Inspection on 17/10/07 for Larchmere House

This inspection was carried out on 17th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Larchmere House 27/09/06

Larchmere House 16/01/06

Larchmere House 09/06/05

Larchmere House 17/01/05

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Larchmere House Biddenden Road Frittenden Kent TN17 2EN Lead Inspector Mrs. Susan Hall Key Unannounced Inspection 09:30 17th October 2007 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.V345880.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. Larchmere House DS0000050016.V345880.R01.S.doc Version 5.2 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@btconnect.com 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.V345880.R01.S.doc Version 5.2 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. 27th September 2006 Date of last inspection Brief Description of the Service: Larchmere House is a modern detached building, which has had a purpose built extension added, to increase it’s facilities. It is situated in the attractive village of Frittenden, which is near to the towns of Ashford and Maidstone. It is easily accessible by road, and car parking is available at the front of the premises. Frittenden has limited access to public transport, but the nearby village of Staplehurst has a main line railway station, and other public transport. The home is owned by Family Care (UK) Limited, and the providers take an active interest in the management and running of the business. At least one of the Directors is on the premises for 3-4 days each week. Accommodation is provided on two floors and comprises 23 single bedrooms, 6 of which have en-suite facilities; and 5 shared bedrooms, 2 of which have ensuite facilities. A passenger lift provides easy access between floors. There are a variety of communal areas, including a large lounge, a smaller sun lounge, a separate dining room and a small quiet room. Gardens at the rear provide additional seating areas in good weather. The home is well known in the village, and there are excellent day to day links with the village community. The home provides nursing care for older people, and therefore has trained nurses on duty 24 hours per day. The current fees range from £520.00 to £730.00 per week, depending on the assessed needs of individual clients. Items covered/not covered by the fees are clearly presented in the residents’ handbook. Larchmere House DS0000050016.V345880.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection, which incorporates all information gained about the service since the previous inspection, as well as a visit to the home. This was the first visit to the home for this inspector, and she assessed all of the key standards, and most of the other national minimum standards as well. This enabled her to gain a more comprehensive view of how the home is operating. Survey forms were sent out to residents, relatives, staff, health professionals and care managers prior to the visit, and the inspector was pleased to receive 20 completed forms. 7 of these had been completed by residents, and 13 were from the other sources. They included many positive comments about the home, such as “I am very happy and satisfied. There is lovely food, and I have no complaints. I am so lucky to have such a clean and happy home”; and “I am very pleased with the treatment I receive. Staff are very helpful. I enjoy the trips out.” CSCI have not received any complaints about the service since the previous inspection, and there was just one telephone call requesting some advice. There have been no issues raised around “Safeguarding Adults”. Residents said that they know who to talk to if they have any concerns, and that the manager or nurses are always available. The inspector viewed all areas of the home and gardens, and was able to chat with 10 residents and 9 staff members during the visit. This was in addition to the manager and 2 of the providers, who were available throughout the inspection, and assisted with information. The inspector also examined documentation, including some care plans, medication records, policies and procedures, staff files and maintenance records. A frequent visitor to the home said that “Larchmere, in my opinion, is exceptional. The nursing and care is individually tailored to each resident, with love and much encouragement.” What the service does well: As already entered above, the home provides care which is tailored to individual needs. This was evident by the way in which care plan reviews are held every 2 months, with the manager, nurse, key worker, resident and relatives all discussing the individual care programme, and ensuring that it meets the needs of that person. The home provides comprehensive information for people who are enquiring about the home, and produces this in a large print, easy to read format. Larchmere House DS0000050016.V345880.R01.S.doc Version 5.2 Page 6 There are 2 activities co-ordinators, working 6 days per week, to provide a full and varied programme of activities, entertainment and outings. The kitchen has been given a gold standard food award by Tunbridge County Council/Environmental health department. The home has exceptionally good links with the community, and is well known in the village. Contacts include residents and relatives visiting the local pub for meals; visits from local schoolchildren; church services held in the home by local people; and food obtained from local sources (fruit, vegetables, meat and bread). The local Parish Council have recently approved a plan to put benches in a recreation field at the back of the home, (with a new pathway and easy access), so that residents can enjoy taking part more easily in village life. Residents and relatives spoke highly of the staff team. This is a stable team, committed to putting residents first, and treating them with respect, courtesy, and sensitivity. They are led by a highly competent