Care Home: Lynwood Lodge

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What the care home does well Staff are able to access into a training programme and National Vocational Training. The manager was to commence studying for the Registered Managers Award. There was evidence of an ongoing supervision programme for staff. This ensures that senior staff monitor the performance of staff and any training needs. A member of staff confirmed that they received regular supervision, and that there was a programme for training. The manager maintained records in respect of fire safety at Lynwood Lodge. The checks to fire safety equipment were recorded as having been completed as required by the fire authority. This practice safeguards residents and staff. The atmosphere of the home is relaxed and friendly. People living at the home spoke positively about the staff team and were seen laughing and joking with one another. Service users spoken with said they enjoyed the activities provided each day in the week. In response to the question what does the service do well one member of staff responded, "Treats the residents with compassion, respect and care". Another staff said, "Caring the residents". A further staff member said, "Communication with others". An additional staff said, The communication between staff and clients, and both recognising rights and choices". Another staff member said, "It gives a good service to the residents and also support to the family". What has improved since the last inspection? Care plans have been reviewed in line with regulations and include as required on the last inspection that each service users having a nutritional assessment and oral care and foot care details. Risk assessments were also identified as needing to be reviewed as part of the monthly review of the care plan. The requirement to do this has been achieved. The recommendation of the last inspection has been achieved. This was to encourage residents or their representatives to sign care plans to provide evidence that residents had been involved in the care planning process. We were told that all service users or their relatives or friends had signed that they had read and agreed and understood the care plan. There was one outstanding. The manager was awaiting the relative of a newly admitted service user to visit so they could read the care plan and see if they are happy with what is being provided before they sign the record. Focus groups have been introduced which are when service users and some relatives get together with staff and discuss areas that they want to change or do differently. The group also discuss all aspects of care and any ideas anyone may have about anything, which makes service users more comfortable whilst staying at Lynwood Lodge. We were told the manager hoped in forthcoming months to encourage more relatives to take part. The requirements and recommendations from the last inspection were assessed. There was four requirements and one recommendation arising from that inspection. The requirements had been complied with from that inspection. What the care home could do better: There are no requirements arising from this inspection. There are recommendations, which need to be given due consideration to ensure best and good practice is always adopted and that service users and staff are kept safe. The manager needs to provide staff with further direction and guidance on what detail needs to be recorded in the daily records ensuring the content is not judgemental and also reflects service users daily life within the home, service user achievements and individuality as well as care staffs` individual support. To safeguard service users and staff the manager needs to ensure that when staff are handwriting medication on the medication administration records that they sign the record and a second member of staff also signs the record to confirm and verify that the entry has been copied accurately. This goes some way to make sure service users get the right medication. As an additional safeguard to make sure that there are no errors in how often medication is given to service users the manager needs to arrange for medication that is prescribed, "as directed" to be referred back to the GP/Pharmacist and clear dosage and frequency obtained and indicated on the medication administration records. To promote best practice the manager needs to make sure that when administering controlled drugs medication that the medication administration records are double signed to confirm medication administration to the service user. We had a variety of differing comments about the activities provided at Lynwood Lodge. We feel it would be a good opportunity to review the activitiesavailable to service users, evaluating the activities already provided and include service users, staff and relatives/ friends to see if they have any more ideas or, information about service users past lives that would assist in the development of additional or differing activities. As a hot breakfast option is not currently available as a matter of routine to service users, the manager needs to review and amend the menus to provide service users with a hot meal option at breakfast. To make sure that service users get the food they like which is cooked to their taste and liking the manager needs to look again at the meals and food provided at Lynwood Lodge to ensure that the best use of cooking staff are used and the meals are homely and well cooked and enjoyed. We need an action plan to be compiled on how and when the registered person is to attend to the redecoration and recarpeting and the replacement of furniture and furnishings in the home and a copy of this needs to be provided to the Commission. To ensure that staff can do their jobs properly and protect service users and their own safety all staff must have updates to their moving and handling training at the regularity indicated by regulations. CARE HOMES FOR OLDER PEOPLE Lynwood Lodge 20-22 Broad Road Sale Manchester M33 2AL Lead Inspector Kath Oldham Unannounced Inspection 3rd July 2008 08:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lynwood Lodge DS0000005620.V366330.