Inspection on 06/09/05 for Larchwood Care Home

This inspection was carried out on 6th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Larchwood Care Home 18/04/07

Larchwood Care Home 05/05/06

Larchwood Care Home 28/04/05

Larchwood Care Home 30/09/04

Larchwood Care Home 02/06/04

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

CARE HOMES FOR OLDER PEOPLE Larchwood Care Home 108 Broad Road Braintree Essex CM7 9RX Lead Inspector Brian Bailey Final Report Unannounced 6th September 2005 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. Larchwood Care Home I56 I05 S17864 Larchwood V247401 UI 050905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Larchwood Care Home Address 108 Broad Road Braintree Essex CM7 9RX 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) 01376 347777 01376 345556 Southern Cross Care Homes No 3 Limited Unit 2G Enterprise House, Valley Street North, Darlington, Co Durham DL1 1GY Sharon Thompson Care Home 64 Category(ies) of Dementia - over 65 years of age (64) registration, with number of places Larchwood Care Home I56 I05 S17864 Larchwood V247401 UI 050905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 64 persons). Date of last inspection 28th April 2005 Brief Description of the Service: The owners of Larchwood are Southern Cross Healthcare, which merged with Highfield Care Homes in February 2005. The registered manager is Sharon Thompson. Larchwood is a large purpose built two-storey care home for older people. The residents’ accommodation is arranged within three self-contained group living units each with its own group of bedrooms, lounge/dining area, bathrooms/WC’s and kitchenette. The home is set back from the main road in a residential area on the outskirts of Braintree. There are ample car parking facilities and access to public transport is good. The home is divided into three units, “Acorn” and “Chestnut” on the ground and first floor in one building, and “Rowan”, which is a larger unit on the ground floor in an adjoining building. All bedrooms are for single occupancy with en-suite WC facilities. There is a passenger lift available. The grounds adjacent to each unit are enclosed and there is a secure central courtyard area. Access to the building and all areas is good. Larchwood specialises in the care of older people with dementia and also frail elderly people. Larchwood Care Home I56 I05 S17864 Larchwood V247401 UI 050905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on Tuesday 6th September 2005 from 9.45am until 6.000pm. This was the second inspection of Larchwood in the inspection year 2005/6. The inspection included a tour around most parts of the building, but focussed on Chestnut Unit on the first floor and Rowan Unit, a number of the records, health and safety matters, policies and procedures and medication were inspected. Staff, residents and a visitor were spoken to. What the service does well: What has improved since the last inspection? What they could do better: Resident care plans are detailed and cover a range of issues but the home needs to evidence that residents and/or their relatives are consulted and kept informed. Staff gave examples of activities that normally take place, but in the absence of the organiser, the provision of activities is dependent on the availability of care staff. Larchwood Care Home I56 I05 S17864 Larchwood V247401 UI 050905 Stage 4.doc Version 1.40 Page 6 Residents living on the first floor do not have free access to the home gardens and although this is difficult to achieve, routines should be introduced to ensure this choice is provided. There is in general good compliance with health and safety matters but the report indicates the need for two issues to be dealt with. 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. Larchwood Care Home I56 I05 S17864 Larchwood V247401 UI 050905 Stage 4.doc Version 1.40 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 Larchwood Care Home I56 I05 S17864 Larchwood V247401 UI 050905 Stage 4.doc Version 1.40 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) 4. Prospective residents and relatives benefit from being able to visit the home to make sure it meets their needs and to find out the range of services provided. EVIDENCE: Staff spoken to said that prospective residents and their relatives are invited to visit the home to see for themselves the range of facilities available, to meet the staff and other residents, look at the bedroom and have an opportunity to ask questions. In general, it is relatives that visit on behalf of the prospective resident to assess its suitability. During the inspection, a visitor said that they had been given the opportunity to visit the home but had declined, as they were aware of the facilities available. The home’s statement of purpose states that prospective residents and their relatives are encouraged to visit. The home does not offer an intermediate care service. Larchwood Care Home I56 I05 S17864 Larchwood V247401 UI 050905 Stage 4.doc Version 1.40 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 & 9. Progress continues to be made on improving care plans and the frequency of reviews but they and/or their relatives are not consulted sufficiently when changes to care plans are necessary. Residents are enabled to access health care professionals in order to assist them with their health care needs. EVIDENCE: Residents’ care records were checked on Chestnut and Rowan Units. These were up to date and