and efficient manager. What has improved since the last inspection? What they could do better: The inspector noted that the providers have an ethos of constantly striving to improve the home, and were already aware of things that they could do to make the home even better. This includes their plans to have an area at the side of the home re-landscaped, so that it provides another patio/courtyard garden. The plans include fitting in a pond/water feature, and creating another area for residents to sit or walk. Recruitment is well managed in the home, but the inspector noted that application forms did not specify that a full employment history must be requested. Larchmere House DS0000050016.V345880.R01.S.doc Version 5.2 Page 7 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. Larchmere House DS0000050016.V345880.R01.S.doc Version 5.2 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.V345880.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1-5 (standard 6 does not apply in this home). People who use the service experience good quality outcomes in this area. The home provides clear and detailed information for prospective residents. A full needs assessment is carried out prior to admission. EVIDENCE: The statement of purpose is a well produced document, which includes all information as required by the national minimum standards, and is set out in a format which can be easily followed. The providers have also produced a colour brochure with photographs, which gives an overview of the home for people who are enquiring about placements. The Service Users’ Guide is headed as a “Residents Handbook” and is excellently produced in large print, and in a colour which is easy for reading, and stands out clearly from the page. The secretarial staff prepare a personalised copy for each new resident, with the resident’s name on the front cover, and including the details of their individual named nurse and key worker. Information is very clearly worded, so that residents have no doubt about who to go to for further details or advice for different subjects (e.g. their Larchmere House DS0000050016.V345880.R01.S.doc Version 5.2 Page 10 named nurse for health needs, activities co-ordinator to discuss their social preferences, or matron/manager for any concerns). The handbook includes an outline of the usual daily routine for the home, and information about different aspects of the running of the home such as meals/food, activities, visiting arrangements, doctor’s visits, use of call bell system, and laundry. It also includes a copy of the terms and conditions of residency, details of how to make a complaint, and a sample form for residents’ satisfaction surveys. Most enquiries are the result of referrals from residents already in the home, (or their relatives), and the home has a good local reputation. There is currently a waiting list for vacancies. Pre-admission assessments are carried out by the manager or her deputy, using a pre-set format. The inspector viewed two completed assessments, and these included comprehensive information. All aspects of daily living are discussed as far as possible, with particular attention paid to ensuring that the room available will be suitable for the person concerned (e.g. in relation to any equipment they may need), and that they meet the home’s category of care. The home is not registered for residents with dementia, although there is a recognition that many residents may have short term memory loss, or some level of confusion. If there is any doubt about the home’s ability to meet the needs of the person in relation to mental health, the manager will request a psychiatric assessment to check this out. No resident would be admitted who displayed any aggressive tendencies or behavioural problems. Joint assessments are obtained from Social Services/hospitals as applicable, and information is requested from other sources such as relatives or other carers. Residents are invited to spend time in the home prior to admission, but as many are admitted from hospitals, this is not always possible. A trial period of one month is offered prior to confirming residency. A detailed review is held at the end of this time to check the suitability of the placement. This meeting includes the manager, named nurse, key worker, the resident, and relatives/care manager as applicable. Contracts show the details of what is included in the fees, and what is not included (e.g. hairdressing, chiropody), and are signed and agreed by both parties. All residents- whether private or Local Authority funded – are provided with the home’s terms and conditions of residency. Larchmere House DS0000050016.V345880.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7-11 People who use the service experience excellent quality outcomes in this area. Detailed care plans, and regular reviews, demonstrate the home’s commitment to putting the health and welfare of residents at the heart of all they do. EVIDENCE: The admission process includes carrying out assessments for all aspects of care, such as mobility, nutrition, medication, continence, skin integrity and social needs. Care plans are then formulated from the details of the assessments. These are set out in individual folders, which are indexed and divided into sections, for easy access of information. The first page includes a photograph of the resident, and a profile of their life history, which includes their family details and background. This immediately determines the home’s ethos, in that residents are seen as individuals, and not just assessed according to medical criteria. Assessments and care plans are reviewed every month. Risk assessments are in place for identified risks such as use of bedrails, walking with a zimmer frame, and capabilities for joining in with activities. The risks are clearly Larchmere House DS0000050016.V345880.R01.S.doc Version 5.2 Page 12 explained to the resident (or