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lynwood Lodge DS0000005620.V366330.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lynwood Lodge Address 20-22 Broad Road Sale Manchester M33 2AL 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) 0161 973 7210 0161 962 6424 Trinity Merchants Limited Manager post vacant Care Home 24 Category(ies) of Dementia (10), Old age, not falling within any registration, with number other category (24) of places Lynwood Lodge DS0000005620.V366330.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home only - code PC, to people of either gender whose primary care needs on admission to the home are within the following categories: OP age not falling within any other category - Code OP Dementia - Code DE (maximum number of places: 10) The maximum number of service users who can be accommodated is 24. Date of last inspection 11th July 2006 Brief Description of the Service: Lynwood Lodge provides residential accommodation with board and personal care for up to twenty-one (21) service users within the category of old age (OP), who could also have a physical disability (PD/E). Trinity Merchants Limited owns Lynwood Lodge. The registered manager has recently left her employment and an acting manager was due to commence at the home on the day after the inspection. Lynwood Lodge is a large Victorian property, which is set in its own grounds. The grounds are enclosed and are accessible and well maintained. To the rear of the property is a patio and seating area. There is car parking space to the side of the property. The home has seventeen single and two double bedrooms. Thirteen single bedrooms are en-suite and both double bedrooms are en-suite. There is a passenger and stair lifts. The home is situated within a residential area of Sale and is close to the town centre, a local park, Metro and public transport. The current fees for accommodation at the home range from £380.00 to £475.00 per week the fees include all meals, laundry, NHS chiropody, Physiotherapy and entertainment. Additional costs include hairdressing, dry cleaning and telephone calls Lynwood Lodge DS0000005620.V366330.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 the people who use this service experience good quality outcomes. This was a key inspection which included a site visit to the service. This visit was unannounced, which means the managers and staff were not told we would be visiting, and took place on 3rd July 2008, commencing at 8:00am until 6.00pm. The inspection of Lynwood Lodge included a look at all available information received by the Commission for Social Care Inspection (CSCI) about the service since the last inspection. We also sent the manager a form before the visit for her to complete and tell us what they thought they did well, and what they need to improve on. We considered the responses and information provided and have referred to this in the report. We call this form the Annual Quality Assurance Assessment (AQAA). Lynwood Lodge was inspected against key standards that cover the support provided, daily routines and lifestyle, choices, complaints, comfort, how staff are employed and trained, and how the service is managed. Comment cards were sent prior to the inspection for distribution to people staying at Lynwood Lodge their relatives and staff, the views expressed in returned comment cards and those given directly to the inspector are included in this report. We found our information at the visit by observing care practices, talking with people staying at Lynwood Lodge; talking with the manager, area manager, and staff. A tour of Lynwood Lodge was also undertaken and a sample of care, employment and health and safety records seen. The main focus of the inspection was to understand how Lynwood Lodge was meeting the needs of residents and how well the staff were themselves supported to make sure that they had the skills, training and supervision needed to meet the needs of guests. Since the last inspection the CSCI have not received any complaints and no safeguarding issues have been raised about Lynwood Lodge. The care service provided to two residents was looked at in detail to help form an opinion of the quality of the care provided. Lynwood Lodge DS0000005620.V366330.R01.S.doc Version 5.2 Page 6 A brief explanation of the inspection process was provided to the manager on arrival at the home. Time was spent at the end of the day to provide verbal feedback to the manager and area manager. What the service does well: What has improved since the last inspection? Care plans have been reviewed in line with regulations and include as required on the last inspection that each service users having a nutritional assessment and oral care and foot care details. Risk assessments were also identified as needing to be reviewed as part of the monthly review of the care plan. The requirement to do this has been achieved. The recommendation of the last inspection has been achieved. This was to encourage residents or their representatives to sign care plans to provide evidence that residents had been involved in the care planning process. We were told that all service users or their relatives or friends had signed that they had read and agreed and understood the care plan. There was one Lynwood Lodge DS0000005620.V366330.R01.S.doc Version 5.2 Page 7 outstanding. The manager was awaiting the relative of a newly admitted service user to visit so they could read the care plan and see if they are happy with what is being provided before they sign the record. Focus groups have been introduced which