Care Home: Lynwood House

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What the care home does well The home provides a very good range of information to people thinking of coming to the home, so they can make an informed decision. The home makes a full assessment of a person`s needs before deciding if it can meet all those needs. The home draws up plans to meet the care needs of its service users. (These are currently under review) Service user`s health care needs are also fully assessed and properly met. The home stores medicines safely, and administers them correctly and safely. Service users say that staff treat them well and treat them with respect. The staff are working hard to provide a stimulating atmosphere in the home, with appropriate social activities for service users. Service users are encouraged to keep in regular contact with family and friends, who say they are always made welcome in the home. One relative said, "The family are very happy with the care they provide here. The care is first class". Service users are also encouraged to take as much control over their own lives as they are able, and make their own decisions. Without exception, the service users were very complimentary about the care that they receive, several spoke highly of the staff and all were very happy with the accommodation. Service users were very complimentary about the food, and there is a balanced diet, with service users choice included. Complaints and concerns are taken seriously and are responded to properly. The home is kept clean and hygienic and free from odours. The home has enough staff to meet the needs of service users The staff team had very good knowledge of the service users care needs. The home is very careful as to how it recruits new staff, and runs all the necessary checks on them to protect its service users. The manager is experienced and is providing positive leadership to the home. The home is being run in the best interests of the service users. Service users finances are protected by the home`s policies and accounting systems. The health and safety of the service users and of the staff are protected by the home`s policies and systems. What has improved since the last inspection? Several communal areas within the home have been decorated to a high standard, including new carpets, curtains and new TV`s. Staff have undertaken deprivation of liberty, mental capacity training. New menus have been devised with the help from nutritional experts from Newcastle University. The main focus being, healthy eating. The menus are appealing, wholesome and nutritious. What the care home could do better: The service user care plan format does not clearly identify each persons holistic needs. Information within the care records is not easily accessible. This could potentially compromise the care to be delivered. However, a working party within the council has been established to design a more user friendly care plan format. Consideration should be given to refurbish parts of the building. Externally, the building appears neglected and has not been maintained to an acceptable standard. Key inspection report Care homes for older people Name: Address: Lynwood House Durham Road Lanchester Co Durham DH7 0LP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Jim Lamb     Date: 0 4 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Lynwood House Durham Road Lanchester Co Durham DH7 0LP 01207520292 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): ann@steadman.durham.gov.uk www.durham.gov.uk Durham County Council Name of registered manager (if applicable) Mrs Ann Steadman Type of registration: Number of places registered: care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Learning Disability - LD(E) and LD That 6 places be maintained for those service users in the category of LD(E) and one for a service user in category LD until those service users no longer require this accommodation. Date of last inspection Brief description of the care home ,Lynwood House is a long established care home for older people. Durham County Councils Adult and Community Services Department is the registered provider of the service. All the bedrooms are singles and are on the ground floor. Some are larger than average because they were previously double rooms, and they provide more space for people, who need equipment to help them move around. The home provides permanent care for some people, respite care and also a unit which is used to carry out assessments of people s needs so that decisions can be made about the care they Care Homes for Older People Page 4 of 27 Over 65 10 26 0 0 Brief description of the care home need in the future. The home is close to the centre of the small village of Lanchester, with local shops, pubs and church. It is surrounded by a large lawn and garden. The amount service users pay depends on their personal circumstances. This does not include the costs of hairdressing, newspapers and toiletries. There has been uncertainty for a few years about whether the home would continue to stay open, or whether the site would be redeveloped to meet social and health care needs in other ways. A final decision has not been made yet. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The quality rating for this service is 2 stars. This means that the people who use the service experience good quality outcomes. How the inspection was carried out. Before the visit we looked at information we have received since the last visit, how the service dealt with any complaints and concerns since the last visit, any changes to how the home is run, the providers view of how well they care for people, and the views of Care Homes for Older People Page 6 of 27 people who use the service and their relatives, staff and other professionals. During the visit we talked with people who use the service, relatives, staff, the manager, and visitors, looked at information about the people who use the service and how well their needs are met, looked at other records which must be kept, checked that staff had the knowledge, skills and training to meet the needs of the people they care for, looked around the building/parts of the building to make sure it was clean, safe and comfortable, and checked what improvements had been made since the last visit. We told the manager/provider what we found. Care Homes for Older People Page 7 of 27 What the care home does well: The home provides a very good range of information to people thinking of coming to the home, so they can make an informed decision. The home makes a full assessment of a persons needs before deciding if it can meet all those needs. The home draws up plans to meet the care needs of its service users. (These are currently under review) Service users health care needs are also fully assessed and properly met. The home stores medicines safely, and administers them correctly and safely. Service users say that staff treat them well and treat them with respect. The staff are working hard to provide a stimulating atmosphere in the home, with appropriate social activities for service users. Service users are encouraged to keep in regular contact with family and friends, who say they are always made welcome in the home. One relative said, The family are very happy with the care they provide here. The care is first