, these are served in the large dining room however should people wish to have them in their own room then this too can be arranged. Meals are referred to a ‘marvellous mealtimes’ with the aim of providing a more relaxed atmosphere and are carried out in such a way as to allow people time to enjoy their meal without being rushed. There are 5 weekly menus, large copies are displayed on the board in the dining room, with a daily menu provided on each table. Breakfast includes a choice of cereal, fruit and toast and cooked breakfast on request. One person spoken said that sometimes she likes cereal followed by eggs on toast and the cook makes this for her. They also said, ‘there’s always enough’, you can have what you want’, ‘the food is lovely’ and ‘it’s home cooked food and it’s good’. A lighter meal is served at lunchtime with the main meal in the evening. A choice of meals are offered however should there not be a choice to their liking, people are asked to request an alternative. Drinks are also served throughout the day. Those people with particular dietary needs are also catered for. Supplements are arranged via the GP for those residents who need extra help with their Lyndhurst DS0000005747.V359643.R01.S.doc Version 5.2 Page 17 dietary intake, and eating aids are provided where necessary to help residents eat independently. Lyndhurst DS0000005747.V359643.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A clear complaints system was in place which people were familiar with. Staff training and good recruitment practices ensured that, as far as possible, residents were protected from abuse. EVIDENCE: The home has an easy to read complaints procedure within their brochure. Information can also be found in the reception area of the home therefore accessible to relatives and visitors. The procedure asks that people raise any issues with staff first who will try to address the matter. Alternatively there is a ‘customer feedback form’ or people can write directly to the organisations feedback manager. Information provided within the AQAA showed that there has been one complaint issue about the home over the last 12 months. The local authority is investigating this. The manager has kept us fully informed about the issues raised. No issues have been raised directly with us (the commission). From the feedback surveys received, two were not sure whom they would speak to if they were unhappy however three people stated that they knew what to do if they had any concerns. A relative also confirmed that they were aware of the procedure in place and who to speak to if they had any issues. Lyndhurst DS0000005747.V359643.R01.S.doc Version 5.2 Page 19 One issue has also been raised with regards to safeguarding. Other members of staff brought the concern to the manager’s attention. All appropriate action has been taken to ensure people are protected including a referral to the safeguarding team. Training is required for members of the team in relation to the local authority safeguarding procedure. The manager has received information about courses that are to be provided by the local authority. Arrangements are to be made for staff to attend. Lyndhurst DS0000005747.V359643.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Lyndhurst provides comfortable, clean and spacious accommodation for people living at the home. EVIDENCE: Lyndhurst is a purpose built home close to the centre of Leigh. The home is close to all local amenities such as shops, public transport and GP surgeries. The home is a large 3 storey building and provides a number of lounge areas, including a conservatory, which offers people a choice of places to sit and socialise with other people in the home should they wish. Some of the rooms were used for watching television or sitting and relaxing. Each of the rooms were homely and had been decorated with ornaments and pictures, which gave rooms a comfortable feel. Since our last visit some of the furniture has been replaced. Lyndhurst DS0000005747.V359643.R01.S.doc Version 5.2 Page 21 There is also a 1940’s lounge where people enjoy reminiscence activities as well as another small lounge used for activities such as flower arranging or arts and crafts. The home provides 40 single bedrooms, none of which have en-suite facilities. People had brought some personal items from home such as ornaments and pictures, which had been used to personalise their room. A small number of rooms were looked at. Rooms appeared comfortable and clean. People had access to the call bell should they need to request assistance, a lockable space was provided and those wishing to were able to have a key to their door. There are 3 bathrooms, 1 shower room and 14 toilets. Facilities have been adapted to assist people in meeting their physical needs. A random check was carried out on the water temperature in a ground floor bathroom, laundry and toilet. Outlets appeared to be running cool. This was raised with the manager who stated that this had already been reported by staff. The maintenance man was asked to look at this. A smoke room has been made available for those people who wish to smoke. This is a small quiet lounge on the ground floor with through access from the main part of the building to bedrooms. It was noted that one of the doors had been propped open and the second was not fully closed. The grounds of the home are limited in size. However there is a courtyard