Inspection on 09/03/09 for 1 Larch Road

This inspection was carried out on 9th March 2009.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

1 Larch Road 07/11/06

1 Larch Road 16/01/06

1 Larch Road 17/08/05

1 Larch Road 06/01/05

1 Larch Road 21/10/04

Extracts from inspection reports are licensed from CQC, this page was updated on 06/08/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 1 Larch Road Eckington Sheffield Derbyshire S31 9ED one star adequate service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rob Cooper Date: 0 9 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. They reflect the things that people have said are important to them: 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 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (20092008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Information about the care home Name of care home: Address: 1 Larch Road Eckington Sheffield Derbyshire S31 9ED (01246)431158 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Enable Care & Home Support Limited care home 8 Number of places (if applicable): Under 65 Over 65 8 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 8 The registered person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD Date of last inspection A bit about the care home 1 Larch Road is a purpose-built home for eight people with learning disabilities. The home consists of two adjoining bungalows no 1 and no 3 with separate entrances. It is situated in Eckington, approximately six miles from Chesterfield. The home provides personal care and accommodation. The home is spacious and accessible, providing ground floor accommodation with single bedrooms and a pleasant garden. The home is near to local shops, pubs and public transport. Two mini buses are unavailable for the use of the people who live there. The acting manager said that the fees range from: £1,324 to £1,158 per month depending on needs. 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced visit as part of the key inspection process, so that no one at Larch Road knew that the inspection visit was going to take place. The visit took approximately five hours through the middle of the day, with one inspector present. In preparing for this inspection, the information that the Commission holds about this care home was reviewed, this included looking at the last inspection report, the inspection record, considering any complaints or concerns that have been made about the service, and reviewing any notifications made relating to incidents that affect the well being of people living at Larch Road. The methods used during this key inspection and site visit were to visit the home, where a method called case tracking was used; this involved identifying four people who live there and looking at their individual files and making a judgement about the quality of care they are receiving, and if their needs are being met. This was followed by a partial tour of the bungalows, looking at the activities on offer, and talking to three people who live there, and two members of staff about the quality of the service, and their experiences of living and working at Larch Road. The Commission for Social care inspection sent out an Annual Quality Assurance Assessment (known as an AQAA) as part of the inspection methodology, this allows care homes like Larch Road to self assess their service. Information provided by the home helped to form the judgements in this report. We also sent out five surveys asking for views and information to people who live at the home, and five to staff. Of these we received all five surveys back from people living at the home, and three surveys from members of staff, which also helped with the judgements that we made. The registered manager is currently on long term sick leave, and therefore the acting manager provided much of the information during this key inspection visit. On the day of this inspection there were seven people living at Larch Road. People who might want to live at Larch Road can obtain information about the home direct from them, and this would include seeing previous inspection reports prepared by the Commission for Social Care Inspection. What the care home does well What has got better from the last inspection A number of improvements have been made since the last key inspection including: New kitchens in both bungalows (total refits), some new carpets, new boilers in both of the bungalows, new bedding and some new staff members. What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Rob Cooper Care Quality Commission CPC1 Capital Park Fulbourne Cambridge CB21 5BR 01223 771300 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 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 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. People, who live at this care home, and those who would want to, have access to detailed information about the services on offer, which allows the people and their families to make an informed decision about whether the home can meet their needs. Evidence: Both the statement of purpose and service user guide for Larch Road were seen during the inspection visit. These documents contained useful information about the care home, with some use of pictures and signs to help those who might have difficulty with written English. The information available would allow people living at the care home, and those who might wish to in the future, to make an informed choice about living there. Discussions with three people who live at Larch Road showed that they had been given copies of the service user guide, and copies were seen in the peoples bedrooms. As part of the case tracking process four people who live at the care home were identified, and their files were seen. The individuals identified had been living at Larch Road for many years, and their original assessments had been archived off site, so were not seen. Discussions with the acting manager, and a review of the documentation showed that care plans were devised from assessments, and that there were regular reviews to ensure peoples needs were being met. The files of four people were identified and seen, each one contained an agreement from Social Services to fund their placement, a tenancy agreement, and a copy of the terms and conditions of residence. Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. People have their individual needs met in a professional and individualized manner by the staff, which encourages people to make choices within their lives. Evidence: Each of the files that were seen contained a plan of care, which identified personal goals and identified peoples needs and how to meet them. Evidence was seen that care plans were being reviewed regularly, and there were daily entries by care staff, to record progress and any issues relating to individuals care. Discussions with three people who live at Larch Road, showed that they were aware of the content of their care plans, and were happy with the way in which care is being delivered. On the day of the inspection three of the people who live at Larch Road were at home, discussions with them about their care, and decision making, showed that care is being delivered on an individualized basis, with plenty of opportunity for people to comment, and put across their point of view. One person said: If I wasnt happy about something I would say so. The four files that were seen contained risk assessments, and discussions with the acting manager and a review of these forms showed that they covered both general risks and specific risks for the individuals. The risk assessments had been completed in a way that would allow staff to understand the specific risk and what to do to reduce it. Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 people who live at the home are able to take part in appropriate activities, and are part of the local community, with their rights and responsibilities being respected by the staff. Evidence: Evidence was seen in documentation that people living at Larch Road are involved in a number of social activities through the week. Some people attend a Monday club, which is a social club in the local area, and the local Gateway club, as well as having one day a week at home to carry out domestic chores, such as washing, room cleaning and shopping. In addition evidence was seen that people living at Larch Road go on holiday every year, with one person saying how they had been abroad last year, and they were planning another similar holiday this year. The same person showed me some artwork in their bedroom they had completed, and talked enthusiastically about the activities available. Comments received from people who live at the home in questionnaires included: Im happy here and I like it. I like to go shopping, and on day trips or sometimes I like to stay in and watch television. Documentary evidence in peoples files showed that people living at the home use the local pubs, shops and restaurants and have positive relationships with their neighbours. The acting manager said that part of the ethos of the home was integration into the local community, which has largely been achieved. Discussions with two people who live at Larch Road identified that they have good Evidence: contact with their families. Several of the people who live at the home have regular contact with relatives, and contact varies between visits to Larch Road, visits to the relatives homes, and meeting elsewhere - a shopping centre or a cafe for example. Two people who were spoken with said they were happy with the arrangements, and they felt they could see their relatives when they wanted to. People who live at Larch Road do take responsibility for certain tasks within their lives. People have a day at home to concentrate on cleaning and tidying their bedrooms, and sorting out their clothes washing. These tasks are undertaken by the individual with as much help from the staff as the individual may require. Discussions with two people showed that that daily tasks such as laying and clearing the table are undertaken on a voluntary basis, and are seen as part of ordinary life. Discussions with people who live at the home and the acting manager showed that menus are prepared on a weekly basis, with lots of individual choice. Sample menus were seen, and both of the people who were spoken with said the food was very nice, with one adding: We have some very good cooks here, so the food is really nice. One of the people living at the home has diabetes, and there are guidelines for diabetes and low cholestrol diets on the fridge door for the staff. Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. People living at the care home receive personal support in the way that they prefer, and they are protected by the policies and procedures in place for dealing with medication. Evidence: The staff team at the home is mixed sex. The male staff do not attend to any of the personal care needs of the females living at the home, which is through personal choice (of those individuals, not necessarily the staff) and as one lady said: They are not allowed in the bathroom! although she did add that male staff can help with the cooking and the cleaning in their bungalow. When asked how she felt about this the lady in question said she thought it was a good thing, and she was happy with the arrangements. Within each of the four files that were seen, there were care plans relating to health care needs. These care plans identified the individuals specific needs, and how they would be met. There was an ongoing record in each of the files of healthcare professionals involvement, in the form of a diary. An inspection of the Larch Roads medication systems showed that medication is handled safely, with safe storage, and a clear audit trail for the medication. Administration records were seen and found to be complete. One person currently self medicates, and copies of risk assessments and care plans were seen, together with the storage facilities for that individuals medication. The procedures showed that people living at the care home were safe. Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. People living at the care home feel their complaints are listened to and acted upon. The policies and procedures in place ensure people are protected from abuse, neglect and self harm. Evidence: Larch Road has received one complaint since the last key inspection in November 2006. A review of this complaint showed that it had been dealt with in line with the homes complaints procedure, which is on display, and also forms part of the service user guide. Discussions with two people who live at the home indicated that they knew who to complain to, and how to complain, although neither of them had ever needed to. In their AQAA the home said: All residents are encouraged to talk about any complaints or worries they may have. All complaints and concerns are acted upon. A review of the staff training records in relation to safeguarding adults showed that ten out of nineteen care staff had undertaken this training in the last twelve months, with training booked for the others in June 2009. The training is aimed at raising staff awareness of abuse, and issues around abuse and through raising those issues, offering people greater protection against abusive practice, while also making sure that the staff understand the correct procedure to follow if abusive practice is found. Two members of staff were asked about safeguarding adults training and both said they were aware of the issues, and had undertaken this training. Larch Road have not had made any safeguarding adults referrals since the last key inspection. 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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. People live in a safe, clean and comfortable home, with their personal possessions around them, however there is a specific issue relating to the maintenance which is affecting the quality of the environment. Evidence: A partial tour of Larch Road showed that it was comfortable and well maintained, with good quality fixtures and fittings. However there is a problem with black mould in the shower room in bungalow number 3, which is spreading across the ceiling, and is in need of urgent attention. Discussions with three people who live at the care home showed that they thought that it was comfortable and meets their needs. Several bedrooms were seen, and these were well personalised, and homely, all of the people who were spoken with said they felt they had everything they needed, and that they thought their bedrooms were comfortable and the home was well equipped. Staff were seen cleaning in different parts of the home during this inspection visit, and discussions showed that there were systems in place for cleaning, and there was a good supply of cleaning materials. The building was found to be clean, and smelt fresh. In relation to cleaning the home said in their AQAA: A high standard of cleanliness is maintained. 