CARE HOMES FOR OLDER PEOPLE
Larchmere House Biddenden Road Frittenden Kent TN17 2EN Lead Inspector
Justine Williams Key Unannounced Inspection 27th September 2006 09:30 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.V308766.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.V308766.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.V308766.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. 16th January 2006 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 who 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 the Home. The current fees range from £500.00 to £695.00 per week. Residents pay for hairdressing, chiropody, toiletries and some outings in addition to the fees. Larchmere House DS0000050016.V308766.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. An unannounced inspection was carried out on 27th September 2006 between 10.00am and 4.00pm by regulatory inspectors Justine Williams and Lynnette Gajjar. During that time a number of residents, relatives, staff, the registered manager and responsible individual 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 received feedback at the end of the inspection. This report contains assessments made from observation, conversation and records. Comments made by relatives and residents included the following: “it’s very nice here, the staff are very kind” “thank you for the care you gave (relative) during her 2 year stay” “we are grateful for the great kindness shown” “we are very pleased with the quality of care at Larchmere House” “when my (relative) died there the attention and sensitivity shown by all the staff was exemplary” What the service does well:
Larchmere House continues to provide a warm and homely environment for residents. The home continues to benefit from a stable staff team with an experienced manager. The turnover of staff is very low this helps to provide good continuity of care and good relationships between staff and relatives and staff and residents. Residents feel well cared for, listened to and involved in making every day decisions. Residents enjoy good relationships with a caring and skilled staff team. Residents enjoy a structured but flexible activity programme which includes activities that they want to get involved in. Larchmere House DS0000050016.V308766.R01.S.doc Version 5.2 Page 6 Residents continue to speak highly of the quality of the meals provided, their presentation and the variety. Whilst some health and safety issues were identified the outcomes for residents remain very good at this home. What has improved since the last inspection? What they could do better:
Addressing the following issues will protect the residents from potential harm: An approved receptacle must be provided for smokers to extinguish cigarettes, in accordance with fire safety legislation and guidance. Refuse containers must be closed and locked when not in use. COSHH cupboards must be kept locked and accompanying data sheets be accessible in respect of the chemicals stored. The sheds in the grounds containing potential hazards must be kept locked. Larchmere House DS0000050016.V308766.R01.S.doc Version 5.2 Page 7 The unused rusting shower chair must be removed from the shower room or made good, as this is a tissue viability and infection control hazard. Infection control hazards as follows must be addressed. The cracked tiles and flaking paint in the sluice and the damaged bath sealant must be repaired. Risk assessments in respect of individual residents should be more comprehensive in scope. Residents recorded allergies must be noted and revisited by staff regularly so that the risk of “oversights” is reduced or eliminated. Risk assessments must be undertaken for self-administration of all medicine including “over the counter” medicines, and safe storage must be used. Work should continue to ensure that 50 of care staff, excluding qualified staff, should be trained to NVQ 2 or equivalent. This recommendation is repeated from the last 2 inspections and is ongoing with clear evidence of the home’s commitment to support staff in this. In line with the amended regulations quality assurance systems should be further developed. 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.V308766.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.V308766.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 Quality on this outcome area is good. This judgment has been made using available evidence including a visit to the service Residents are confident their needs can be met in the home through good admission procedures. Intermediate care is not provided. EVIDENCE: The manager and responsible individual discussed with the inspectors that they propose to amend the service users guide to include the new breakdown of fees required by the new Care Homes Regulations. Admission records and assessments were seen in respect of 4 residents, 1 of who was newly admitted to the home. The assessments are undertaken by the manager or qualified nursing staff and are reasonably comprehensive. All but one of the records contained all the information required, the remaining record for the newly admitted resident, contained no information on social interests and social history. Joint assessments from social services were seen on record and had been requested by the home. All residents are assessed for their nursing care needs