representative acting on their behalf), and signed to confirm understanding and discussion of each situation. Care plans are written by the named nurse, and are updated as any changes occur. Each resident has a care plan review after the first 4 weeks, and then approximately every 2 months. These are formal meetings held with the resident, manager, named nurse and key worker, and with any relatives according to the resident’s choice. The inspector was impressed that these meetings are held so regularly, and the resident and relatives have the opportunity to discuss any suggested changes, and to know that their individual care is of paramount importance to the home. The home’s own brochure states that “our first concern is always the wellbeing of our residents”, and these detailed meetings back up that claim. The inspector viewed 3 care plans, and noted that these contained details such as: for nutrition – identifying where a resident had lost weight, and a check carried out on their diet and ability to swallow; for skin integrity, where a resident is at risk of developing a pressure ulcer, and the action taken to prevent this; and for wound care – identifying the condition of the wound at each dressing change, charting these on a body map , and including a written evaluation of the wound as well. All wounds are documented and evaluated separately, so there can be no confusion in regards to the healing process. The inspector regarded these records as excellently completed. Daily records are completed at the end of each shift, and include details about what the resident has done that day, and how they have been feeling. There is a weekly key worker diary with additional information, and activities records completed by the activities co-ordinators. The home is fortunate to have a GP from a local surgery who is a visiting medical officer, and visits the home routinely every week, as well as for emergencies. Residents can, of course, arrange for the GP of their choice, but most prefer to be registered with this surgery. This promotes continuity of care, and the doctor carries out routine checks for medication reviews, as well as seeing residents on a frequent basis. Referrals are made to other health professionals as indicated (e.g. physiotherapy, speech and language therapist). The home routinely checks for the residents’ history of falls, and assists them in retaining their mobility by weekly exercise classes. The inspector received many comments on survey forms about the home’s management of health care needs, such as “The service provides a caring, homely atmosphere, with a good standard of health care and professionalism.” “I am very happy with the care and support I receive. I am looked after extremely well.” And “We are very happy with the standard of care our relative is receiving.” Residents spoke highly of the staff’s caring attitudes, their attention to privacy and dignity, and their consideration of individuals different needs. Larchmere House DS0000050016.V345880.R01.S.doc Version 5.2 Page 13 Medication is stored in a small clinical room, and the providers are aware that the temperature is on the high side (24-27 degrees C) for correct medication storage (limit of 25 degrees C), and that this matter needs their attention. They had already tried using an air conditioning unit, but it was not successful, and they are looking at alternative solutions. The drugs fridge temperature is satisfactory. There is a good system of stock rotation. The Controlled Drugs cupboard conforms to the required standards. There is a policy in place for the use of homely remedies (e.g. for paracetamol, cough linctus), and the products available to use have been decided by the GP and signed by him. A local pharmacist supplies most medication in a monitored dosage system. Medication Administration Records (MAR charts), are accompanied by a photograph of the resident, and a record of any allergies, or specific concerns. Handwritten entries are signed by 2 nurses. MAR charts showed receipt of medication, and were well completed. The nursing staff record each time that “as necessary” medication is given on an additional sheet, showing the reason why it was given (e.g. if it was for pain, where the pain is, and the severity of it). The manager asks for any specific details regarding death and dying during the admission process, in case of sudden illness. This enables the staff to know if the resident would want particular relatives to be informed and to stay with them. One of the nurses has completed a 5 month course in palliative care, and other nursing staff have had some training in this. Larchmere House DS0000050016.V345880.R01.S.doc Version 5.2 Page 14 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): 12-15 People who use the service experience excellent quality outcomes in this area. The home provides a wide range of activities and outings; and staff are constantly looking for ways to enhance residents’ lives within the boundaries of their health needs. EVIDENCE: The home now employs two activities co-ordinators, and they work well together to discuss forthcoming activities, and planning and carrying these out. There is an activities co-ordinator in the home for either Saturday or Sunday each week, as well as on weekdays; and two volunteers also assist with activities. Each resident is provided with the next month’s planner for activities, as well as these being displayed on a notice board on the ground floor. This enables residents to decide if they wish to join in, or sit somewhere else away from the activity. There is a good range available, including group quizzes and crosswords, games, exercises, videos, arts and crafts, flower arranging and cookery. Residents are also able to have manicures, choose library books/talking books or be taken out for a walk. One resident told the inspector how the activities co-ordinator had taken her out recently to visit the