contained detailed care plans, which were being reviewed on a monthly basis. Southern Cross has introduced new care records that are gradually being put into place, but this will take a while for them to be fully implemented. There was no evidence that the home had consulted residents and/or relatives following a change of circumstances. The daily care records were easy to read and were in general sufficiently detailed. It was noted however, that a major change in one resident’s circumstances had not been recorded. It was evident from observation though that staff were well aware of the need to offer support to the resident, but this relied on them being told and their memory. Evidence was available in the care records to show that the full range of services provided by health care professionals were obtained. Records Larchwood Care Home I56 I05 S17864 Larchwood V247401 UI 050905 Stage 4.doc Version 1.40 Page 10 checked showed that the residents had seen GP’s, a dentist, optician, chiropodist and community nurses. A record was also available of residents’ weight, which is recorded monthly. Residents seen and spoken with appeared well cared and had been enabled to maintain their hair, skin and nails in a healthy condition. The home had appropriate policies and procedures for the administration of medication. All medication is kept in locked trolleys within locked cupboards. The home uses a monitored dosage system which was well organised and maintains Medicine Record Sheets for each resident. These were up to date and accurate. Controlled dugs are kept in a separate locked cupboard and a register is maintained with two signatures for each entry. The manager said that staff that have the responsibility to administer medication are assessed to ensure their understanding of the system and their competency although the staff records were not checked. Larchwood Care Home I56 I05 S17864 Larchwood V247401 UI 050905 Stage 4.doc Version 1.40 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. Residents benefit from being able to maintain contact with relatives and friends but are not all residents are enabled to undertake interesting and enjoyable activities on a regular basis. Residents living on the first floor do not have free choice and access to the gardens and natural daylight. EVIDENCE: The activities coordinator was on sick leave at the time of the inspection. It was therefore the responsibility of care staff to offer activities in the interim period. This is not a real alternative as from observation and discussion with staff, they have very little time to spend with residents other than to ensure residents’ personal care needs are met. The majority of residents were seen to sit in the lounges or dining room without any form of stimulation taking place. A care assistant was observed however, to sit with residents and trim their fingernails and to offer good support to a resident that was distressed. Alternative arrangements should be made in the absence of the activities coordinator. This standard will be assessed fully at the next unannounced inspection. Residents living at Larchwood are generally very dependent on staff for support and are unable to make choices. It was evident however, that there were no restrictions on residents’ movement within the safe areas of the home. Some residents had chosen to spend time in their bedrooms. Residents living Larchwood Care Home I56 I05 S17864 Larchwood V247401 UI 050905 Stage 4.doc Version 1.40 Page 12 Chestnut Unit on the first floor are totally dependent on the availability of staff to access the garden areas. Visitors are encouraged and from observation were free to visit at any time and make themselves at home. They were made welcome and appeared to have established good relationships with staff. Larchwood Care Home I56 I05 S17864 Larchwood V247401 UI 050905 Stage 4.doc Version 1.40 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) EVIDENCE: None of the above standards were assessed at this inspection. Larchwood Care Home I56 I05 S17864 Larchwood V247401 UI 050905 Stage 4.doc Version 1.40 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. Improvements to the buildings continue to be of benefit to residents. The lack of real alternative bathing and shower arrangements on the first floor limits residents’ choice. Outstanding repairs to the first floor bathroom may present a risk to residents. EVIDENCE: Since the last inspection, carpets had been fitted in the corridors of Acorn and Chestnut Units, which has greatly improved their appearance. There are two bathrooms on Chestnut Unit, one of which is not used owing to the type of bath installed. The main bathroom is equipped with an assisted bath, but this requires some maintenance work as there is a leak and staff said the temperature gauge is inaccurate. A 13amp power socket in the corridor of Chestnut Unit was loose and requires attention. All areas of the home seen were clean and tidy and odour control was good. A domestic said that the carpet cleaner had broken down on the day of the Larchwood Care Home I56 I05 S17864 Larchwood V247401 UI 050905 Stage 4.doc Version 1.40 Page 15 inspection. Concerns were expressed about the cleanliness of the home whilst waiting for the machine to be repaired, as the home did not have alternative equipment. The veranda outside of Chestnut unit on the first floor has safety bars fitted to prevent an accident. The home needs to consider whether an alternative