Larchmere House DS0000050016.V308766.R01.S.doc Version 5.2 Page 10 contribution from the NHS in accordance with guidelines from the Department of Health. Intermediate care is not provided at Larchmere House. Larchmere House DS0000050016.V308766.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality on this outcome area is adequate. This judgment has been made using available evidence including a visit to the service Residents’ health and social care needs would be better managed by increasing the scope and detail of risk assessments. EVIDENCE: Care plans seen were comprehensive and detailed. All the care plans seen had been regularly reviewed and reviews resulting in changes in care needed had been written into the care plan. Evidence of relatives having been involved in the care plan was seen, residents who are able to should be asked to agree and sign their care plans. Some residents spoken with had been involved in drawing up their care plans. Risk assessments were seen in respect of falls, moving and handling, nutrition, tissue viability, continence, etc. Risk assessments should also be undertaken in respect of other specific possible risks, i.e. keeping alcohol in residents’ rooms. The content of key worker records was good; content of daily records could be enhanced by including more information about how residents spent their day. Larchmere House DS0000050016.V308766.R01.S.doc Version 5.2 Page 12 In general the health care needs of residents are well managed, however the inspectors found clear records that a resident has a urinary catheter in situ that the resident is documented as being allergic to. Clear records of visits by the residents GP’s and other healthcare appointments were seen. The home has a medication policy that has recently been reviewed to include details of homely remedies, instructions regarding PRN or “as required” medication and risk assessments for residents who are self medicating. Two residents had an ‘over the counter’ cough medicine in their rooms. One resident is taking this at night; there was no record of the residents taking this medicine. A risk assessment must be produced in respect of all medicines self administered, be they homely remedies, over the counter, or prescribed medicines. The aims and objectives of the home reinforce the importance of treating residents with respect and dignity and these values are fundamental to the philosophy of care. Good relationships are shared between staff and residents and residents appreciate the caring staff team. Larchmere House DS0000050016.V308766.R01.S.doc Version 5.2 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 Quality on this outcome area is excellent. This judgment has been made using available evidence including a visit to the service The range of activities and lifestyle experienced at the home surpasses most residents’ and relatives’ expectations. Residents are encouraged to make choices about aspects of their daily lives. EVIDENCE: Residents are able to enjoy a full and stimulating lifestyle with a variety of options to choose from. The home has sought the views of residents and considered their varied interests and abilities when planning the routines of daily living and arranging activities. Routines are very flexible and residents can make choices in all areas of their life. Information about planned activities is displayed on the notice board. Residents are encouraged to keep in contact with family and friends. Visitors are welcome at any time and facilities are available for them to have a drink or a meal with the resident. Residents can choose to entertain visitors in their own rooms or other communal areas. Recent activities organised by the home included charades, ludo, flower arranging, and a pub lunch. The activities co-ordinators visit residents who
Larchmere House DS0000050016.V308766.R01.S.doc Version 5.2 Page 14 prefer to stay in their rooms and not participate in organised activities, as do care staff. Residents’ rooms were personalised with their own belongings and furniture. Residents spoke very highly of the food and one resident who is going home after a period of respite has arranged with the home to return for lunch every day. The menus run on a 4 weekly basis and are changed with the seasons. Thought should be given to displaying the menus more prominently for residents as many said they were forgetful and could not remember what was for lunch. Whilst there is a choice of meal every day the main meal is displayed but the choice is not. Residents needing help with eating and drinking are helped by staff discreetly and special diets are provided for. Some residents choose to eat in the dining room; others eat in the lounge or their bedrooms according to their choice. Larchmere House DS0000050016.V308766.R01.S.doc Version 5.2 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 Quality on this outcome area is good. This judgment has been made using available evidence including a visit to the service. Residents can be confident that concerns and complaints will be listened to and taken seriously, and that they are protected from abuse as far as is possible. EVIDENCE: The home has received 4 complaints since the last inspection, all of which were substantiated and have been resolved. Whilst the residents spoken with had not had any cause to complain, they were aware of the home’s policy and said they would complain to the manager, or a member of staff if necessary. The complaints file contained detailed information about complaints received, how they were investigated and actions or outcomes following the complaints. The complaints made had been dealt with within the home’s stated timescale. Staff receive regular adult protection training. Adult protection training is also part of the induction for new staff. There are no current adult protection alerts relating to this home. Larchmere House DS0000050016.V308766.R01.S.doc Version 5.2 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): 19,21,26 Quality on this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. The home provides residents with an attractive and comfortable environment in which to live. Resolution of the potential infection control and health and safety issues identified would ensure the home remains safe and clean. EVIDENCE: The home in general was clean and comfortable and provided a homely atmosphere that residents enjoy. There is a seating area in the grounds for residents to use. During the inspection the main entrance to the home was unlocked and some fire doors were unlocked and open, which could present security issues. The provision of an appropriate receptacle for smokers to use which complies with fire safety guidance is needed. Larchmere House DS0000050016.V308766.R01.S.doc Version 5.2 Page 17 The home has 3 bathrooms and 1 shower room, of the 2 bathrooms upstairs, 1 is out of use and is being repaired. The inspectors were informed that the 2nd bathroom upstairs is in use although it appeared to be used for storage. The manager and