local church. Entertainment is arranged on a regular basis, and includes visits Larchmere House DS0000050016.V345880.R01.S.doc Version 5.2 Page 15 from local school classes in the community, musical entertainers, and small theatre productions. Church services are also arranged in the home. Some residents stay in bed or in their rooms according to their health needs or personal choice. The activities co-ordinators spend time with them on a one to one basis, and some residents said that other staff frequently check to see they are ok. Residents are invited to take part in trips out, and some of the photos on display showed residents enjoying outings to Hastings and Eastbourne. Arrangements have been made with a company who supply a 12-seater minibus, and this provides the opportunity for relatives to take part in outings as well. The activities co-ordinators carry out a risk assessment prior to outings, checking that the venue will be suitable, and that there are sufficient relatives/staff to assist with the outing. The local public house is just over the road, and provides good food, and residents enjoy going there for meals sometimes. There are very good links generally with the local community, and the home is well known in the village. The home has just produced their first newsletter, to keep residents and relatives up to date with any events in the home, and reporting on special items such as birthday parties or wedding anniversary celebrations. This was very nicely produced, with lots of photos, good information, and large print. This was in response to a suggestion raised at a residents and relatives’ meeting. The staff had produced an excellent programme the previous year for Christmas, and one of the secretarial staff was in the process of completing the programme for this year. There are activities, outings and entertainment provided throughout December, and opportunity to share in activities such as cooking mince pies, and joining in carol singing. There is something on nearly every day, and the programmes are beautifully produced, and resident and relatives are all supplied with a copy. A relative commented, “The activities programme is full and varied. The communication between the home and families is excellent. All is done with good humour and real concern, to make residents lives as good as they can be.” Visitors said that they are always made to feel welcome in the home. One commented “ Visiting friends and family are welcomed with real hospitality, even when staff are very busy.” Residents are encouraged to bring in their own items of furniture, and photos, pictures etc. to personalise their rooms according to choice. The inspector visited the kitchen, which was clean and tidy, and talked with one of the cooks. Records are retained for what each resident eats. Menus were seen to be very varied, and to provide excellent choice. Residents are asked for their choice each day, and there are always choices for main meals and desserts. The cooks will make additional dishes on request. At teatimes there is a choice of a hot meal, soup, 4 sorts of sandwiches and 3 sorts of cake (home-made) as well as fresh fruit. Tables in the dining room are laid out Larchmere House DS0000050016.V345880.R01.S.doc Version 5.2 Page 16 attractively, and residents may choose to have their meals in their rooms or in the lounges if they prefer. Menus are displayed on the dining tables. Food is obtained from local sources wherever possible e.g. the local butcher, greengrocer and baker are all used by the home. Most residents said that the food is “very good” or “excellent”. Larchmere House DS0000050016.V345880.R01.S.doc Version 5.2 Page 17 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 People who use the service experience good quality outcomes in this area. Any complaints are taken seriously, and are dealt with appropriately. Residents are protected from abuse. EVIDENCE: The complaints procedure is included in the residents’ handbook, and each resident is provided with one of these. It is also displayed on a notice board on the ground floor. Any one with any concerns is encouraged to speak initially to the nurse on duty or their named nurse, or the manager. The complaints log showed that all concerns are taken seriously and dealt with quickly and appropriately. The providers are also frequently in the home (3-4 days per week), and are available for people to share their concerns. Residents said that they know who their named nurses are, and there are frequent resident/relatives meetings which provide an opportunity to raise any concerns in a shared environment. The complaints procedure includes information about CSCI, but did not include any details regarding Social Services. The Inspector suggested that it might be helpful for residents to be reminded that this is another possible point of contact, if they do not wish to speak directly to the manager or providers. All staff have been trained in the recognition and prevention of adult abuse, and there are good training records to confirm this. The home has good recruitment procedures. The whistle-blowing policy is clearly written, and is included in the induction. Larchmere House DS0000050016.V345880.R01.S.doc Version 5.2 Page 18 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 People who use the service experience good quality outcomes in this area. The premises are kept clean throughout, and provide a homely atmosphere for residents. The providers are being proactive in looking at further ways to enhance the facilities for residents. EVIDENCE: The inspector viewed all areas of the home, which was clean throughout, and generally well maintained. Details mentioned in the last inspection report have been addressed. There is now a keypad lock on the front door for additional security. There is an ongoing programme of redecoration throughout the home. Communal rooms include a large lounge and a smaller