garden, which is easily accessible. The home employs a domestic supervisor and 9 domestic staff who take responsibility for cleaning the home, assisting in the kitchen or carrying out the laundry. Shifts are identified on the rota throughout the week. The home was clean, tidy and free of odour. Suitable arrangements are in place to ensure there is no cross infection. Staff were seen to be wearing protective clothing when providing support with specific care tasks. Adequate hand washing facilities are provided throughout the home. People living at the home ticked ‘always’ when asked in the surveys if the home was fresh and clean. There was some discussion with the manager about the long-term future of the home. CLS are currently developing new projects called ‘Belong’. One of the new developments is to be opened in Atherton in 2010 and will replace Lyndhurst and another home within the group. Facilities will include spacious living accommodation, en-suite bedrooms, shops, salon and restaurant. Those people living at Lyndhurst will move into the new home. Lyndhurst DS0000005747.V359643.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Robust recruitment procedures are in place ensuring people living in the home are protected. Ongoing training takes place so that staff have the knowledge and skills required for their role. EVIDENCE: The home is registered to accommodate up to 40 people. At the time of the visit there was 1 vacancy. Copies of staff rotas were looked at for several weeks up to the site visit. Staffing comprises of 1 care team leader and 3 carers throughout the day and 2 night staff between the hours of 10pm and 8am. Discussion was held with the manager about the staffing levels based on occupancy. We were advised that should additional staffing be required then arrangements would be made. The manager also said that there was also an on call system in place should staff need additional support or advice. As noted on the previous inspection visit the manager should keep this under review ensuring the assessed needs of people can be fully met. Other members of the team include the manager, service manager, domestics, cooks and maintenance man. There has been some new staff since our last visit to the home. Staff recruitment files were requested for two members of the team. Information included an application form, written references, health screening, interview Lyndhurst DS0000005747.V359643.R01.S.doc Version 5.2 Page 23 notes, statement of particulars and POVA/criminal record checks. None of the staff had commenced their employment until the enhanced CRB had been received. References had been received from the person’s previous employer and a full employment history was recorded. The manager also holds information and checks for all members of the team including none care staff ensuring people living at the home are protected and staff have been rigorously recruited. There was evidence of a detailed induction being undertaken by the newest member of staff. Shadowing shifts are also accommodated on the rota to allow time for new staff to work alongside more experienced staff. Training information was looked, which details what training staff have completed along with copies of their certificates. Some of the courses, which had been held during 2006/2007, included fire safety, moving and handling, pressure care, infection control, first aid and NVQ. Some staff required training updates. The manager has identified training needs for the forthcoming year. Courses will include moving and handling, safeguarding adults, infection control, pressure care, fire safety, medication and dementia. During the visit some staff were having moving and handling training, which is facilitated by the organisations health and safety trainer. Training in pressure care had also been scheduled for later in the week. Information also held on the training file included information from the local authority training and development team in relation to adult protection. The manager stated that arrangements will be made for staff to attend this course ensuring they are aware of the local authority procedure. NVQ training has also been provided for staff. Further funding has been sought for those over the age of 25. The manager stated that all but 1 member of the care team has either completed or is working towards level 2 or 3. Training has also been provided for the domestic staff covering topics relevant to their role. Feedback received from staff spoken with and comments within the surveys included; ‘the manager is very supportive’, ‘ the service provides well for people living at the home and promotes independence amongst other things’, ‘we put the residents first’, ‘all our residents are treated with the best care and respect’. In relation too staff support, one person commented, ‘my induction covered everything I needed to know’, ‘we receive mandatory training as well as other courses such as pressure care and dementia’ and ‘all information is documented and discussed between staff at handovers’. Lyndhurst DS0000005747.V359643.