CARE HOMES FOR OLDER PEOPLE
Larchmere House Biddenden Road Frittenden Kent TN17 2EN Lead Inspector
Justine Williams Announced Inspection 16th January 2006 10:00 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 Larchmere House DS0000050016.V264865.R01.S.doc Version 5.1 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. Larchmere House DS0000050016.V264865.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Larchmere House Address Biddenden Road Frittenden Kent TN17 2EN 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) 01580 852335 01580 852222 Family Care UK Limited Mrs Daphne Dawn Brockman Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places Larchmere House DS0000050016.V264865.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. A maximum of 5 terminally ill persons over 65 years of age can be accommodated in any single room or double room that is not shared. 9th June 2005 Date of last inspection Brief Description of the Service: Larchmere House has been owned and managed by Family Care (UK) Limited since October 20th 2003. The home is registered to offer accommodation to 33 residents over 65 years of age requiring nursing care, with specific conditions as detailed above. Larchmere House is situated in Frittenden, a small village with limited access to public transport. Staplehurst, approximately three miles from Frittenden, offers the usual facilities of a small town and has a mainline railway station. The Home is a converted modern detached building with a purpose built extension. Accommodation is on two floors and comprises 23 single bedrooms, 6 of which have en-suite facilities and 5 shared bedrooms, 2 of which have en-suite facilities. Each bedroom has a television point and is connected to the staff call system and some service users rooms have a telephone point. A shaft lift provides access to the first floor. Communal living space consists of a main lounge area and a conservatory area. There is a separate dining room. The gardens are to the rear of the building with car parking to the front. The Home employs nursing and care staff that work on a roster basis giving 24-hour cover. Other ancillary staff are also employed to offer catering, domestic, activities, administration and maintenance support to support the Home. Larchmere House DS0000050016.V264865.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. An announced inspection was carried out on 16th January 2006 between 10.00 am and 5.00pm by regulatory inspector Justine Williams and Lynnette Gajjar. During that time a number of residents, staff, and the registered manager agreed to speak with the inspectors both in public and privately. Feedback was given to the manager during, and at the end of the inspection, the responsible individual joined us at the end of the inspection for feedback. This report contains assessments made from observation, conversation and records. As part of the inspection process comment cards were received from residents, relatives and professionals. Comments made included: “My (relative) has flourished since living at Larchmere, the care my (relative) gets is fantastic, they all deserve a medal” “All carers and staff are very helpful” “I was very impressed with the care and time given to the residents both by the care and senior staff” “Larchmere is a home on its own, wonderful caring staff, delicious food… I can’t praise it enough” “We have regular residents meetings where issues involving care or complaints can be aired, matron is available for private matters” “Residents activities and entertainment are excellent” “I have booked my bed!” What the service does well:
The home provides a warm, comfortable, pleasantly decorated, homely environment, residents said that the owner is very generous and provides anything that you need. The home benefits from a stable staff team with an experienced manager. Residents are happy living at the home as they feel involved in the running of the home, listened to and cared for. The home provides a varied menu with plenty of alternatives with effort made to make meals attractive and appetising. Nursing standards are high with trained staff always on each shift.
Larchmere House DS0000050016.V264865.R01.S.doc Version 5.1 Page 6 Residents said their clothes were well cared for. Relatives think communication between staff and themselves is good. Residents enjoy varied planned activities provided by the activity coordinators. What has improved since the last inspection? What they could do better:
Risk assessments must be undertaken for self-administration of medicine, to evidence that service users are capable of administering their own medicines. Specific instructions regarding the use of PRN (as required) medicine should be recorded, so that individualised care is given, and staff are aware of what triggers to look before giving medication. The use of homely remedies should be for all residents and consent from other GPs should be sought.
Larchmere House DS0000050016.V264865.R01.S.doc Version 5.1 Page 7 Specific individualised information should be recorded in the care plan for example, specific interventions by staff to manage a residents challenging behaviour, information regarding what pressure area relieving equipment is being used, etc. A policy should be devised for the use of a listening device within the home to ensure resident’s privacy is protected. The device located in the upstairs corridor has been used for a particular resident who does not use the nurse call bell and calls out. Some health and safety issues must be addressed to minimise risk to residents and staff, items stored on top of wardrobes should be reviewed and stored at an appropriate level to minimise the risk of over reaching, dropping of items, poor manual handling techniques. The damage to the bath surface be made good to ensure risk of infection is minimised. The use of net underwear is for named individuals and not shared. Consideration should be given to the purchase of a cleaning trolley, which holds rubbish bags and mop and bucket as well as other cleaning equipment for safe storage and moving and handling by staff. Toilet frames should be fixed or removed and alternative equipment be fitted. 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. Larchmere House DS0000050016.V264865.R01.S.doc Version 5.1 Page 8 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 Larchmere House DS0000050016.V264865.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4,6 Residents have the information they need to make an informed decision to move into Larchmere House. Residents are confident their needs can be met in the home through good admission procedures. EVIDENCE: Minor amendments required and identified at the last inspection have been made and the statement of purpose and service users guide reflect the range of services offered at Larchmere house. The service users guide is available in large print and would be made available in other formats such as audiocassette on request. Residents spoken with said they had been assessed by the Matron prior to moving into the home and the matron had described the home and provided them with the service users guide. A copy of the social service assessment is requested by the home if one has been done.