are when service users and some relatives get together with staff and discuss areas that they want to change or do differently. The group also discuss all aspects of care and any ideas anyone may have about anything, which makes service users more comfortable whilst staying at Lynwood Lodge. We were told the manager hoped in forthcoming months to encourage more relatives to take part. The requirements and recommendations from the last inspection were assessed. There was four requirements and one recommendation arising from that inspection. The requirements had been complied with from that inspection. What they could do better: There are no requirements arising from this inspection. There are recommendations, which need to be given due consideration to ensure best and good practice is always adopted and that service users and staff are kept safe. The manager needs to provide staff with further direction and guidance on what detail needs to be recorded in the daily records ensuring the content is not judgemental and also reflects service users daily life within the home, service user achievements and individuality as well as care staffs’ individual support. To safeguard service users and staff the manager needs to ensure that when staff are handwriting medication on the medication administration records that they sign the record and a second member of staff also signs the record to confirm and verify that the entry has been copied accurately. This goes some way to make sure service users get the right medication. As an additional safeguard to make sure that there are no errors in how often medication is given to service users the manager needs to arrange for medication that is prescribed, “as directed” to be referred back to the GP/Pharmacist and clear dosage and frequency obtained and indicated on the medication administration records. To promote best practice the manager needs to make sure that when administering controlled drugs medication that the medication administration records are double signed to confirm medication administration to the service user. We had a variety of differing comments about the activities provided at Lynwood Lodge. We feel it would be a good opportunity to review the activities Lynwood Lodge DS0000005620.V366330.R01.S.doc Version 5.2 Page 8 available to service users, evaluating the activities already provided and include service users, staff and relatives/ friends to see if they have any more ideas or, information about service users past lives that would assist in the development of additional or differing activities. As a hot breakfast option is not currently available as a matter of routine to service users, the manager needs to review and amend the menus to provide service users with a hot meal option at breakfast. To make sure that service users get the food they like which is cooked to their taste and liking the manager needs to look again at the meals and food provided at Lynwood Lodge to ensure that the best use of cooking staff are used and the meals are homely and well cooked and enjoyed. We need an action plan to be compiled on how and when the registered person is to attend to the redecoration and recarpeting and the replacement of furniture and furnishings in the home and a copy of this needs to be provided to the Commission. To ensure that staff can do their jobs properly and protect service users and their own safety all staff must have updates to their moving and handling training at the regularity indicated by regulations. 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. Lynwood Lodge DS0000005620.V366330.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lynwood Lodge DS0000005620.V366330.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are provided with sufficient information about Lynwood Lodge prior to admission to assist them in making a decision about moving to the home. Service users needs are assessed before a service is offered. EVIDENCE: Prior to admission people are provided with a statement of purpose of the care and service offered at Lynwood Lodge. Prospective service users are also provided with their own service user’s guide which is specific to the service they will receive. The information in each document is regularly reviewed by the manager and informs service users about the care offered, staff structure, premises and information on how to complain or who to speak to if they are not happy about any aspect of their care. Lynwood Lodge DS0000005620.V366330.R01.S.doc Version 5.2 Page 11 A number of comment cards were forward to service users, and their relatives or friends to seek their views about Lynwood Lodge. Six people said they received information about the home prior to admission. Before prospective service users come to stay at Lynwood Lodge they are offered the opportunity to visit. The manager of the home meets with relatives and the person considering moving in to discuss care issues and complete the homes own pre admission assessment forms. This form provides the opportunity for the manager to get information about the person’s health and personal care needs, abilities, cultural, social and religious needs and information on the person’s wishes and preferences. This information along with information provided by the social worker is used to develop a care plan on how the staff will meet peoples assessed care needs. Service users funded by the local authority were provided with a statement of terms and conditions of their placement. The home does not provide intermediate care. Lynwood Lodge DS0000005620.V366330.