Care Home: Lynton Hall Care Centre

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What the care home does well The majority of people we spoke to said that they were happy living at the home. They told us they like the staff and say that they are polite and respectful. The food provided has improved in recent months. The people who live there know how to make any concerns or complaints known and feel able to do this if so required. The environment is kept very clean and is well decorated. People told us that they like their bedrooms and are able to have visitors when they liked. Activities are provided and a dedicated area provided for these to take place. What the care home could do better: We think that there are improvements being made at Lynton Hall but it is clearly a `work in progress`. It is important that progress continues and staff are helped to move from task orientated care to a person centred model. There needs to be much more emphasis on individual wellbeing, engagement and occupation. We have made one Requirement and a number of recommendations. The issue around staffing levels must be looked at again as a number of people living there still feel that there are not enough staff on duty and are saying that call bells sometimes take a long time to be answered. this was the case tat the August 2009 inspection. The home must fully re-assess the individual needs of the people living there in order to inform the correct staffing levels required. The staffing ratios must be based on the current needs of people and not their number. The environment and the need to move away from task focused care will also impact on this assessment. We will look at this issue again at our next inspection. The organisation needs to make sure that its quality assurance procedures is effectively picking up issues such as call bells taking a long time to answer and that it is also lookingat the levels of wellbeing of people living at the home. There needs to be a focus on delivering more person centred care and ensuring that staff benefit from strong leadership and role modelling. The appointment of a deputy manager may help to support changes out on the floor. Mealtimes could be made better for the people living there. The home needs to look at the mealtime experience and think about how to make it a more pleasant social occasion for everyone involved. Care plans could include more personalised information and capture more of the individual`s life, their preferences and the small things that make a difference to the person each day. Activity, occupation and engagement should be an important part of the carers role and the plans in place reflecting this. The bathrooms could be made less clinical and the communal areas more user friendly. Items for occupation and engagement could be provided throughout and shared spaces made more homely. Random inspection report Care homes for older people Name: Address: Lynton Hall Care Centre 2 Lynton Road New Malden Surrey KT3 5EE two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Jon Fry Date: 1 1 1 1 2 0 0 9 Information about the care home Name of care home: Address: Lynton Hall Care Centre 2 Lynton Road New Malden Surrey KT3 5EE 02089491765 02083361288 cartebar@bupa.com www.bupacarehomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : BUPA Care Homes (ANS) Ltd care home 57 Number of places (if applicable): Under 65 Over 65 2 1 57 57 dementia learning disability old age, not falling within any other category terminally ill Conditions of registration: 0 1 0 57 A variation has been granted to allow one specified service user in the Learning Disability, over 65 (LD(E)) category and one specified service user in the Learning disability (LD) category to be accommodated. As agreed on 12/6/06 a variation has been granted to allow 2 specified service users in the Dementia, over 65 (DE(E)) service user category to be accommodated. as agreed on 12/6/06 a variation has been granted to allow one specified service user (female) aged 54 years, requiring general nursing care, to be accommodated. Date of last inspection 1 3 0 8 2 0 0 9 Care Homes for Older People Page 2 of 11 Brief description of the care home Lynton Hall is a nursing home owned by BUPA. It is situated in residential area, close to the town, in New Malden, Surrey and is close to public transport routes and the local shopping centre. A garden and off-street parking are to the rear of the home. The home is registered to provide nursing care for up to 57 older people. Accommodation is arranged over two floors, each of which has its own lounge, and bathroom and toilet facilities are on each floor. There are five double and forty-seven single bedrooms. All have washbasins and eleven have en-suite facilities. Adaptations within the home ensure that it is accessible to those who have physical disabilities and nurse call bells are in all areas. The home is staffed twenty-four hours a day by both trained nurses and care staff. In addition, a chef, activities coordinators, handyman and domestic staff are employed. Copies of the Statement of Purpose for the home and Service User Guide may be obtained from the home while the latest inspection report may be downloaded from the Care Quality Commission website at CQC.org.uk Care Homes for Older People Page 3 of 11 What we found: Two inspectors made an unannounced visit to the home and spoke to twelve people who live there, three visitors, the manager and five members of staff. We also looked at records kept by the home including individual care plans and assessments. General comments from people who live there included I like it here very very much, put me down as quite happy - I want to stay here, Its all very nice, they care for you and on the whole they look after you well. One person said standards have dropped whilst another individual reported that you can see the improvements. The people we spoke to told us that staff respected their privacy and dignity. Their comments included very good carers, I cant fault any of the staff, they always acknowledge you and see if they can help, very polite and lovely. As at the August 2009 inspection, there were again comments about the number of staff on duty and the length of time people had to wait when they rang their call bell. Feedback included I sometimes wait a long time when I press the bell especially at night, they are sometimes slow to answer the call bell but you always think you can do better than them, I have to ring the bell two or three times, the main problem is the call system - you have to keep pressing it and sometimes they get short staffed - take a bit of time to come. Other comments included the workers really do have to go and they are short staffed. The manager told us that a new call bell system is due to be fitted in 2010 and this may help to track time taken for individual bells to be answered. Comments from staff about this issue included the mornings can be very difficult and very stressful. One staff member felt that there were enough staff on duty but would welcome more time to spend with people. A visitor spoken with said theres not enough stimulation and they need more staff. We saw that staff on duty were always very busy and there were times when there were no staff around in communal areas as