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. Staff have been recruited professionally, however there are shortcoming in the training programme which potentially means that the people who live at the care home are not having their needs met. Evidence: The care industry considers National Vocational Qualifications (NVQ) to level II in care to be the basic qualification for staff working in residential care. A review of the staff training records showed that currently there are nineteen care staff at Larch Road, of whom there are two with NVQ level II, and one with NVQ level III qualifications. The National Minimum Standards recommend that 50 of any staff team should have a National Vocational Qualification to level II as a minimum, and the evidence highlights a short fall. The files of four members of staff were seen, to check that they contained all of the information that would show that staff at Larch Road had been recruited in a safe manner, namely that applicants had filled out an application form, provided two written references and had had a Criminal Records Bureau (CRB) check. The documentation showed that the homes recruitment policy and procedure had worked to protect the people living there. Discussions with two members of staff about their recruitment showed that they had gone through all of the pre employment checks, and had not started working until those checks had been completed. Comments received in staff questionnaires included: Even though I had my CRB document from my previous employer it was looked at, but not taken into consideration. My check was thorough and I had to wait several weeks before my employment commenced, but I had the satisfaction of knowing that these checks were being made to protect the service user. The staff training records showed that Larch Road does have a training plan for its staff. The training records showed that staff were receiving the training to help them Evidence: to do their jobs, including the mandatory training in moving and handling, fire and safeguarding adults. Discussions with two staff members provided evidence of the training courses staff had attended, together with certificates in staff files. Larch Road has a formal staff supervision system in place, in which staff receive supervision, from a senior member of staff. This is usually in a one to one meeting. Formal supervision offers staff support and guidance in carrying out their work, and is seen as an essential management tool in residential care. A review of the staff supervision records showed that staff are receiving formal supervision, but the National Minimum Standard of six times a year is not being achieved. Two members of staff were asked about formal supervision, and they all said they felt well supported. Comments received from staff questionnaires included: My manager is always available should I wish to discuss any issues to do with my job role. Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The local management arrangements at Larch Road are unclear, and this is affecting the quality of the service on offer. The lack of robust management arrangements is potentially leaving people who live at the home at risk. Evidence: The Registered Manager for Larch Road is currently on long term sick leave, and has been for over a year. Consequently there is an acting manager in place to run the home, and make day to day decisions. The staff rota indicates that there are no management hours built into the work schedule, so that the manager is hands on and involved in the day to day care. As a result a number of management tasks are not being carried out effectively, due to the manager not having enough management time to complete these tasks, for example staff supervisions, running meetings and evaluating and implementing issues raised through the quality assurance system. Larch Roads quality assurance system relies on questionnaires being filled in by people who live at the home, relatives and visitors. Copies of these questionnaires were seen, however they are not being sent out in a formalized way, and the questionnaires that were seen were over a year old. Larch Road do not currently hold meetings for the people who live there, although the acting manager said that she regularly meets with people on a one to one basis to discuss their care. These meetings are informal and no records are kept. Regulation 26 visits (these are monthly audits by a representative of the owners management team) are taking place, with copies of reports seen; these are part of the homes quality assurance system. A range of different health & safety records were seen, including the fire safety records, water temperature checks and the Control of Substances Hazardous to Health Evidence: (COSHH) records, all were found to be correct and up to date, which shows that people are living and working in a safe environment. Are there any outstanding requirements from the last inspection? Yes  No  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 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 Description 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 Description Timescale for action 1 37 9 The provider must clarify the 31/05/2009 management arrangements at the home, and ensure that a Registered manager is in post, and working at the home. It is an offence under the Care Standards Act (2000) for an unregistered person to manage a care home. 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 22 The problem with the black mould in the shower room in bungalow number 3 needs to be resolved, as this is affecting the quality of the environment, and could be detrimental to peoples health. An ongoing programme of training for staff in National Vocation Qualifications (NVQ) to level II should be introduced, with a target of 50 of the staff team having 2 32 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 these qualifications by 2011. 3 4 36 37 All members of staff should have a minimum of six formal supervisions session per year. The manager should have supernumery time built into the rota, so that they can carry out the necessary management tasks to ensure that the home runs effectively. Formal meetings with the people who live at the home should be held, with minutes kept to ensure that peoples views are recorded. The system for sending out questionnaires to people who live at the home, their relatives and visitors should be formalized, so that questionnaires are sent out on a regular basis, and responses are monitored and reviewed. 5 39 6 39 Helpline: Telephone: 03000 616161 or Textphone : or 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) Commission for Social Care Inspection (CSCI). 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