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans set out the health, personal and social care needs of service users and where possible reflected chosen and preferred plans of support. EVIDENCE: On the previous visit to Lynwood Lodge a requirement was issued in relation to care planning and what should be in a care plan to make sure that service users needs and preferences were identified and how they were going to be met by staff. On that inspection the care plans did not include a nutritional or foot care assessment. We were told on that visit that the organisation had developed a new care plan format that included a nutritional assessment. All service users files looked at contained a care plan and we were told that this was the new format. The detail in the care plans in the main was good with explicit instructions on occasions on how and when service users want and need their care. Best practice would be to further develop this so all staff are Lynwood Lodge DS0000005620.V366330.R01.S.doc Version 5.2 Page 13 clear how and when support is to be provided in a way which supports the service users and is their preference. There was no detail in the care plans about service users night time care needs as described to us by staff as being provided. This should also be included in the plan of care so again service users get what they want and need in a way in which they desire. The information in the care plan is reviewed on a regular basis to ensure any changes are identified and where necessary action required to continue to support the service user It was recommended on the last inspection that service users or their representative sign care plans to provide evidence that service users have been involved in the care planning process. This has been actioned by the manager and we were told that service users or their relative except for one recent admission have signed the care plans. The care plans we looked at had been signed. Some of the comments from relatives or friends of service users included, “Although they look after X quite well they do not follow the care plan specified by the social worker”. “Due to age and infirmity most residents at the care home have no choice in the way they live. The care home does try to give the residents as much freedom as there physical and mental state allows”. “Staff make the residents feel at home. There is a very relaxed atmosphere”. “The staff take an interest in the residents individually. The staff appear to know each residents needs/wants and act appropriately maintaining the dignity of the resident”. In order to ensure that service users and staff can monitor personal belongings and identify when items are missing and or lost, each service users should have their own personal possessions list in place. These lists should details all their belongings including clothing and bedroom fixtures and fittings, together with items such as jewellery and ornaments. Such a list was on file for one of the service users however this was not dated. This would be best practice as new items are purchased these can be added to maintain service users possessions safely. Independence and increased life skills should be promoted within a risk management framework. The care files looked at on this visit included up to date risk assessments. There was evidence that risk assessments had been updated to ensure that the staff team manage newly identified risks appropriately. Lynwood Lodge DS0000005620.V366330.R01.S.doc Version 5.2 Page 14 Examination of the daily reports, which are used by staff to record the support and intervention and the development of service users contained staff judgements. It was not always recorded in the daily reports for example if service users took part in activity. One service users’ care plan identified that they liked to do crosswords. There was no suggestion that this was supported whilst staying at Lynwood Lodge. There is a form within service users’ care files to record service users’ weights. One of the care files looked at recorded that the service users had gained a lot of weight from one month to the next. There was no indication what the reason for this was or whether it was an error. This wasn’t recorded or the resident re weighed to double check. Staff need to be more mindful of why they are weighing service users and look at previous weights so it is noted and investigations can take place at the right time to safeguard service users. Each service user is registered with a local General Practitioner (GP) and where possible service users are able to retain their own GP. Access to other healthcare professionals was by GP referral. The manager feels the staff have a sound professional relationship with outside agencies such as district nurses, social workers and GPs. Examination of the records detailed visits to or from health care professionals. Health professionals spoken with on the visit indicated that staff carry out support to service users as indicated by district nursing staff. A requirement was made on the last visit in relation to medication in that the manager must make arrangements for the recording, handling, safe keeping, safe administration and disposal of medicines received into the care home. There have been changes to medication procedures and safe keeping of medication. The requirement is complied with. Medication is stored in a secure area and accessed only by staff with responsibility for medication. A record is maintained of medication received and returned for disposal to the pharmacist. We were told medication is reviewed with service users general practitioner on admission to Lynwood Lodge to ensure medication directions are current. Examination of a sample of medication records identified that they had been completed appropriately with no omissions in the record of administration of prescribed medication. There were a couple of areas where the manager can further develop best practice in relation to medication which includes when handwritten medication is entered on the medication administration records that these entries are Lynwood Lodge DS0000005620.V366330.R01.S.doc Version 5.2 Page 15 signed by the person writing the record and signed by a second member of staff to verify that they have been copied accurately. In addition it would be safe and best practice if on administration of controlled drugs that these are double signed in the medication records on administration to service users by the staff signing the controlled drugs register. There was one medication, which was identified to be prescribed, “As directed”. Clear instruction of dosage and frequency of administration needs to be obtained from the GP or pharmacist and printed on the records so errors cannot be made when understanding what “as directed” means. The good practice of retaining a list of staff responsible for administering medication including sample signatures and initials was in place. Lynwood Lodge DS0000005620.V366330.