sun lounge; a dining room and a quiet room. There are different areas of seating outside, which residents enjoy in good weather. This includes benches at the front – where they can “watch the world go by”, and garden furniture in the back garden for more seclusion. The home is presented with attractive hanging baskets at the Larchmere House DS0000050016.V345880.R01.S.doc Version 5.2 Page 19 front and rear, and has a lawn and well stocked flower beds in the rear garden. The premises back on to a recreation field belonging to the Parish Council, and the providers have now obtained permission for a pathway and gateway leading directly into this. They have also been given permission to pave a corner of the field through the gateway, and place some benches there, so that residents can feel more involved in village life. This work was already under way. The providers have other plans in place to improve an area of garden at one side of the home, so that residents have even more choice Bedrooms are usually redecorated before a new resident is admitted, and residents are able to choose their own colour for the décor. Carpeting and furniture is replaced as necessary. Residents can bring in their own items of furniture by agreement with the manager. All rooms are fitted with a call bell. Many residents have their own phones, and these can be fitted in other rooms by arrangement. Most bedrooms have en-suite facilities. There are 5 shared rooms, and these have suitable screening to promote privacy. The home is equipped with 4 bathroom/shower rooms, and one on the first floor was being upgraded to provide a “wet” room. This will include a backwash sink, to be used by the hairdresser, and will make it easier for residents to have their hair washed. When this room is completed, there will be a bathroom and a shower room on each floor. The home is equipped with a passenger lift, which enables easy access between floors, and is suitably fitted with aids such as handrails, raised toilet seats, and pressure-relieving equipment. This includes airflow mattresses and cushions. There is a sluice room with a sluice disinfector on each floor. Mobile hoists and stand aids are provided on each floor. Radiators in bedrooms have low surface temperatures, and are fitted with individual thermostats for residents’ comfort. Hot water temperatures are controlled, and the maintenance man checks these monthly. The laundry is equipped with 2 washing machines and 1 dryer. The washing machines have a sluicing facility. Soiled items are dealt with using an alginate bag system, which promotes management of infection control. There is a Laundry Assistant on duty each day (including weekends); and 3 cleaners daily throughout the week, and 2 at weekends. Bedrooms are spring cleaned on a rota basis. The kitchen is in satisfactory condition. The Environmental Health Officer said that the current kitchen units will last for a few more years. The providers are aware that they need to keep kitchen facilities under review. Larchmere House DS0000050016.V345880.R01.S.doc Version 5.2 Page 20 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): 27-30 People who use the service experience good quality outcomes in this area. Staffing levels are well maintained. Residents are confident that they are cared for by a good staff team, who are well trained, and work well together. EVIDENCE: The home has a very stable staff team, with many staff having worked here for years. This is a good outcome for residents, who have experienced and well trained staff, and who work well together. There is a recognition that each staff member’s role is important, and that they are valued for what they do. Staffing numbers are well maintained, with a total of 7 care staff on duty in the mornings, and 5 in the afternoons/evenings. There is always a trained nurse on duty, and in the mornings, there may be 2 nurses and 5 carers sometimes, and 1 nurse and 6 carers on other days. There is 1 trained nurse on night duty, with 2 care staff. The manager can increase these numbers if there is particular reason; for example: a resident with especially high nursing needs, or if additional staff are needed to help with an outing. The home is booked with an agency in case of need – usually only if there are several staff off sick at one time. The nursing and care staff are well supported by ancillary staff, which includes 2 activities co-ordinators, 2 secretarial staff, a housekeeper and 2-3 domestic staff each day, a cook and kitchen assistant each day, a full time maintenance man, and a gardener. Larchmere House DS0000050016.V345880.R01.S.doc Version 5.2 Page 21 The home supports care staff in training for NVQ level 2/3, and has a level which is currently just below 50 of staff who have completed this training. There are several staff currently completing NVQ 2, and the percentage will be above 50 when they have completed training. One is about to start NVQ 3. Recruitment procedures are well managed. The manager retains an interview record. The inspector viewed 3 staff files, and these contained all required documentation. POVA First and CRB checks, and PIN numbers for nurses, are checked prior to confirmation of employment. The inspector noted that the application form did not specify that applicants must complete a full employment history, and brought this to the attention of the management. The induction programme is excellently managed with very good details and content included. Staff commented on survey forms that the induction process had been helpful. This includes them being required to read key policies and procedures, and writing a brief resume to show that they understand the content of each policy, and how this should be applied to their work. The Skills for Care programme is used as the main part of the induction. Staff training records are well maintained, and a staff training matrix shows clearly that staff are kept