Larchmere House DS0000050016.V264865.R01.S.doc Version 5.1 Page 10 Matron described how a resident has recently been moved to a different service, as Larchmere house could no longer provide the specialist support she needed. The home is committed to meeting needs and if resident needs can no longer be met the matron works with other healthcare professionals to find an appropriate placement for the individual. Intermediate care is not provided at Larchmere House. Larchmere House DS0000050016.V264865.R01.S.doc Version 5.1 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Residents have their needs recorded in the plan of care; small improvements in recording would better evidence this process. The development of risk assessments for residents who wish to self medicate will better protect the residents and the home. Residents are treated with respect and dignity by all staff. EVIDENCE: Each resident has a plan of care written within 5 days of admission in accordance with the homes policy. One resident exhibits challenging behaviour, the care plan for this resident should be expanded upon to identify any triggers and a management plan of what staff should do in the event of the resident becoming aggressive and challenging. Other plans should include more specific information regarding what incontinence products the individual uses, and what pressure relieving equipment the resident is using. The care plans were regularly reviewed. Resident’s files included risk assessments for falls and other specific activities the resident may engage in. The daily record contained reasonable detail, and residents spoken with were aware of their care plans and had signed them.
Larchmere House DS0000050016.V264865.R01.S.doc Version 5.1 Page 12 A record of all visits by healthcare professionals is kept in each file and this showed good access to a variety of professionals including chiropody, visiting opticians and visits to hospital out patients departments. All residents are assessed for their risk of developing pressure sores, and residents are also regularly assessed for nutritional risk and incontinence. The home has purchased some pressure relieving equipment and one resident said she was very happy and comfortable since the owner had purchased a pressure-relieving cushion for her. Qualified nursing staff administer medication. Following the pharmacy inspection the medication policy has been amended to include more information on when to give PRN (as needed) analgesia, this must be further developed to include any PRN medication. Risk assessments must be undertaken for residents who self medicate. The home already seeks written consent from the GP for the individual to self medicate. The homes Visiting Medical officer (VMO) has signed written agreement for the home to administer paracetamol as a homely remedy, not all residents are under the care of the VMO therefore consent for this homely remedy should be sought from these residents GP’s. Medication is stored correctly and securely. Lockable facilities are provided in rooms should residents choose to selfadminister their medication. Residents said they are always treated courteously and with their privacy and dignity protected by staff. Staff use the residents preferred terms of address. Screening is provided in shared rooms. A policy should be developed for the use of a listening device plugged in the corridor and dining area, to ensure the privacy of residents is not compromised. Personal wishes in the event of illness and death are recorded, to ensure residents wishes are carried out as far as possible. Larchmere House DS0000050016.V264865.R01.S.doc Version 5.1 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The range of activities and lifestyle experienced at the home meets residents’ expectations. Residents are helped to exercise control and autonomy over their lives. EVIDENCE: Residents are asked their preferences regarding routines of daily living such as times they like to rise and go to bed, this information is recorded and every effort to meet these is undertaken. Residents choose which activities they participate in and those not wishing to participate are visited in their rooms for 1 to 1 time if they wish. The home has recently employed a 2nd activity coordinator and there are now planned activities from Monday to Saturday, the Matron said that should an evening activity be planned cover would be arranged. There are a good range of activities planned including trips out to the pub for lunch, entertainers invited to the home, manicures, quizzes and word games. Open discussion with the owner and manager regarding alternative and varied activities that may enhance the current programme was welcomed. Residents have visitors at any reasonable time and said their visitors were made to feel welcome.
Larchmere House DS0000050016.V264865.R01.S.doc Version 5.1 Page 14 Residents are encouraged to continue to manager their affairs including their finances for as long as possible. Residents are able to bring in items of furniture and personal possessions. The home has a 4-week rolling menu, which the cook changes from time to time, and in summer and winter. Special diets are catered for including diabetic, soft and pureed and a resident who was on the Atkins Diet. Residents said that there were improvements in the toileting arrangements at meal times, since the last inspection. Residents said there was plenty to eat, that the food in particular the evening meal was beautifully presented with plenty of choice. The cook makes every effort to ensure that the pureed diets are presented to make the food look appealing. Residents chose where and with whom they eat. Larchmere House DS0000050016.V264865.R01.S.doc Version 5.1 Page 15 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Residents feel confident to raise concerns or complain, as they know they will be listened to, with action taken to resolve them. Protection from abuse is promoted through staff training and understanding of the support and actions they may need to take. EVIDENCE: Residents were aware of the complaints policy and how to complain. The complaints log included details of action taken by the home to resolve the complaint. And the matron said any correspondence in relation to a compliant would be kept on file. Copies of the complaint procedure are available in the home. The matron now keeps a separate book for minor complaints or dissatisfaction and actions taken are recorded. Staff spoken with showed a good understanding of how to protect and prevent abuse through reporting under local procedures. There are no current adult protection alerts relating to this home. Larchmere House DS0000050016.V264865.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22,25,26 Residents live in a comfortable, nicely decorated and clean home. EVIDENCE: The home was clean, comfortable and well maintained, the grounds are not being used much at present but are well used and enjoyed by residents in the summer. The premises have been reviewed by an occupational therapist and the recommendation made have all now been actioned and completed. Skandia frames were seen in 2 bathrooms these should be removed or fixed to the floor to ensure the safety of residents. The home has a range of moving and handling equipment aids and adaptations to meet the needs of the residents. Rooms are centrally heated and all areas of the home were warm and comfortable. The owner said that exposed pipe work in one bathroom would be boxed in to minimise risk to residents.
