Inspection on 09/06/05 for Larchmere House

This inspection was carried out on 9th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Larchmere House 17/10/07

Larchmere House 27/09/06

Larchmere House 16/01/06

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 Frittenden Kent TN17 2EN Lead Inspector Lynnette Gajjar Unannounced 9 June 2005 10:00 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 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 H56-H06 S50016 Larchmere House V223163 090605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Larchmere House Address Frittenden Kent TN17 2EN Telephone number Fax number Email 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 Familycareuk@virgin.net Family Care UK Limited Mrs Daphne Dawn Brockman CRH Care Home 33 Category(ies) of OP Old Age registration, with number of places Larchmere House H56-H06 S50016 Larchmere House V223163 090605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: A maximum of 5 teminally ill persons over 65 years of age can be accommodated in any single room or double room that is not shared. The home is restricted to provide nursing care for one female service user whose date of birth is 22 March 1938 who has secondary care needs of learning disability. Date of last inspection 17th January 2005 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 ensuite 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, administration and maintenance support to support the Home. Larchmere House H56-H06 S50016 Larchmere House V223163 090605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, the first in the year running from April 1st 2005 to March 31st 2006. The visit lasted from 10:00am to 17:00pm. The home currently has 29 residents and is running with vacancies. The visit was spent talking directly with residents, both privately and collectively, with staff and the registered manager. Due to the nature of the service, it is difficult to reliably incorporate accurate reflections of the service users in the report. Some judgements about quality of life and choices were taken from direct conversation with residents and observation followed by discussion with support staff and evidencing records held at the home. A tour of the premises was undertaken. What the service does well: What has improved since the last inspection? The home entrance, exits and facilities used by residents have been made safer through the installation of a number of recommendations made by the occupational therapist. Resident’s independence and safety will be further enhanced following the completion of the remaining occupational therapist recommendations. Larchmere House H56-H06 S50016 Larchmere House V223163 090605 Stage 4.doc Version 1.30 Page 6 Staff have welcomed additional information and planned training being provided to develop their skills and knowledge in working with residents who have secondary care needs of a learning disability to maintain their dignity and improve care offered. Residents are happy with the replaced lounge chairs, stating the new ones are much more comfortable and easier to get in and out of. Residents feel safe at the home through the caring and confident staff supporting them on a daily basis. Laundry services are being reviewed through the new-motivated staff to enhance the efficient service for both household linen and personal clothing care. Through regular contact with the responsible person visiting the home, staff feel the company is approachable, listen and understand the needs of residents through direct interaction. What they could do better: 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 H56-H06 S50016 Larchmere House V223163 090605 Stage 4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection Larchmere House H56-H06 S50016 Larchmere House V223163 090605 Stage 4.doc Version 1.30 Page 8 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 standard(s) 1,2,3,4,, Residents and representatives are given all the information they need to be able to make an informed decision to live at Larchmere House. EVIDENCE: Residents have access to a statement of purpose and service users guide, which is currently being reviewed with some minor alterations to clearly reflect the service offered. Larger print formats are available on request. Other formats such as photographic, audio or Braille were not currently offered but were an area the manager was keen to explore further. Residents spoken with detailed involvement in visiting the home and the staff visiting them where they were living to assess their needs prior to deciding to move in. Many residents spoke of how they had left this to their relatives due to being in hospital at the time and not being well enough to visit. “My daughter visited two or three homes but decided this was the nicest for me, I have to say she didn’t make a bad choice”. Residents spoke highly of the staff and registered manager through their openness and support at this time. Larchmere House H56-H06 S50016 Larchmere House V223163 090605 Stage 4.doc Version 1.30 Page 9 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 standard(s) 7,8,10,11 Residents are treated with genuine respect and dignity by all staff. Individual health and social care needs are managed well. EVIDENCE: Care plan records seen were sufficiently up to date, detailed and contained clear information instructing staff to how meet the needs of the individuals. Residents spoken with had varying understanding of their care plans, some with no interest at all. Those spoken with were aware of paperwork needing to be done but were happy to leave that to the staff. Residents and relatives were observed to talk directly to care staff sharing information to help to develop their care and personal needs. Care staff are mindful of how to prevent risks of falls, taking action to ensure safety for individual residents and this is clearly recorded. Residents confirmed regular contact with the GP, chiropodists, opticians and consultant appointments, sometimes with relatives taking them or staff from the home. Records supported this and are stored securely. Interaction between residents and staff is good showing genuine respect and appropriate familiarity with each other. Personal wishes in the event of illness and death, although a difficult subject, are discussed sensitively with residents and families to ensure appropriate levels of support are respected and personal dignity maintained at such times. Larchmere House H56-H06 S50016 Larchmere House V223163 090605 Stage 4.doc Version 1.30 Page 10 Larchmere House H56-H06 S50016 Larchmere House V223163 090605 Stage 4.doc Version 1.30 Page 11 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 