Care Home: Lynfield

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What the care home does well Lynfield really does work hard at keeping on top of a robust and thoughtful process of assessing abilities and needs. This has included constructing agreed, in depth, plans for care arising from these assessments. It proved easy to see from individual personal files what people wanted, what they needed and preferred. Staff had very clear help and guidance in delivering the care that individuals needed in the way in which they wanted it done. The home initially set up a strong rapport with service users`, relatives and representatives, and although people say that there was a `hiccough` in the communication they had come to expect during the last year this appears to have been overcome. People still say that they feel involved and supported in their own continuing caring roles. Staff training has also set an impressive pace [in broad terms] since the home opened. Staff said that they felt properly supported and clear in their roles. The incorporation into the home of the supportive work coming directly from employees of one of the purchasing organisations [Norfolk] has added an extra dimension to what was already in place. What has improved since the last inspection? There has been a broad upward trend along the lines predicted in the last inspection report. Some weaknesses exposed by actual contact with the real world of practice have been identified and resolved. What the care home could do better: It is probably time to think about how to keep a focus on the small number of `key` items in each individual care plan. This needs to be done in such a way as not to loose the rest of what has been garnered. This was even truer now in 2008 than it was last year. To a great extent this is simply a reflection of how well the home has done. All professional person centred assessment and care planning systems reach the stage where they risk drowning in their own information. This is usually the point where they also risk losing sight of the key direction an individual`s progress is taking them in.The manager reported that there have been [and still are] some issues relating to communication needs for service users and staff. Their assessment makes good sense and has had an impact. This means that care has to be taken to avoid a repeat of the situation and to ensure a speedy resolution of any lingering difficulties. CARE HOME ADULTS 18-65 Lynfield 22 Norwich Road Ditchingham Norfolk NR35 2JL Lead Inspector Silas Siliprandi Unannounced Inspection 14th February 2008 09:00 Lynfield DS0000067879.V360772.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 Lynfield DS0000067879.V360772.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. Lynfield DS0000067879.V360772.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lynfield Address 22 Norwich Road Ditchingham Norfolk NR35 2JL 01986 897196 01986 895748 joe@kingsleycarehomes.com 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) Kingsley Care Homes Ltd Vacant post Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Lynfield DS0000067879.V360772.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th March 2007 Brief Description of the Service: Lynfield provides residential care for nine adults with learning difficulties. The home is sited on the western edge of the small village of Ditchingham but it is also just into the northern outskirts of Bungay, but within easy reach of the town and far wider range of amenities. Bedroom accommodation is all in single rooms with communal lounges and dining area. Accesses has been worked on by providing ramps in key areas There is a sizeable garden behind the house, with paved as well as lawned areas. Lynfield DS0000067879.V360772.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 stars. This means that the people who use this service experience good quality outcomes. Lynfield is a comparatively new home that had worked hard to build on the good foundation it laid during the process of registration. The home didn’t rush to fill its beds, but took time to implement and develop a properly professional basis of assessment and consultation to give people genuine choice and support. In the year since the last inspection this assessment process did have some challenging testing. Probably due to its comparative ”newness” the home did encounter some problems with the admissions process. The manager said that this was an unfortunate part of the learning process and that the lesson has been learned. They also said that the basic structure was still sound. The Commission sees this as a wholly reasonable viewpoint. The policies and procedures of the home lay out a very strong commitment to individual consultation and choice. The actual practice is now clearly following the early expectations of the first inspection last year. The staff group has grown since last year, and work has continued [in broad terms] to help in ensuring that they bring the right kind of attitude to the job, and that they are properly supported by training and instruction in their roles. Those staff interviewed were all very positive and enthusiastic about developments over the last year. The building itself ought to be able to meet quite a range of demands, it has plenty of space inside; people living at the home do have space, both in their private rooms and in the communal areas. There is also a large garden with both paved and lawned areas that provides a sensible amount of safe outdoor space. The home is sited in an area where here is actually opportunity to access outside services such as education and a range of social activities. People living at the home were positive about what they had to say. There have been some concerns raised by relatives/representatives of users of the service, but this concern has been focussed on two specific issues, one of which was related to an admission that didn’t go as everybody hoped, and the other was specific to some staff issues [see below]. Apart from that underlying levels of satisfaction continue to be good. Lynfield has made good the bulk of the progress predicted in the last inspection report. This is further commented on in the individual judgements throughout the report. Lynfield DS0000067879.V360772.