up to date with mandatory training. This includes fire safety twice per year, moving and handling updates every year (a trainer comes into the home for this), and adult protection updates every year. Staff are kept up to date with health and safety and COSHH training, infection control, and basic food hygiene. Nursing staff are provided with plenty of opportunity to keep their own skills and competencies up to date, and to develop these in new areas. This includes training in subjects such as wound care, taking blood tests, male catheterisation and use of syringe driver (for pain relief). One nurse had just completed a 5 month course in palliative care. A relative said that “The staff are caring and courteous and respectful of my relative’s wishes. I couldn’t ask for better staff.” Larchmere House DS0000050016.V345880.R01.S.doc Version 5.2 Page 22 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 & 35-38 People who use the service experience excellent quality outcomes in this area. The home is run by an efficient and competent manager; and residents are confident in the high quality of the leadership and ongoing performance of the home. EVIDENCE: The manager has many years experience in caring for older people, and has worked in this home for over 4 years. She is a trained nurse, and is familiar with the illnesses associated with older age. Staff and residents spoke highly of the way in which she leads the staff team, and promotes good standards of care throughout the home. She is ably assisted by a deputy matron, who was also on duty on the day of the inspection. When the inspector arrived at the home, the deputy was carrying out a competency check for a nurse who was doing the medication round. This is a routine exercise, and demonstrates the Larchmere House DS0000050016.V345880.R01.S.doc Version 5.2 Page 23 ethos of the home in being sure that staff keep up to date with training and competency requirements. The inspector observed good interaction between staff and residents, and while very friendly, staff also show professionalism in their work and behaviour. A health professional who visits the home regularly said “The home is extremely efficiently run, and the patients’ needs and requirements are fully met. It is a very happy home, the patients are content, and the staff extremely friendly.” A staff member confirmed that there are frequent staff meetings, when all staff are able to share ideas and areas for possible improvement. The home also has regular residents/relatives meetings, and this provides opportunity for feedback. There is a very open atmosphere in the home, and visitors know that they can speak to someone in charge at any time. The home has it’s own quality assurance processes, which include giving out survey forms to residents/visitors at different times during the year. Residents know that their views are taken into account and acted on. The home does not act as an appointee for any residents regarding their finances, but does keep small amounts of pocket money for them in a safe place. These are stored individually and a record is kept for each resident for input/output for their individual accounts. They value having a small amount of money available, and can buy small items from a “shopping trolley” which is taken through the home every 2 weeks by the activities co-ordinators, or go to the pub or shop in the village. All receipts are retained, and the accounts can be viewed at any time on request. The secretarial staff check the individual amounts together at each transaction, and sign to confirm that the amount tallies with the records. All staff have formal one to one supervision sessions. The manager carries this out for the trained staff, and heads of departments, and they are then delegated to carry out supervision for others. Staff commented on survey forms that they have regular supervision sessions, (every 2 months), which is an opportunity to discuss practice issues, and to identify training needs. Each staff member also has a yearly appraisal. There are comprehensive handovers for care staff at each shift change when individual residents’ health needs are discussed. The inspector viewed various records in the home, including some policies and procedures, care plans, staffing files, fire records, and maintenance records. Documentation is appropriately stored in accordance with confidentiality needs, and is neatly and accurately maintained. Fire records were viewed and show that fire alarm tests are carried out weekly, and that there are regular fire drills for staff. The inspector viewed some servicing records, and these included gas safety certificate, electricity, PAT testing, water temperatures, and lift and hoist servicing certificates. These were all up to date. The health and safety issues remarked on at the last inspection have all been met. Larchmere House DS0000050016.V345880.R01.S.doc Version 5.2 Page 24 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 4 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 4 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 4 X 3 3 3 3 Larchmere House DS0000050016.V345880.R01.S.doc Version 5.2 Page 25 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 OP9 Good Practice Recommendations To keep the room temperature of the clinical room under review, and take action to address the situation as needed. To continue with the ongoing programme for improving the premises; including interior décor, and exterior landscaping. To maintain the existing programme for enabling staff to carry out NVQ 2/3. To ensure that application forms specify that a full employment history is required. 2 OP19 3 4 OP28 OP29 Larchmere House DS0000050016.V345880.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Larchmere House DS0000050016.V345880.R01.S.doc Version 5.2 Page 27 - 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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