Larchmere House DS0000050016.V264865.R01.S.doc Version 5.1 Page 17 The premises were clean and free from offensive odours. The home currently does not use net underwear for individual residents or single use, thus they are “shared” net underwear must be individually labelled and used for the named residents only. Net underwear is used for some residents who are incontinent. The inspectors were assured that this practice would be addressed immediately. The surface of one of the baths is damaged on the side and this may present a risk of cross infection, as it may not be adequately cleaned. Larchmere House DS0000050016.V264865.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Residents benefit from being cared for by a competent, trained, and safely recruited staff. EVIDENCE: Staff said they felt they had enough time to carry out their jobs effectively, there is a rota to show what staff are on duty. There are adequate numbers of ancillary staff to maintain the cleanliness of the home, ensure it is adequately maintained and to provide the good standards relating to food. Residents spoke fondly of the staff and interaction witnessed between staff and residents was friendly and caring. Approximately 15 of staff have attained NVQ 2 however the matron and owner continue to put staff forward for NVQ training. Staff receive a thorough induction and the manager said she will check the skills sector website to ensure she has all the information they recommend. The home operates a robust recruitment system, where 2 written references are requested and staff are confirmed in post subject to satisfactory CRB checks. Staff receive a range of training appropriate to their jobs. The manager keeps a training matrix to keep track of updates needed.
Larchmere House DS0000050016.V264865.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,36,37,38 Residents are confident that the home is well managed, some improvements in health and safety practices would enhance the safety of residents. EVIDENCE: The registered manager is the matron of the home and is a qualified nurse, she has also attained NVQ 4 in management, she had many years experience in working with older people and managing homes. There are clear lines of accountability in the home. The home has regular staff meetings and residents meetings, which enable them to feedback about how the home is run. Satisfaction surveys are undertaken regularly by the home. Staff receive supervision although the frequency of supervision should be increased to ensure staff receive supervision 6 times per year.
Larchmere House DS0000050016.V264865.R01.S.doc Version 5.1 Page 20 Records required were kept up to date ands stored securely. Information received in the pre inspection questionnaire indicated that all necessary servicing and maintenance of equipment is up to date, a spot check confirmed this. It is recommended that consideration be given to the purchase of a larger cleaning trolley. Storage of pads and other items should be reviewed, as these are currently stored on top of wardrobes, which presents a risk to residents and staff. Some infection control issues were identified in standard 26, (the use of shared net underwear and damage to a bath surface). Skandia toilet frames should be fixed or removed, and alternative equipment fitted as necessary. Risk assessments are undertaken with respect to the environment, accidents illnesses are recorded and reported. Larchmere House DS0000050016.V264865.R01.S.doc Version 5.1 Page 21 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 3 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X 3 3 3 Larchmere House DS0000050016.V264865.R01.S.doc Version 5.1 Page 22 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. 1. Standard OP9 Regulation 13 (2) Timescale for action The registered person shall make 15/03/06 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home: -Risk assessments must be undertaken for selfadministration of medicine. - Specific instructions regarding the use of PRN medicine should be recorded. - The use of homely remedies should be for all residents and consent from other GPs should be sought. Requirement RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Larchmere House DS0000050016.V264865.R01.S.doc Version 5.1 Page 23 1 OP7 2 3 OP10 OP28 4 OP38 Specific individualised information should be recorded in the care plan – regarding PRN medication, specific interventions by staff to manage a residents challenging behaviour, information regarding what pressure area relieving equipment is being used, etc. A policy should be devised for the use of a listening device within the home to ensure resident’s privacy is protected. Work should continue to ensure that 50 of care staff, excluding qualified staff, should be trained to NVQ 2 or equivalent by end 2005 This recommendation is repeated from the last inspection and is ongoing with clear evidence of the homes commitment to support staff in this. It is strongly recommended that the following health and safety issues be addressed-Items stored on top of wardrobes is reviewed and stored at an appropriate level to minimise the risk of over reaching, dropping of items, poor manual handling techniques. -The damage to the bath surface be made good to ensure risk of infection is minimised. -The use of net underwear is for named individuals and not shared -Consideration is given to the purchase of a cleaning trolley, which holds rubbish bags and mop and bucket as well as other cleaning equipment. -Toilet frames are fixed or removed and alternative equipment be fitted. Larchmere House DS0000050016.V264865.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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