proprietor are considering converting this bathroom into a shower room, as many of the residents prefer to shower. The home employs a member of staff dedicated to laundry duties, the staff member is responsible for marking net underwear, which are now used for individuals and not shared, this minimises any infection control issues. The laundry was well organised, clean and tidy, the walls and floor finishes are impermeable and readily washable, the laundry has a dedicated hand-washing basin. The washing machines have a sluicing facility. One of the sluice rooms has cracked wall tiles and flaking paint, which must be attended to, to reduce any risk of infection. The shower room has an un-used shower chair attached to the wall, which is rusty and presents infection control and tissue viability hazards. The sealant around one of the baths also needs replacing to reduce any risks of cross infection. Larchmere House DS0000050016.V308766.R01.S.doc Version 5.2 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 Quality on this outcome area is good. This judgment has been made using available evidence including a visit to the service. Residents can feel confident that a well-trained and competent staff group will meet their needs. EVIDENCE: The staffing numbers are reviewed in response to residents’ changing needs, and the home had 1 RGN and 5 care staff on duty the morning of the inspection, for 32 residents. 1 RGN was off sick and the manager had been unable to replace the staff member. In addition the activity co-ordinator, cook and kitchen assistant, 2 cleaners, the laundry and maintenance person were on duty, as well as the manager and 2 administrators. Residents said they do not have to wait long for assistance and felt that the staffing numbers were fine. Approximately 33 of staff have now attained an NVQ qualification, the manager continues to encourage staff to undertake the training. Three staff personnel files were seen; all included 2 written references, evidence of CRB check, POVA check proof of identity, etc. In line with amended regulations the inspectors discussed the need to amend the application form to specify that one referee must be a professional reference, although the files seen all had the last employer as one reference. The manager authenticates the professional reference with a follow up telephone call.
Larchmere House DS0000050016.V308766.R01.S.doc Version 5.2 Page 19 The pre inspection questionnaire indicated that staff receive comprehensive and regular training. Larchmere House DS0000050016.V308766.R01.S.doc Version 5.2 Page 20 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): 31,33,35,38 Quality on this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. The home is competently managed. Some minor health and safety issues were identified, which once resolved will enhance the safety of staff and 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. The proprietor undertakes monthly visits under regulation 26, and this information is forwarded to the Commission.
Larchmere House DS0000050016.V308766.R01.S.doc Version 5.2 Page 21 The amendments to the regulations regarding quality assurance were discussed and the home now needs to further develop the quality assurance systems in line with the new regulations. A spot check on residents’ finances was carried out and found the home’s systems robust and accurate. The home keeps and manages small amounts of monies in residents behalf’s, but does not act as an appointee. The pre-inspection questionnaire indicated that all necessary servicing and checks of equipment are up to date and undertaken by appropriate persons on a regular basis. The health and safety issues documented under the environment standard and some additional issues must be addressed: The cupboards containing COSHH substances must be kept locked and the accompanying data sheets for the chemicals should be readily accessible. The data sheets seen did not correlate with the chemicals being stored. The sheds in the grounds containing potential hazards to residents should be kept locked. The large rubbish containers in the grounds should have lids closed and locked to prevent fire and other hazards. The manager must report incidents under regulation 37 without delay to the commission. Larchmere House DS0000050016.V308766.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X X X X 2 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 X 3 X 3 X X 2 Larchmere House DS0000050016.V308766.R01.S.doc Version 5.2 Page 23 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 OP38 Regulation 12 (1)(a) Requirement The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of the service users; in that -An approved receptacle be provided for smokers to extinguish cigarettes. -refuse containers be closed and locked when not in use -COSHH cupboards be kept locked and accompanying data sheets be accessible in respect of the chemicals stored. -sheds containing potential hazards be kept locked. -the defunct rusting shower chair be removed form the shower room infection control hazards as follows be addressed -cracked tiles, and flaking paint in the sluice, bath sealant cracked and discoloured. Timescale for action 30/12/06 Larchmere House DS0000050016.V308766.R01.S.doc Version 5.2 Page 24 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. 2 3 4 Refer to Standard OP7 OP8 OP9 OP28 Good Practice Recommendations Risk assessments in respect of individual residents should be more comprehensive in scope. Residents’ recorded allergies should be noted and revisited by staff regularly so that the risk of “oversights” is reduced or eliminated. Risk assessments must be undertaken for selfadministration of all medicine including “over the counter” medicines, and safe storage must be used. 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. In line with the amended regulations quality assurance systems should be further developed. 5 OP33 Larchmere House DS0000050016.V308766.R01.S.doc Version 5.2 Page 25 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
© 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.V308766.R01.S.doc Version 5.2 Page 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