class. Service users are also encouraged to take as much control over their own lives as they are able, and make their own decisions. Without exception, the service users were very complimentary about the care that they receive, several spoke highly of the staff and all were very happy with the accommodation. Service users were very complimentary about the food, and there is a balanced diet, with service users choice included. Complaints and concerns are taken seriously and are responded to properly. The home is kept clean and hygienic and free from odours. The home has enough staff to meet the needs of service users The staff team had very good knowledge of the service users care needs. The home is very careful as to how it recruits new staff, and runs all the necessary checks on them to protect its service users. The manager is experienced and is providing positive leadership to the home. The home is being run in the best interests of the service users. Care Homes for Older People Page 8 of 27 Service users finances are protected by the homes policies and accounting systems. The health and safety of the service users and of the staff are protected by the homes policies and systems. What has improved since the last inspection? What they could do better: 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users are provided with enough information about the service to enable them to make an informed choice about whether this is where they want to live. Evidence: The home has a Statement of Purpose and Service Users Guide that gives clear information about the service. These include good details of the accommodation for the people who have moved here. Information is available in a range of formats and languages. This is very good practice. There is comprehensive assessment process that includes the input of the prospective service user, their relatives, social worker, care manager and, where appropriate, psychology, and psychiatry services. This ensures that the needs of each prospective service user are fully assessed before a decision is made about whether the service can meet their individual needs. Care Homes for Older People Page 11 of 27 Evidence: The pre-assessment information in the home gives very clear details of service users specific needs. The pre admission assessment is completed by the persons care manager together with a senior staff member from the home. All the people who live here have contracts that outline their rights and responsibilities whilst living here. These are kept in their care files which they can access, with support if necessary. The contracts also include details of the individual fees for each service user and their contribution. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning system is not yet clear enough to ensure that staff have the information they need to meet the assessed needs of the service users. (This is currently being addressed) Evidence: During the inspection, there was evidence that the people using the service made their own decisions about how they lived their lives. For example, four service users said that they are supported to make decisions about their day-to-day lives. The care records of three service users were examined. Their care plans had not fully taken account of the information contained in the assessments and care plans supplied by care managers. The current system used for recording each persons holistic needs, was found to be cumbersome, and did not allow for individual plans to be evaluated. The staff somehow, manage to document each persons needs, but the system makes access to this information difficult to locate. The manager said that a working party within the local authority has been established. The aim is to review, evaluate and streamline the current care planning system. Care Homes for Older People Page 13 of 27 Evidence: Care plans are not currently based around service users strengths, and their preferences for how they wanted to be cared for. All care plans should be easy to understand and written in plain English. Each plan must accurately describe the service users needs/preferences and how staff will meet these needs. All plans must be individually evaluated/ reviewed monthly. A key worker system was in operation and this allowed staff to work more closely with some people whilst also contributing to the care of all living at the home. Comprehensive risk assessment information was available. For example, risk assessments covering the following areas had been completed: nutrition, falls, mobility, skin care and living independently. Pressure area care assessments are completed if necessary. No limitations had been placed on service users right to make decisions and choices about how they lived their lives. The visiting district nurse said, The care here is exceptional, this is probably the best home i have ever been involved in. The staff are dedicated and always provide the best possible care and support. A relative said, The care here is exceptional, the staff should be commended for the work that they do, the care provided is first class. Medicines held on behalf of service users are administered, according to the homes policies and procedures, by members of staff who have received appropriate training in the safe handling of medicines. All medicines are stored appropriately in a secure facility. Medication records are accurately maintained. It was observed during the inspection that people living in the home are treated with respect and addressed courteously and appropriately. The service users confrimed their needs and preferences about such things as diet, times of getting up and going to bed, personal care etc, are always respected. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users are offered a good quality lifestyle, which includes social contact, and activities. Evidence: The manager has plans to display a whole range activities and events in the home. Activities include favourites such as reminiscence sessions, bingo, carpet skittles, quizzes, crafts, baking, dominos and cards. There are film shows and weekly pamper days such as hairdressing and manicures. The usual range of festivals and other significant days are celebrated. These include Valentines Day, Shrove Tuesday (pancake tossing), Burns night, Halloween etc. with photos taken and displayed in the home. There are occasional trips out to local places of interest. There are no visiting restrictions. Service users confirmed that they are encouraged and supported to be as independent as possible. They are free to choose their daily living patterns, in terms of when they Care Homes for Older People Page 15 of 27 Evidence: get up and go to bed, what to wear, when to bathe, what to eat and when. (The kitchen is never locked). They are assisted to vote, if they so choose. All are also encouraged to comment on the running of the home in their meetings. The menus promote very healthy eating. Alternative choices are available for every mealtime, there is provision for individual choice of, omelette, jacket potatoes, soup etc, on request. The menus were drawn up with the help of the service users, and consultation with nutrtional experts from Newcastle University. The Chef had excellent knowledge of the service users nutritional needs/preferences. Snacks are available at all times, day and night. There is a suitable budget for the catering staff to work to. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints management is effective, and this results in the service users being protected from harm and abuse. Evidence: There is a complaints procedure. The procedure is written in a way that ensures service users fully understand its contents. One service user said that she had been given a copy of the procedure and that staff always listened to any concerns and always dealt with them fairly. The home keeps a record of complaints. The home has a Whistle Blowing policy, the Local Authorities Vulnerable Adults procedures, and a copy of the Department of Healths document, NO SECRETS. Staff are aware of these procedures and have easy access to them. Since the last inspection visit, there have been no complaints received. Safeguarding adults training is ongoing for all staff. Service users can deposit cash for safe keeping, and records are kept of accounts. A sample of personal finances records was examined. Transactions were appropriately recorded and had two signatures for each entry. There was plenty of evidence of personal spending. Receipts are obtained for purchases and numbered to crossCare Homes for Older People Page 17 of 27 Evidence: reference to the transaction. Weekly checks of balances and cash are carried out. All service users are supported to participate in the current political general election. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comfortable and safe environment for those living there. Evidence: The premises maintain a very pleasant and homely atmosphere. All parts of the building seen were exceptionally clean. The communal areas have been decorated with wallpaper, and this makes these areas appear more homely and attractive. There is an ongoing programme of decoration and refurbishment and several bedrooms have been refurbished, the dining room has been decorated to a high standard, the main lounge has a new carpet, and new TVs have been purchased. There is lots of photographs of recent events displayed around the home. The grounds are well maintained and are used regularly by service users, there are lots of seating areas, and the service users take an active interest in the local wildlife: birds, rabbits and hedgehogs etc. A number of service users spoke positively about their bedrooms and the accommodation in general. All bedrooms viewed were highly personalised and nicely Care Homes for Older People Page 19 of 27 Evidence: decorated. The outside of the building does need to be upgraded, the paint on the window frames and doors are peeling, and some of the guttering needs to be replaced. Overall, this is an attractive environment that provides a very comfortable and safe place for service users. The home has policies and procedures on hygiene and control of infection. Staff receive infection control training. There is suitable hand washing facilities throughout the building. Disposable gloves and aprons are provided for staff use. Arrangements are in place to dispose of clinical waste. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a good match of well-qualified staff, who are appropriately recruited and supervised. Evidence: The home currently has 24 service users. There are enough staff employed to meet the service users needs. In addition to the manager, there is 6 care staff from 8am to 5pm, 5 care staff from 5pm to 10pm. From 10pm to 8am there is 2 care staff on duty. Durham County Council has a very robust recruitment and selection process in place. Vigorous checks are completed : application forms, the dates of employment history are checked, making it easy to follow a clear employment audit trail. two work references, (crb) criminal record bureau check, documentary evidence of identity, induction and training and development information. The manager also completes an audit check list and this ensures that all the necessary checks have been completed prior to commencing employment. All staff have an annual training matrix drawn up, this covers all mandatory training needs, and other core training needs, such as control of infection and Adult Protection. Individual staff members have his or her individual training needs analysis on their personal file. Care Homes for Older People Page 21 of 27 Evidence: The staff team have also undertaken, mental capacity and deprivation of liberty training. The homes induction training programme meets the National Training Organisation requirements for the first six months. All staff team has completed NVQ level 2/3. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is supported by the Council in providing good leadership throughout the home, with staff demonstrating an awareness of their roles and responsibilities. Evidence: The registered manager has the required qualifications and experience to run the home. There is a range of quality systems in the home. There is an annual survey of the views of the service users and their families. The findings are collated and an action plan drawn up to address any areas of concern. Good accounting procedures are followed, with receipts and signatures being obtained for all financial transactions involving service users personal monies, clear individual accounts and records are maintained. Service users have ready access to their money, even at short notice. Care Homes for Older People Page 23 of 27 Evidence: There are also regular meetings held with both the service user groups and with the staff group. These are minuted and action points listed. Both individual and central supervision records are kept. All staff receive appropriate bi-monthly pattern of supervision, with an annual work performance appraisal. All staff receive annual health and safety training. This is good practice. Checks of the fire log book showed that all the required checks and tests of equipment and systems take place at the proper intervals, as does fire safety training. The homes accident book is kept up to date and information is fully recorded. Each accident is reviewed to check the outcomes of the accident and any treatment given. Service users and staff expressed satisfaction with the way the home was run and the good standards that were evident in many instances. For example, all service users and relatives commented that the home was always fresh and clean. Service users and staff said they enjoyed living/visiting (Respite/assessment) and working at the home and believed the home was safe and run in the best interests of the service users. Servicing and maintenance records are comprehensive and well maintained. Care Homes for Older People Page 24 of 27 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 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, Care Homes 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 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 Continue with the work to review and evaluate the current care planning system used. A simplified, and streamlined system will make it easy to identify and monitor each persons holistic care needs. Externally, all parts of the building must be well maintained. A routine maintenance programme should be implemented. 2 19 Care Homes for Older People Page 26 of 27 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. 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