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 &15. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The daily activities and meals provided are in keeping with the expectations of the service users and provide them with some choice and control over their daily lives. EVIDENCE: We were told that there was something going on each day during the week and this was enjoyed. Service users said you could choose whether to take part in activities. Service users were complimentary about the skills and personality of the activities coordinator saying, “ We have a laugh”. One service user added, “you would have a laugh if you heard her sing”. Service users were supported to access community resources and to maintain contact with relatives and friends. Lynwood Lodge DS0000005620.V366330.R01.S.doc Version 5.2 Page 17 Relatives spoken with said they were made to feel welcome at the home and their cared for service users was supported to do what they want during the day. In response to the question how do you think the care home can improve, one relative said, “Maybe by not having a TV in both lounges. A TV in one lounge would give the choice to watch or not and sometimes it appears that the TV is on to provide a background and permanent noise or presence. Music could have the same effect and might be more beneficial, calming effect (not thinking of radio two something more soothing”. Another person said, “The care home could improve by offering a greater variety of daily activities and trips out, instead of offering painting, knitting and watching TV”. A further person said, “Stimulate residents, get them more involved. A better television with bigger screen” In response to the question what could the service do better one member of staff responded, “Maybe if the home had more day outings for service users. Example day trips out or the theatre, musicals because a lot of residents do like days out. Maybe one or two don’t”. The manager is advised to constantly evidence discussions with people about programmes of activity offered at Lynwood Lodge. Currently a hot breakfast option is not available with service users having cereals or cereal and toast. We were told that service users can have a cooked breakfast but no one has it. Service users should be provided with an opportunity of having a hot breakfast option and this needs to be explored by the home. The hours the cook works in the week does not promote the availability of a cooked breakfast, as she doesn’t start work until 9.30am. We were told that in September 2008 these hours are to be changed to an earlier start. At weekend the cook starts work at 8.45am. There were mixed comments about the quality of the food from both service users and relatives. We had lunch with service users. It was noted that the lunch time meal served on the visit was all shop bought with no home made cooking. We feel that service users enjoyment of meals will be further enhanced if food was home cooked. One of the sweet options was home baked. We were told that pies and some other items are shop bought but sometimes home cooking is provided. Service users on the inspection said the meals were alright. We were also told that service users were more vocal at weekends about the food commenting regularly that they liked and enjoyed the food. Lynwood Lodge DS0000005620.V366330.R01.S.doc Version 5.2 Page 18 In response to the question do you like the meals, four service users said they usually like the meals and one service user responded “always”. One service user that responded usually added, “We do have a choice”. Relatives and friends were asked, how do you think the care home can improve. One person responded, “A better menu”. Another commented, “Food is not very good. The care manager is aware that this is a problem that they can not get a cook of the necessary standards”. A further relative said, “Food is the only reservation. When the main cook is present the food is very good, but sometimes when other staff have prepared the food, the choice has involved items not always well suited to a low cholesterol diet”. Staff at Lynwood Lodge did not maintain a record of food served to service users. It would not be possible to assess for example if service users were having a good diet in relation to nutrition or otherwise. We were told of the benefits this would have and how it could be used if for example a service users was loosing or gaining weight when this information could be presented to health professionals. Lynwood Lodge DS0000005620.V366330.