standard(s) 12,13,14,15 Residents are encouraged to make choices about all aspects of their daily lives. Residents would feel more comfortable and maintain dignity if mealtime support and availability was reviewed for those who need to use the toilet. EVIDENCE: The home has effective working relationship with the local health and social care professionals, supporting residents in their health and social care needs. Care plans seen recorded regular contact both at the home and their local practices/work place. Reviews with care managers take place, with two residents having their yearly review with their allocated care manager today. Discussion took place with residents regarding the food at the home. The majority of feedback was exceptionally positive; all spoke with high regard to the cook’s versatility, willingness to make any alternatives and the high standard of food provided. Food served today was hot and well presented. An area for reviewing, that was raised by more than 2 residents, was the frustration felt at meal times when they wished to be supported to the toilet and being asked to wait until after the meal has finished, “Only thing I would change is being able to go the toilet at mealtimes, it’s quite frustrating when the nurses have the blue aprons on, they can’t take you as they are handling food”. Regular activities and entertainers are booked to stimulate and encourage interaction with peers, including outings in adapted vehicles and popping over the road to the local public house for meals and a drink. Larchmere House H56-H06 S50016 Larchmere House V223163 090605 Stage 4.doc Version 1.30 Page 12 Residents spoke highly of the activity co-ordinator and her commitment to arrange things to do. Two ladies from the local church were at the home today offering morning service and hymns. There was a continuous flow of visitors to the home during this visit, all received warmly by staff. Larchmere House H56-H06 S50016 Larchmere House V223163 090605 Stage 4.doc Version 1.30 Page 13 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 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 spoken with knew who to talk to if they had a concern or wished to make a compliant, this included care staff, the manager, relatives and the inspector. Copies of the complaint procedure are available in the home. An area of concern was raised today regarding care; this was referred to the manager immediately. The resident felt this was listened to and that the manager had been very nice; they were happy with the outcome. This should be recorded in the home’s complaint record and actions taken to monitor issues raised and show the homes willingness to listen and take concerns seriously. Not all concerns raised have been logged and this was discussed in detail with the manager who could see the potential positive use of monitoring and reviewing services provided, but also to monitor patterns, triggers or common themes. 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 H56-H06 S50016 Larchmere House V223163 090605 Stage 4.doc Version 1.30 Page 14 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 standard(s) 19,20,21,22,23,24,25,26 Residents live in a comfortable, nicely decorated and clean home. Safety will be enhanced further following completion of the occupational therapy recommendations currently being put into place through the maintenance programme. EVIDENCE: The home continues to be presented to good standard of hygiene and cleanliness. Lounge furniture has been replaced with appropriate seating to meet the needs of the residents. The maintenance staff were completing full enclosure of the ramp exit to the back garden, followed by the installation of the grab rail. There was evidence of other work being completed. The manager detailed proposals to complete all recommendations made by the occupational therapist report on 7th January 2005 through a structured plan of renewal and maintenance. The garden was in use today with staff supporting residents to sit in the warm sun or shade. Due to the hot weather today and the small compact laundry getting very hot, an external door was left open. This area of the home is not in constant use. This must be assessed and an appropriate measure put in to place to ensure safety and security of personal Larchmere House H56-H06 S50016 Larchmere House V223163 090605 Stage 4.doc Version 1.30 Page 15 possessions of those living and working at the home. Rooms are personalised and those spoken with were happy with their surroundings. All rooms are now supplied with height adjustable nursing beds. Larchmere House H56-H06 S50016 Larchmere House V223163 090605 Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 Resident’s benefit from the support and care of competent and skilled staff, resulting in good morale and enthusiasm to improve their quality of life. EVIDENCE: Staff discussed attending a number of courses related to health and safety core training and nursing care, increasing their personal knowledge and understanding of individual care needs and their responsibilities. Specialist training and guidance has been arranged to assist staff working with those who have a learning disability to understand their additional care and support needs above the nursing care. Staff felt the company were very supportive to training requests and attendance. The home continues to aim to support care staff to complete their NVQ 2 and 3 in care with 50 . The home has a consistent and stable staff team. Both qualified nurses and care staff spoken with and directly observed evidenced clear and good understanding of different individual care needs. Residents talked fondly of individual staff and their kindness. Staff were seen to support individuals respectfully but also with respectful familiarity resulting in some fun joking and banter from both parties. Residents “ would like staff to sit and chat more with them, especially at mealtimes would be nice, but I understand they are busy girls”. “They can’t do enough for you”. A visiting care manager expressed the how good the staff were, referring to their open and relaxed manner towards their care of the residents. Larchmere House H56-H06 S50016 Larchmere House V223163 090605 Stage 4.doc Version 1.30 Page 17 Larchmere House H56-H06 S50016 Larchmere House V223163 090605 Stage 4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,35,36,37,38 Residents’ personal preferences about care needs are encouraged through the registered managers open leadership and the promotion of a safe home and working environment. EVIDENCE: The registered manager has service user group for 18 years, is a qualified nurse RN1 level and has completed NVQ 