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: It is probably time to think about how to keep a focus on the small number of ‘key’ items in each individual care plan. This needs to be done in such a way as not to loose the rest of what has been garnered. This was even truer now in 2008 than it was last year. To a great extent this is simply a reflection of how well the home has done. All professional person centred assessment and care planning systems reach the stage where they risk drowning in their own information. This is usually the point where they also risk losing sight of the key direction an individual’s progress is taking them in. Lynfield DS0000067879.V360772.R01.S.doc Version 5.2 Page 7 The manager reported that there have been [and still are] some issues relating to communication needs for service users and staff. Their assessment makes good sense and has had an impact. This means that care has to be taken to avoid a repeat of the situation and to ensure a speedy resolution of any lingering difficulties. 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. Lynfield DS0000067879.V360772.R01.S.doc Version 5.2 Page 8 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 Lynfield DS0000067879.V360772.R01.S.doc Version 5.2 Page 9 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): Key standard 2 was inspected. Standards 1,3,4,& 5 were also looked at briefly to assist in seeing the wider picture. Quality in this outcome area is good People who may use the service and their representatives do have the information needed to choose a home that will meet their needs. They have their needs assessed and a contract that clearly tells them about the service they will receive. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been minor developments of both the Statement of Purpose [SOP] and the Service User Guide [SUG]. They are both plain understandable documents that give a useful range of information.The section explaining what needs the home can and cannot meet is also clear. The SUG [recently revised and up-rated] is also available in “Widgets”, which is a standardised picture format aimed at making the information more widely accessible to some service users. Neither the SOP or SUG are available in other formats [such as video] as yet. Lynfield DS0000067879.V360772.R01.S.doc Version 5.2 Page 10 The assessments sampled were detailed, solid and comprehensive. Social and emotional issues were as well looked after as issues around basic care and health needs. The “Interventions” sections of the assessments lay a good foundation for deciding how well the home can meet individual assessed need. [Which then develop into more detailed care plans]. There is an admissions policy to guide decision-making and individual understandings of the scope of care available in the home. The policy of promoting visits and stays prior to admission has been observed. This is also true of an emergency admission where although attenuated, visits were scheduled into a tight timetable. It is now policy and practice to involve users of the service when considering new admissions. This now brings to fruit the underlying intention sketched out last year and as originally delineated in policy documents. The contracts for each service user proved clear and detailed and had been issued in a timely fashion. Lynfield DS0000067879.V360772.R01.S.doc Version 5.2 Page 11 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): Standards 6,7,8 and 9 were inspected. Standard 10 was not inspected. Quality in this outcome area is good Individuals are involved in decisions about their lives and do play an active role in planning the care and support they need. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are very solid and comprehensive individual plans. These plans detail how individuals will be supported in doing what they prefer to do. The plans are specific and personal. They offer clear guidance and support to staff in their caring roles to the individual. The plans also open doors to potential new interests and activities. They also keep track of activities and programmes. Lynfield DS0000067879.V360772.R01.S.doc Version 5.2 Page 12 The plans facilitate professional updating, but could use a different model to improve the way in which it is possible to track key ‘changes’ in peoples’ lives. The plans are becoming very full of information, and the information is becoming difficult to retrieve in some cases. A different model would also offer an easier route to this. There is now a completely new format for care planning that is being trialled with four of the people living at Lynfield. The manager said that this new format will extend to everybody if It proves successful or advantageous. This new format does aid the ability to retrieve some of the core information [for example by opening with a précis of the original assessment] and by laying six more clearly defined ‘areas’ of wishes, needs and care responses. Nonetheless, some specialist re-modelling would still assist in keeping easier track of ‘change issues’. The home has made steady progress in the last year with its original intent of seeking to identify and access educational resources to assist in meeting identified and potential need. A meeting was taking place in the home at the time of the inspection with representatives of a local college for just exactly this purpose. There was a very clear policy to guide staff in understanding the importance of respecting and promoting choice. Staff were able to describe what “choices” comprised of, and also were able to explain the importance of choice in daily life. People living in the home were positive about their choices being respected. Users of the service now have formal access to satisfaction questionnaires and monthly resident meetings. In general terms the care plans, risk assessments and policies all pointed firmly towards a proper and professional intention. This intention was supported by what staff and the manager had to say. Lynfield DS0000067879.V360772.R01.S.doc Version 5.2 Page 13 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): Standards 