method of protection can be fitted that would improve the view for residents. Larchwood Care Home I56 I05 S17864 Larchwood V247401 UI 050905 Stage 4.doc Version 1.40 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 & 30. Staff at the home are trained and employed in sufficient numbers to meet the needs of residents, although an up to date assessment of residents dependency needs may indicate a shortfall. EVIDENCE: Staff rosters were checked and it was found that the staffing levels had not changed since the last inspection. Some staff were of the opinion that the number of staff allocated to each of the units was insufficient. The manager is reminded to determine the dependency levels of residents and then to check the Department of Health staff guidelines “Residential Forum” to see whether the current staff numbers available for each shift is sufficient to meet the needs of residents. Records were available to show that all new employees are required to undertake an induction into the home. Southern Cross has introduced an induction programme that meets the requirements of the National Training Organisation. These records will be checked at the next unannounced inspection. Larchwood Care Home I56 I05 S17864 Larchwood V247401 UI 050905 Stage 4.doc Version 1.40 Page 17 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) 38. Residents and staff are protected by effective and well-documented Health and Safety systems although until work is carried to repair a power socket, people may be placed at risk. EVIDENCE: Evidence was available to show that the home treats health and safety as a high priority. The home has a good system of recording significant events and the maintenance of equipment and services. Health and safety matters are generally delegated to a maintenance person. Weekly checks are carried out on call points, fire alarms, window restrictors, door closures and the emergency lights, and a fire drill was last held on 26/7.05. Hot water outlets used by residents are checked regularly and records showed that some readings were below the maximum temperature of 43 degrees C, which would be too cold. The maintenance person was aware of the situation but was finding it difficult to rectify the problem. Larchwood Care Home I56 I05 S17864 Larchwood V247401 UI 050905 Stage 4.doc Version 1.40 Page 18 Nine beds have bedrails fitted. Staff said risk assessments are always carried before an agreement is reached for their use and protective bumpers were always used. Staff were aware that bedrails can be the cause of accident. The maintenance person was aware that the annual check of the fire protection system was overdue. As already indicated under the environment standards, a 13 amp power socket on the first floor corridor was loose and therefore a hazard to staff and residents. An accident to a resident earlier in the year, identified that wardrobes in bedrooms were at risk from falling onto people if pulled. Work has been carried out ensure these are secured to the wall to prevent another accident. Larchwood Care Home I56 I05 S17864 Larchwood V247401 UI 050905 Stage 4.doc Version 1.40 Page 19 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 x x x 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 x COMPLAINTS AND PROTECTION 2 2 2 x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x 2 Larchwood Care Home I56 I05 S17864 Larchwood V247401 UI 050905 Stage 4.doc Version 1.40 Page 20 No Are there any outstanding requirements from the last inspection? 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 7 Regulation 15 Requirement Care plans and reviews must be carried out in consultation with residents or their representative whenever possible. Significant changes to a residents circumstances must be recorded to provide staff with up to date information and guidance. A range of stimulating activities must be provided to all residents on a regular basis. Residents living on the first floor must be routinely provided with opportunities to access the garden areas of the home. Repairs to the first floor bath must be carried out and a study undertaken to assess whether alternative bathing facilities are required. The dependency levels of residents must be assessed to enable the manager to check with the DoH staffing guidelines that the current staffing levels are sufficient. The 13amp power socket on the first floor must be repaired. The hot water outlets used by residents must be adjusted to enable an average temperature I56 I05 S17864 Larchwood V247401 UI 050905 Stage 4.doc Timescale for action 1/12/05 2. 3. 12 14 16 23 1/12/05 1/12/05 4. 21 23 1/12/05 5. 27 18 1/11/05 6. 7. 38 38 12 12 1/10/05 1/12/05 Larchwood Care Home Version 1.40 Page 21 close to 43 degrees C. 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. Refer to Standard 19 26 Good Practice Recommendations The home should consider whether the bars on the veranda outside the first floor lounge could be fitted with an alternative method to prevent accidents. The home should purchase an additional carpet cleaner. Larchwood Care Home I56 I05 S17864 Larchwood V247401 UI 050905 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Fairfax House Causton Road Colchester CO1 1RJ 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 Larchwood Care Home I56 I05 S17864 Larchwood V247401 UI 050905 Stage 4.doc Version 1.40 Page 23 - 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. 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