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16&18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Procedures relating to complaints and protection safeguarded people and ensured they were listened to and protected EVIDENCE: The complaints policy and procedure informed service users and their relatives or friends about who to contact if they have a concern or complaint about any aspect of the care they receive. This information is also detailed in the statement of purpose and the service user’s guide. Information about who to contact is detailed in the procedure and an individual record is maintained collectively of complaints received and how the complaint was investigated and the action taken. Since the last inspection the CSCI have not received any complaints about the home. A policy was in place for the protection of vulnerable adults and staff were aware of how to put the policy into practice. We were told adult protection training had been provided to the manager and staff. The manager was Lynwood Lodge DS0000005620.V366330.R01.S.doc Version 5.2 Page 20 advised to attend the POVA training for managers to further develop her knowledge on the actions to be taken if abuse is alleged. No safeguarding issues had been raised in relation to the home. Lynwood Lodge DS0000005620.V366330.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 &26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements have been made to the environment to provide residents with a comfortable, homely and clean place to live. EVIDENCE: A number of rooms are looking tired and would benefit from redecoration. Since the last inspection visit conducted in July 2006 improvements had been made to the environment. For example a number of bedrooms have been re painted and new furniture purchased. Three new bedrooms in the basement were registered in June 2007, which provide spacious and well-proportioned rooms. This increases the number of service users who can live at Lynwood Lodge to 24. Lynwood Lodge DS0000005620.V366330.R01.S.doc Version 5.2 Page 22 We were told that a rolling programme of redecoration is in place to cover all areas of Lynwood Lodge. This will be of benefit to service users and increase the appearance of their bedrooms for example. A number of bedroom carpets need replacing, two of which are needed sooner rather than later as they could be a tripping hazard for service users or staff as they are very buckled. In response to the question is the home fresh and clean, one service user said “always”, three service users said “usually”, and one service user said “sometimes”. We also received comments from relatives about the environment, which included, in response to the question, how do you think the care home can improve, one relative said, “the lounges need decorating, but there are firm plans to refurbish the home this year”. In response to the question, what do you feel the care home does well, a relative said, “Clean and friendly environment” A relative added, “I have had to raise the problem that X’s room is not cleaned on a regular basis. Although it is being done now I feel that this is only because the care home know I inspect X’s room every week”. A resident said in their comment card, “I would like to have my bedroom carpet hoovered weekly as it is not being done”. The AQAA completed by the area manager said, “We have a programme of routine maintenance. Grounds are kept safe and are accessible to service users. We have a programme of ongoing decoration to bedrooms, toilets, bathrooms furniture is replaced when new is needed”. In the last 12 months we were told in the AQAA that, “we have had two downstairs toilets refurbished. The gallery area has been decorated and new kitchen cupboards installed. We have an ongoing programme for the cleaning of all carpets”. When we went to look round the house it was evident that there were some maintenance jobs which needed doing. One toilet door was difficult to slide open; there were no locks on some bathroom/toilet doors. There were no lockable drawers in some of the resident’s bedrooms in which they could keep items securely or privately. The light bulbs were not all working in the ceiling lights in one of the lounges. One light bulb in a service users bedroom was not throwing out much light due to the wattage of the bulb being low. There was nothing recorded to say that this was the service users request to have there bedroom dimly lit. There was a toilet in one of the service users bedrooms, which didn’t have a toilet seat in place it was propped up on the bedroom wall. The manager was aware this was broken. We were told that the manager employed a maintenance person however there was some difficulty as the person couldn’t Lynwood Lodge DS0000005620.V366330.R01.S.doc Version 5.2 Page 23 speak English and she was reliant on a member of staff when they were on duty translating what needed to be done. This arrangement is not satisfactory. Bedrooms were personalised, with items brought from service users’ homes. Some had a television and chose to spend time in the privacy of their rooms when they wished. A passenger lift is available to support service users getting upstairs to their bedroom. We looked at the maintenance record for the lift and it was last serviced in June 2008 and was next due for its next service in six months time as is required by legislation. We couldn’t find the record of the previous service, which the manager was asked to send to the Commission. At the time of writing this report this had not been received. We will write to the home to confirm the need for us to see this report. . Lynwood Lodge DS0000005620.V366330.