12,13,15,16 and 17 were considered in some detail. Standards 11 and 14 were also looked at briefly. Quality in this outcome area is good People who use Lynfield are supported to make choices about their lifestyles and in developing their life skills. Their broad social, emotional, cultural and recreational activities are being tailored to meet their individual preferences and aspirations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The assessments and care plans both of the ‘old’ and ‘experimental’ kind sampled showed clear supporting intentions in their layout. The meeting taking place at the home [and the comments offered to the Commission by the representative of the college, individual support workers Lynfield DS0000067879.V360772.R01.S.doc Version 5.2 Page 14 and the service user’s family at that meeting] was an active demonstration of the good developing level of co-operation being developed with educational resources. There were appropriate prompts to assist in recording individual preferences and choices in both the assessment documents and the care plans. Appropriate care responses were laid out and planned for in this documentation. The risk assessment process covered ground relevant to the individuals sampled. Staff were well directed to the importance of these issues in policy documents. Staff interviewed gave sound explanations of their supportive and exploratory roles in supporting individual lifestyle choices. The manager gave a detailed breakdown of progress so far and described adjustments already made and pointed out proposed future plans and actions directly related to individual needs and wishes. The records [and what service users said] showed an ongoing level of activities inside and outside the home. A member of staff has now been assigned a special role in co-ordinating and facilitating activities. The same range of sources supported the idea that the home was already taking big steps to assist people who lived there to become integrated into the community. The previously rather weak position in respect of the number of drivers [for going out] available within the staff team has been radically improved. The same evidence applied to the solid start well under way with promoting and supporting family and other social links, including a wide range of actual and potential activities outside the home. All of the policies and records support a clear intention of promoting choice and independence and this intention is reflected in individual plans for care. At this stage nobody had been appointed with the specific role [and detailed underpinning knowledge] to assist in ensuring appropriate diets. There was evidence from assessment that there was already some specific need in this area, but at present this was supported by outside advice. Service user and service user representatives interviewed during the visit backed up their previous written comments with equally positive views about lifestyle choices. The overall evidence was limited by the small number of people living at the home so far and by the very early stage of development. Lynfield DS0000067879.V360772.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18,19 and 20 were looked at in detail; standard 21 was also looked at briefly. Quality in this outcome area is good People living at Lynfield receive personal and healthcare support soundly based on assessment and their own personal needs and preferences. Their dignity and privacy are properly safeguarded and promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The assessments sampled [along with the care plans and care actions springing from the assessments] have prompts to assess healthcare needs and to investigate personal individual preferences. The care plans go on to detail care responses based on what was found and recorded in the assessments. Policies and procedures are clear in their instruction and support to staff about the important concept of flexible and individual care. Staff interviewed were equally capable of describing the concepts and their importance. They were able to describe scenarios where their own practice had reflected individual needs or preferences. Lynfield DS0000067879.V360772.R01.S.doc Version 5.2 Page 16 Service users and their relatives/representatives backed up their positive written views of the practice of the home in discussions during the visit. The medicine records were simple and straightforward and the underlying system ought to be sufficiently robust to safely support expansion as more people move into the home. The medicines were safely stored. The manager explained that the intention was to have all care staff [probably excepting relief staff] trained in the administration of medicines. Records showed this process well in hand, but with certain restraints being imposed due to risk assessed communications needs of some staff. There was only a very brief discussion of how Lynfield and its staff would deal with dying and death, and this topic needs to be explored at a later time. Lynfield DS0000067879.V360772.R01.S.doc Version 5.2 Page 17 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): Standards 22 and 23 were both inspected. Quality in this outcome area is good. People using the service at Lynfield can express their concerns and can use a sound complaints procedure. People are also protected from abuse and have their rights protected. The provision has experienced some practice difficulties, but the system is now back on track towards being “good”. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service user’s guide has a pictorial [Widgets] supplement that now also covers the issue of raising concerns or complaints. There is no alternative medium – such as video- to broaden accessibility further as yet. The manager said that there is early research in train for access to advocacy services, but this is an area where it has not yet been possible to make progress on the intention apparent last year. When concerns were raised there were some problems in actually ensuring that the people who raised the concerns were kept in the picture in a timely way, including ensuring that the people with concerns were informed of the final outcome, and they were wholly satisfied with the level of investigation and resolution. This did mean that the Commission became briefly involved in one of the issues in question. Lynfield DS0000067879.V360772.R01.S.doc Version 5.2 Page 18 The manager says that the procedures are now in place to assist in ensuring that this kind of ‘gap’ never appears again. Records show staff being involved in an ongoing programme of Adult Protection training. Policies and procedures were found to contain clear reference to appropriate measures and understandings protective of individuals. Users of the service were able to say who they would talk to in the home if they had any worries. They said that they felt that people could be trusted if they had anything of this kind to say. Lynfield DS0000067879.V360772.R01.S.doc Version 5.2 Page 19 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): Although all of standards 24 to 30 were considered briefly the main focus concentrated on standards 24 and 30. Quality in this outcome area is good The physical layout and design of the home enables the people living there to live in a safe, well-maintained and comfortable environment. The environment encourages their independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The building and its services did make a good match to the assessed abilities and needs of the people living there. There were no significant difficulties or mismatches yet identified in the building and facilities, but there was on ongoing problem relevant to the behaviour of one user of the service that does have an impact on use of one of the communal areas. The size and layout of the rear garden adds to the probability of a good “across the board” match in the potentials that it offers. Lynfield DS0000067879.V360772.R01.S.doc Version 5.2 Page 20 The bedroom shown by one of the service users was obviously individual and personalised. The person concerned described their accommodation with equally evident satisfaction. The communal areas were in good decorative and repair order, but staff and management alike still described them as being rather functional, but this was less true than it was a year ago, and therefore it seems likely to go on improving as things develop. The smaller lounge had been improved noticeably in this respect, and now had facilities to give some extra ‘sensory’ input [but not yet to the extent of being a dedicated and comprehensive ‘sensory room’]. The home was clean and hygienic in all of the communal areas and in the one bedroom seen during the visit. Lynfield DS0000067879.V360772.R01.S.doc Version 5.2 Page 21 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): Standards 31 to 36 were all considered as part of this first inspection of a new home. Quality in this outcome area is adequate. Staff are present in the home in sufficient numbers [broadly speaking] to support the people living in the home. The staff also have a level of basic training that is steadily improving. Staff are properly aware of the vital role they have to play in supporting and protecting vulnerable people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Sampled job descriptions were comprehensive and appropriate to the purpose of the home. Job descriptions clearly stated the intention for the home’s practice to support the White Paper “Valuing People”. The job descriptions also supported other good practice imperatives such as respecting choices and involving service users. Staff interviewed were able to give clear and sensitive explanations of their roles and why it was important to behave in specific ways while performing their jobs. Lynfield DS0000067879.V360772.R01.S.doc Version 5.2 Page 22 Staff interviewed were all emphatic about the way in which they felt that they had been supported by the management of the home in understanding their roles. They were equally positive about their views of the training they had received and continued to receive. The manager said that it was now important to move onto some more specialist training in respect of learning difficulties. The staffing complement is presently sufficient in numbers to meet the needs of the people living at the home. The number of staff in the home was sound, but the Commission has had to take account of the as yet imperfect communication abilities of some members of staff. The Commission tends to see this as a ‘self-solving problem’ in the long run as peoples’ grasp of English steadily improves. However, the Commission also believes that the manager has acted wisely in ensuring that communication issues are safeguarded in risk areas, [such as the administration of medicines and in the handling and use of cleaning materials]. The maintenance of, and close observance of assessments and care plans also has to be taken into account [as the manager has already done]. The essential assurance that all staff have a common viewpoint and practice in respect of ‘quality of life issues’ –also as spelled out in policies and procedures [occasionally in fairly dense English] – is hard to gain in these present circumstances. How this came about has to raise a question over basic recruiting procedures. It also means that restrictions on staff usage reduces the raw ‘full-time equivalent’ count of staff numbers. The manager has also had [quite properly] had to take stock of concerns raised by service users’ representatives in respect of what they see as communication difficulties which has also meant adjustments to some aspects of staff availability. Sampled records [tracking from the homes policies and procedures through to confirmation of employment and issue of contracts] otherwise generally followed the expectations of regulation and good practice. Records showed a very solid level of appropriate training, including training on abuse awareness and “key worker” training. Professional training and development plans for staff were already in place and active. Professional staff supervision and appraisal processes were already in place and active. Lynfield DS0000067879.V360772.R01.S.doc Version 5.2 Page 23 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): Standards 37 to 43 were all looked at, but the main focus remained on standards 37, 39 and 42. Quality in this outcome area is good The management of the home is based on openness and respect. The manager is competent, experienced and qualified for the role. The quality assurance system is at an early [but very sound] stage and is under active and continuing development. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager’s job description tallied with expectations laid out in the National Minimum Standards and with the purposes of the home. The present manager [a change of manager since the last inspection] has a good standard of qualification and considerable experience to suit them for their post. Lynfield DS0000067879.V360772.R01.S.doc Version 5.2 Page 24 The views of the service users and of the staff all agreed in saying that the home was thoughtfully run by somebody they could trust in and talk to. The Quality Assurance process has a sound foundation and is now better underpinned by responses from surveys. The policies continued to be extensively and thoughtfully overhauled and fundamentally improved, chiefly in respect of adjusting their focus more on people with learning difficulties. The manager said that this was all quite new, and further review would take place after a reasonable period of further trial. Evidence gathered throughout the visit had shown good detailed records meticulously maintained and kept up-to-date. The registered manager is the person designated as the person responsible for all health and safety issues [as detailed in job description]. Lynfield DS0000067879.V360772.R01.S.doc Version 5.2 Page 25 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 2 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 2 33 2 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 2 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 3 3 3 X Lynfield DS0000067879.V360772.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA6 Good Practice Recommendations To consider how best to keep an up-to-date ‘abstract’ of key issues in the care plan so the stay readily in view. This will help everybody to keep working consistently on “change” issues. To also consider how to ensure [at the same time] that the impressive weight of information so far gathered remains accessible for consideration. As discussed there may well be methods of achieving both these ends in a way that also performs a significant part of the Quality Assurance process. To consider how best to put somebody trained and/or qualified into a staffing position where they can give reliably founded help and advice about diet and nutrition. This will help ensure that everybody gets the maximum opportunity to choose and receive a healthy diet, and also that people with specific dietary needs receive the best possible care and support. To consider how best to ensure that concerns and DS0000067879.V360772.R01.S.doc Version 5.2 Page 27 2 YA17 3 Lynfield YA22 complaints are always dealt with speedily and in such a way that people raising concerns never feel that they have not had their concerns fully investigated and responded to in a timely and comprehensive way. This will help in ensuring that levels of anxiety are never needlessly raised and that people do feel that their views are taken seriously. This will also assist in assuring that people feel confident in bringing forward issues at the earliest possible stage, thereby helping to safeguard vulnerable people in a very effective way. To consider the role of advocacy services as a means of supporting some service users in accessing the process by which concerns and complaints may be raised in the home. This is actually a broad recommendation to seek to provide advocacy services within the home. Concerns and complaints again seems a good starting point at which to introduce the general concept of advocacy as a support [and independent protection] to vulnerable people living at Lynfield. To consider the best and most expeditious means of bringing forward more specific staff training in the area of learning difficulties. Preferably training with an accredited outcome for staff taking part. Given the gradual shift towards meeting the needs of people with ‘autism spectrum’ needs some extra key training for all staff in this particular and complex area seems highly appropriate. Given the present and past experiences associated with some behaviours which are challenging to others the need for some underpinning training [and risk/harm reduction] also seems an essential adjunct. Also the overall level of staff qualification has not yet reached the minimum level expected by the National Minimum Standards. Preferably training with an accredited outcome for staff taking part. This will help staff understand people living at the home better in respect of specific needs, conditions and syndromes as well as in the general concepts of promoting their general independence and autonomy. The training ought also to increase the self-esteem and confidence of staff. To consider how best to ensure that staff recruitment always ensures that people with appropriate levels of communication in English are selected for roles involving direct personal care, or such other roles where a sound command of English is essential. This is not to say that people with a potential to develop good communications DS0000067879.V360772.R01.S.doc Version 5.2 Page 28 4 YA22 5 YA32 6 YA32 Lynfield skills with service users ought not to be employed in supernumerary or auxiliary roles until they can realise that potential. This ought to help ensure that people living at the home always have the best opportunity to have their own [sometimes limited] communications skills recognised, understood and passed on. It ought also to help in ensuring universal adherence to agreed written plans for care and written expectations and definitions of core practices as defined in policies and procedures. Lynfield DS0000067879.V360772.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection 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 Lynfield DS0000067879.V360772.R01.S.doc Version 5.2 Page 30 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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