4 in Management. Residents and staff expressed a high regard for the management approach to the home. Residents felt the registered manager was approachable and all staff spoken with said they felt well supported by the manager and company. Regular formal supervision takes place. The registered manager and lead nurse demonstrated through discussion, a very clear understanding of the needs of current residents and current issues. Monitoring health and safety in the home is to a good standard through the maintenance staff. Equipment is serviced as required to maintain a safe home and facilities. Risk assessments are completed for individuals and staff activities in the home and care duties. Staff Larchmere House H56-H06 S50016 Larchmere House V223163 090605 Stage 4.doc Version 1.30 Page 19 and the manager did not have a full understanding of accident/incident recording and reporting under regulation 37 to the commission. Guidance is available, with a form to assist them in this and the manager stated all staff would be made aware of this. The manager evidenced regulation 26 visits taking place and the commission up to May 2005 has now received copies. Detailed financial recordings and storage is in place for small amounts of resident personal monies held by the home. Larchmere House H56-H06 S50016 Larchmere House V223163 090605 Stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 3 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 3 2 3 2 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 Standard No 16 17 18 Score 2 x 3 3 3 3 3 3 3 2 2 Larchmere House H56-H06 S50016 Larchmere House V223163 090605 Stage 4.doc Version 1.30 Page 21 Are there any outstanding requirements from the last inspection? YES But there is evidence of these being addressed through homes development plan 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 OP1 Regulation 4 (1), (b), (c)5 (1), (a)Schedu le 1 Requirement The registered person shall compile in relation to the care home a written statement referred to as the statement of purpose, which shall include a statement as to matters as listed in schedule 1, highlighted in the text.The service users guide must include items as stated in Regulation 5.There is evidence of this being addressed with a draft shared today, however minor amendments have been identified by the manager and a final revised copy will be submitted to the commission. The registered person shall ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. In that:Action as defined in the Occupational Therapist report is partially completed with a commitment from the manager and company to complete all recommendations The registered person shall having regard to size of the care Timescale for action 30th July 2005 2. PO22 13 (4) (c) 3. OP24 23 (2) (f) 16 (2) (c) Written repsonse with clear expected completion dates is to be submited to the commissio n by 30th July 2005 Written repsonse Page 22 Larchmere House H56-H06 S50016 Larchmere House V223163 090605 Stage 4.doc Version 1.30 home and number and needs of the service, provide in rooms occupied by service users adequate furniture and other furnishings as listed in schedule 24.2.Action as defined in the Occupational Therapist report is partially completed with a commitment from the manager and company to complete all recommendations 4. with clear expected completion dates is to be submited to the commissio n by 30th July 2005 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 OP1 Good Practice Recommendations It is recommended consideration be given to develop the service user guide further to enhance residents understanding of staff working in the home and services provided. To assist those with sensory loses associated with elder care but also limited concentration and memory retention through photographs and object reference. It is strongly recommended that the details of when ‘as required’ is required should be specific and recorded with a procedure for ascertaining from the service users when ‘as required’ medication is needed and the understanding of why it is administered for i.e. a pain recording chart.Staff confirmed that this is still being addressed with service users, their GP and as appropriate relatives. It is acknowledged that this does take time to ensure good practice and full service user involvement and participation. The medication trolley should be made secure to the wall in the dining area where medication is dispensed. The medication trolley remained secure in the nursing office during medication rounds and staff took medication to the residents directly leaving this locked and secure. Brackets are being explored to be installed It is recommended that records of all concerns/complaints raised are logged and recorded with recorded information of the action taken and whether this was resolved satisfactorily.It is recommended that a regular formal audit H56-H06 S50016 Larchmere House V223163 090605 Stage 4.doc Version 1.30 Page 23 2. OP9 3. OP9 4. OP16 Larchmere House 5. OP19 6. 7. OP28 OP37 8. 9. OP38 OP38 of concerns raised is undertaken to monitor patterns, triggers, need for review of risk assessments and care plans as well as A method for reviewing practice and procedures. It is recommended that risk assessments are undertaken for external doors being left open during hot weather and measures are implemented to ensure the residents safety and security of personal belongings. Work should continue to ensure that 50 of care staff, excluding qualified staff, should be trained to NVQ 2 or equivalent by end 2005. It is recommended that a review be made of the security arrangements of the door leading to the nurse’s station. Consideration should be given to having a keypad locking system to that service users records can be stored in accordance to data protection whilst staff continue to have ease of access. The office door was seen to be locked and those requiring entry had access to a key. The manager is currently exploring a keypad option. It is recommended that copies of servicing certificates of equipment and amenities in use be held at the home. It is recommended that items stored on top of cupboards in the laundry is reviewed and stored at an appropriate level to minimise the risk of over reaching, dropping of items, poor manual handling techniques and heightened risk of falls Larchmere House H56-H06 S50016 Larchmere House V223163 090605 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent 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 H56-H06 S50016 Larchmere House V223163 090605 Stage 4.doc Version 1.30 Page 25 - 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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