they were all helping people in their rooms. The corridor layout of the home also exaggerates this as you cannot easily see that staff members are actually around. We sat in a lounge area with three people who live there and did not see any staff members for an extended period. The manager told us that the service was now not reliant on using agency staff and recruitment was continuing with a deputy manager expected to be appointed soon. Two part time activities people were also now in post. There has been progress on improving the menus and meals provided. People told us that the food is great, very good, it has improved a bit, its getting better and not too bad. The care plans we looked at were well completed with good information recorded about manual handling, health needs and did include evidence of consultation with the individual and their family. We saw that wound care assessments contained good information about the treatment required and that referrals were being made to the tissue viability nurse when required. Care Homes for Older People Page 4 of 11 Medication records were up to date and showed that people are receiving their medication as prescribed. The staff need to make sure that a clear audit trail can be followed by carrying forward quantities of medication from month to month where applicable. The staff we spoke to said that they received the training they need to do their jobs well. There has been particular emphasis on updating staff around manual handling following recent Safeguarding issues and other training has included whistle blowing, dementia care and fire safety. Life mapping training was also being planned to help staff see the person they are supporting. The manager has been in post since August 2009 and has clearly started to make improvements. A system for staff supervision is now in place and there are more regular meetings with the people living there and their relatives. The home is having regular meetings with the Local authority to resolve the outstanding Safeguarding issues and action any shortfalls. What the care home does well: What they could do better: We think that there are improvements being made at Lynton Hall but it is clearly a work in progress. It is important that progress continues and staff are helped to move from task orientated care to a person centred model. There needs to be much more emphasis on individual wellbeing, engagement and occupation. We have made one Requirement and a number of recommendations. The issue around staffing levels must be looked at again as a number of people living there still feel that there are not enough staff on duty and are saying that call bells sometimes take a long time to be answered. this was the case tat the August 2009 inspection. The home must fully re-assess the individual needs of the people living there in order to inform the correct staffing levels required. The staffing ratios must be based on the current needs of people and not their number. The environment and the need to move away from task focused care will also impact on this assessment. We will look at this issue again at our next inspection. The organisation needs to make sure that its quality assurance procedures is effectively picking up issues such as call bells taking a long time to answer and that it is also looking Care Homes for Older People Page 5 of 11 at the levels of wellbeing of people living at the home. There needs to be a focus on delivering more person centred care and ensuring that staff benefit from strong leadership and role modelling. The appointment of a deputy manager may help to support changes out on the floor. Mealtimes could be made better for the people living there. The home needs to look at the mealtime experience and think about how to make it a more pleasant social occasion for everyone involved. Care plans could include more personalised information and capture more of the individuals life, their preferences and the small things that make a difference to the person each day. Activity, occupation and engagement should be an important part of the carers role and the plans in place reflecting this. The bathrooms could be made less clinical and the communal areas more user friendly. Items for occupation and engagement could be provided throughout and shared spaces made more homely. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 11 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 7 of 11 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 27 18 The home must conduct a re-assessment of the individual support needs of the people living there. This is to determine that there are suitable numbers of staff on duty at all times. 01/04/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Care plans could be improved to be more person centred and capture more of the persons life, their preferences and what is important to them. Life story books should be developed. Care plans should help staff to deliver individualised care and not task orientated care. 2 9 Medication records should enable a clear audit trail to be followed. Any quantities of medication carried forward needs to be clearly recorded. All care staff should be encouraged to spend time with people. Increasing wellbeing through engagement and Page 8 of 11 3 12 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations occupation needs to be an integral part of the culture of the service. Activity both in and out of the home should be increased and individuals supported to be part of their local community. 4 15 Menus should be produced in a picture format and be clearly displayed for people to see what is on offer each day. Other ideas for mealtimes could include food tasting sessions, international days, recipes from the people who live there, reminiscence through meals, buffets, breakfast and lunch clubs. 5 15 The mealtime experience should be looked at. The use of plastic aprons and bibs should be reviewed. Protected mealtimes could help staff spend more time with people and make it a more pleasant social experience. Table cloths and decorations should be used more. 6 19 More items could be provided in communal areas for people to engage with. This could include pictures, wall hangings, books, magazines, rummage boxes, hats, sensory items, toys, and reminiscence objects. These may help staff to positively engage with people. The bathrooms could be made more homely as they currently have a clinical feel. One bathroom needs to have a lock fitted. The bedroom door of one person should be looked at to make sure that it closes properly. This issue was highlighted at the time of inspection. The staff training programme should continue to be developed. Further training could include person centred care, dementia care and care planning. More staff should be supported to access the Eden training. 10 31 The management structure should be developed to allow for leadership and role modelling within the service. The culture of the home needs to be developed to promote Care Homes for Older People Page 9 of 11 7 21 8 24 9 30 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations person centred care rather than task based care. Care Homes for Older People Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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