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The managers experience and qualifications ensure the welfare of the people using the service. Some action is required in relation to maintenance work ensuring people living and working at the home are safe. EVIDENCE: The registered manager of the home has worked within the care field for over 25 years starting as a care assistant working up to manager. She has been the manager at Lyndhurst since December 2003 and has completed the NVQ level 4, registered managers award and is an NVQ assessor. Through discussion with the manager it is clear that she is fully aware of her responsibilities and is both competent and committed in managing the home. Lyndhurst DS0000005747.V359643.R01.S.doc Version 5.2 Page 25 Staff spoken with described her as an ‘excellent manager’ and ‘dedicated, always goes the extra mile’. Systems are in place for reviewing the quality of service. The home’ carries out it’s own audit and periodically asks people who use the service, their relatives or other supporters to give feedback about their opinions of the home, the results of which are compiled and reported back at the residents and relatives’ meeting. The manger also completes periodic audits relating to health and safety, medication etc to ensure that systems are working effectively. An evaluation of the service is carried out by an external company (RDB) who, again this year awarded Lyndhurst with 5 Stars. Regulation 26 monthly visits are also carried out by the organisation. Visits are carried out by a senior manager and the results of which are written into a report. This shows that CLS is monitoring the quality of the service being delivered at Lyndhurst and identifying where improvements need to be made, to make the service better for the people who live there. A copy of the home’s annual development plan is kept at the main reception so that visitors to the home can see what improvements are planned for the coming year. The system for managing peoples finances was also looked at. The home does not act as appointee for anyone. Responsibility is either maintained by the individuals themselves, a relative or appropriate representative. Personal allowances are held within the office and are used to pay for items such as trips, hairdressing, newspapers etc. Records and receipts are held to show that money is being managed properly. A random sample was checked and found to correspond with the balance sheets. Records were looked at in relation to health and safety. Safety checks are carried out by the in-house handy man that takes responsibility for the fire safety, water temperature, emergency lighting as well as general repairs and decoration within the home. Records are held of work completed and were found to up to date and in order. Annual servicing is carried out in relation to fire equipment, fire alarm, emergency lighting, hoists, small appliances and the passenger lift. However there was no up to date certificate for the electric circuit and gas supply. The manager is asked to provide this. Arrangements must also be made in relation the smoke room ensuring the doors providing access to the corridors and bedrooms remain shut ensuring fire safety is not compromised and the facilities comply with the new guidance. Water temperatures were sampled in one part of the building in a bathroom, separate toilet and the laundry. They were found to lukewarm. This was Lyndhurst DS0000005747.V359643.R01.S.doc Version 5.2 Page 26 pointed out to the manager and maintenance man. A further check was made. The maintenance man stated that the boiler was not on full and therefore had turned it up. The manager said that this had also been identified by staff earlier in the week and reported. Lyndhurst DS0000005747.V359643.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Lyndhurst DS0000005747.V359643.R01.S.doc Version 5.2 Page 28 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. 1 Standard OP7 Regulation 15(1) Requirement Care plans and risk assessments must be updated to reflect the current and changing needs of people living at the home. This information is needed so that staff are aware of the support to be provided ensuring people are cared for properly and any areas of potential risk are minimised. Medication records need to clearly show that medication is being given, as prescribed ensuring people are not placed at risk of harm. This should include the date and time given and then signed by relevant member of staff administering medication. Timescale for action 30/04/08 2 OP9 13(2) 30/04/08 Lyndhurst DS0000005747.V359643.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations Where possible people should be encouraged to sign their care plan to show that they agree with what has been written. The manager should keep under review the staffing levels provided at the home ensuring the assessed needs of people can be fully met. Mandatory training updates including adult protection need to be planned for the forthcoming year so that staff are aware of the procedures to follow ensuring people are safe. The manager is asked to provide information to show that up to date checks have been carried out in relation to the electric circuits and gas safety. The manager must make sure that the relevant guidance is followed with regards to the smoke room ensuring people at the home are safe. Water temperatures need to be monitored to ensure that they are maintained at 43°C for the comfort of people at the home. 2 OP27 2 OP30 3 OP38 4 OP38 5 OP38 Lyndhurst DS0000005747.V359643.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 Lyndhurst DS0000005747.V359643.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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