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 &30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was staffed with a staff group that was trained to undertake their duties, and recruitment procedure ensured that people living at the home were protected. EVIDENCE: Several staff had worked for many years in the home, with the continuity of care benefiting the people living there. Some new staff have been appointed to care positions in the last 12 months. We were told that staffing levels were maintained in line with the needs of service users living at Lynwood Lodge. Rotas are managed well, with additional staff on duty at peak times of the day. The hours of the cook were discussed with the manager and we were told that the hours for the weekday cook would be changing in September 2008, when the cook would start work earlier. At teatime care staff are preparing, dependent on the menu, the teatime meal. This means that they are taken away from looking after service users. The manager needs to make sure the Lynwood Lodge DS0000005620.V366330.R01.S.doc Version 5.2 Page 25 needs of service users are not compromised by the reduction of care staff when preparing meals. Most service users said that there were usually enough staff working at the home, although one service user said that they wished staff had more time to stop and chat with them. All service users’ comments throughout the inspection were positive regarding the care, treatment and respect they received from staff. Some comments from relatives about staff included, “Some of the staff have experience, other ones have not”. “Overall, Lynwood Lodge staff do a good job, in all areas”. “Patience and empathy shown by the staff are very strong points”. “Staff show a strong respect for each individual”. In response to the question are the staff available when you need them one service user responded, Sometimes they are with some other person”. Staff said they received regular training and updates in techniques and felt that this benefited the service users at the home. Food hygiene, mental health, adult protection, dementia and health and safety training being some of the topics staff have received training in. One member of staff said, “The service provided training so I can meet the needs of my service users.” Three staff personnel files were examined. All contained all the information and documents needed to ensure that the necessary checks had been made before they started work at the home. We were told that their had been changes in the recruitment procedure and a questionnaire is sent out to prospective employees as an additional way of finding out about their understanding about care. The manager needs to make sure that a record of the job interview is signed and dated to evidence the recruitment procedure and to also ensure that proof of identity of staff is maintained on staff files in line with regulations. There was a record on some of the staff files seen of verbal references being sought prior to the receipt of written references. This is seen as good practice. The staff files looked at also contained records of staff supervision and training and individual training plans had been developed for staff. We were told that for one staff member who commenced work at Lynwood Lodge on receipt of a POVA first check did not work alone until a satisfactory criminal record disclosure check was returned. This is how it should be. Lynwood Lodge DS0000005620.V366330.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home are approachable and focus on meeting the needs of people living at the home. EVIDENCE: We were told that the manager was appointed to this role in October 2007. The manager has been proposed to the Commission for consideration for registration and is awaiting the outcome of her registration. The manager has acquired NVQ2, 3 and 4 and has enrolled to commence the registered managers award in August 2008. Information provided in the Annual Quality Assurance Assessment (AQAA) forwarded to the Commission prior to the visit indicated that, “the manager Lynwood Lodge DS0000005620.V366330.R01.S.doc Version 5.2 Page 27 undertakes periodic training to up date her knowledge and skills and competence whilst managing the home”. The area manager told us, that they visit the home in line with regulations, unannounced once a month and undertake specific tasks to check that Lynwood Lodge is being managed appropriately. A written report of these visits should be completed. The reports of these visits had not been completed, as they must be with a copy being given to the manager, which is kept at Lynwood Lodge available for examination by the Commission. The certificate of registration has to be displayed in the home for people to see what the care home is registered to provide. The certificate was displayed however it was the wrong certificate and referred to when Lynwood Lodge was registered to accommodate 21 service users. A new certificate was sent to Trinity Merchants the owners of Lynwood Lodge in June 2007. This was brought to the attention of the manager at the end of the visit. We were told after this visit that this had not been sorted out and the home continued to display the wrong certificate of registration. At the time of writing this report no additional information was available. The accident records seen were completed appropriately. The details of events that affect the service users should be sent routinely to the Commission for Social Care Inspection, in line with regulations. This hasn’t been happening routinely for all events and needs to be addressed. A quality assurance system is in place that seeks the opinions of service users and relatives in terms of their day-to-day experiences. The outcome of the survey needs to be produced and given to people who have contributed to the survey in a format that is understandable. The quality assurance survey needs to be extended to also seek the views and opinions of professionals who come to Lynwood Lodge. There were amounts of money held on behalf of some service users to spend on whatever these choose. Things like hairdressing or toiletries were items regularly purchased. For the sample looked at, receipts were in place for purchases made. The design of the record was not promoting service users privacy and respect for their personal property as the detail of their monies was kept on a record with records everybody else’s money. This needs to be changed so service users have a separate sheet which records their own purchases and monies paid in so it is clear how much money they have and what they have spent it on and this detail is private to them. Information provided in the AQAA indicated that that appropriate policies and procedures were in place for the effective running of Lynwood Lodge. The policies were recorded as having been reviewed in May 2008. Lynwood Lodge DS0000005620.V366330.R01.S.doc Version 5.2 Page 28 There was evidence of an ongoing supervision programme for staff. This ensures that senior staff monitor the performance of staff and any training needs are identified. One member of staff confirmed that they received regular supervision, and that there was a programme for training. The manager maintained records in respect of fire safety at Lynwood Lodge. The checks to fire safety equipment were recorded as having been completed as required by the fire authority. This practice safeguards service users and staff. Examination of the fire drill training practice records did not detail the night care staff as having undergone this training. We were told that night care staff had received this training and the record of this would be sent to the Commission. Evidence that two of the four-night staff team had received this training was sent to the Commission. Contact was made with the manager and a request was made for confirmation that the remaining night staff had also received this training. At the time of writing this report this detail had not been received. Lynwood Lodge DS0000005620.V366330.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 X 2 Lynwood Lodge DS0000005620.V366330.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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 OP7 Good Practice Recommendations Provide staff with direction and guidance on what detail needs to be recorded in the daily records ensuring the content is not judgemental and reflects service users daily life within the home, service user achievements and individuality as well as care staffs’ individual support. To maintain the health and well being of service users ensure that previous weights of service users are checked and action taken if there is a variation to their weight and this is recorded. To safeguard service users and staff ensure that when staff are handwriting medication on the medication administration records that they sign the record and a second member of staff signs the record to confirm and verify that the entry has been copied accurately. As an additional safeguard to make sure that there are no errors in how often medication is given to service users Lynwood Lodge DS0000005620.V366330.R01.S.doc Version 5.2 Page 31 2 OP8 3. OP9 arrange for medication that is prescribed, “as directed” to be referred back to the GP/Pharmacist and clear dosage and frequency obtained and indicated on the medication administration records. To promote best practice make sure that when administering controlled drugs medication that the medication administration records are double signed to confirm medication administration to the service user. Review the activities available to service users evaluating the activities already provided and include service users, staff and relatives/ friends to see if they have any more information about service users past lives that would assist in the development of additional or differing activities. Review and amend the menus to provide service users with a hot meal option at breakfast. To make sure that service users get the food they like which is cooked to their taste and liking look again at the meals and food provided at Lynwood Lodge to ensure that the best use of cooking staff are used and the meals are homely and well cooked and enjoyed. Maintain a record of food served to service users in sufficient detail that a person assessing the record could make a judgement if the diet is satisfactory in terms of nutrition or otherwise. To further evidence the recruitment and selection procedure ensure that the interview questions used and the responses by prospective employees are dated and signed by each of the management team who are on the interview panel To comply with regulations ensure that a copy of staff identification is retained on staff personal files. To promote a safe recruitment procedure ensure that any gaps in employment identified on staff job application forms are explored and explained and this detail is recorded. To ensure that staff can do their jobs properly and protect service users and their own safety. Provide all staff with updates to their moving and handling training at the regularity indicated by regulations. Ensure that the representative of the organisation writes a report in line with regulations of the unannounced monthly visit. A copy of which is given to the manager and available at Lynwood Lodge for inspection by the Commission. DS0000005620.V366330.R01.S.doc Version 5.2 Page 32 4 OP12 5 6 OP15 OP15 7 OP15 8 OP29 9 OP30 10 OP31 Lynwood Lodge 11 12 OP31 OP33 13 OP35 14 OP38 The manager needs to make sure that the current certificate of registration is displayed at all times It is recommended that the manager develops a report of the findings of any quality audit questionnaires and insert it into the home’s statement of purpose as part of its quality monitoring process. To promote service users privacy and dignity change the way in which service users personal monies are recorded ensuring that an individual record is kept of monies and purchases made which is accessible at all times to service users or their representatives to see. All events that affect the health, safety and wellbeing of service users need to be routinely notified to the Commission for Social Care Inspection, in writing, in line with regulations. Lynwood Lodge DS0000005620.V366330.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Waterloo, Liverpool L22 OLG 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 Lynwood Lodge DS0000005620.V366330.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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