CARE HOME ADULTS 18-65
Larchwood Grove 60 Parrock Road Gravesend Kent DA12 1QH Lead Inspector
Jo Griffiths Unannounced 1 September 2005 11:45 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 Grove H56-H06 S23972 Larchwood Grove V247416 010905 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Larchwood Grove Address 60 Parrock Road Gravesenmd Kent DA12 1QH 01474 352722 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) Larchwood Court Limited Miss Janet Aldridge CRH Care Home 8 Category(ies) of LD Learning Disability (8) registration, with number of places Larchwood Grove H56-H06 S23972 Larchwood Grove V247416 010905 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Service users with a learning disability may also have a physical disability. Date of last inspection 7 June 2005 Brief Description of the Service: Larchwood Grove is situated in a residential area in the town of Gravesend. It provides a home to 4 people with a learning disability and has 4 beds allocated to people who wish to use the home for periods of respite.The home has a large rear garden and accomodation is provided over 2 floors. There is no lift access to the first floor and therefore people who use wheelchairs cannot accomodate these rooms. There are two ground floor bedrooms.The home is staffed 24 hours a day with 1 waking night staff and 1 sleep over staff member. Public transport is available to access the town centre and there are a range of pubs, shops and cafes within walking distance. The staff support the service users to undertake a range of activities of their choice. Larchwood Grove H56-H06 S23972 Larchwood Grove V247416 010905 stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced. For the purpose of this report the people living at Larchwood would like to be referred to as the residents of the home. The Manager was present and staff and residents were spoken with. What the service does well: What has improved since the last inspection? What they could do better:
Where the care management assessment does not cover standard 2 the manager should complete a full assessment. Care plans must be reviewed regularly to ensure residents’ needs are still being met. This is particularly important for respite residents whose needs may have changed since the last stay at the home. It remains a recommendation that, where possible residents are involved in their care plan and sign to agree it. The Manager needs to show that residents who share the double respite room have agreed to do so. Some bedrooms and the dining room require new carpets and the bathrooms require redecorating to provide residents with a clean and well-maintained environment. Some bathroom aids require replacement; some of this is already in hand. The garage has been condemned and the planned building works must take place to ensure the removal of this and also the relocation of the laundry room to protect residents’ welfare. It remains a requirement from the last inspection that the outside of the building is repainted. Hot water in the upstairs toilet was not available and in some bedrooms it was too hot. There is also a redundant shower that must be assessed to reduce the risk of legionella.
Larchwood Grove H56-H06 S23972 Larchwood Grove V247416 010905 stage 4.doc Version 1.40 Page 6 Records of activities and meals must be kept by the Manager to ensure residents’ needs in these areas are being met. It is recommended that the physio programme for one resident be reviewed to ensure it is appropriate to his needs. The baby monitor used for one person can be overheard by other residents, an alternative should be sought. Staff must be trained in Manual Handling, Fire safety, Food hygiene and 1st Aid as a matter of urgency. This is particularly important for the 2 night staff that are supporting residents alone at night. All food opened and stored in the fridge must be dated to make sure it is not served after the use by date. It is recommended that the fire procedure be displayed in symbol form for residents to easily understand. A system for reviewing the quality of care residents receive must be developed, including gathering their views of the home. 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 Grove H56-H06 S23972 Larchwood Grove V247416 010905 stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Larchwood Grove H56-H06 S23972 Larchwood Grove V247416 010905 stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3 Residents have an assessment of their needs prior to entering the home, by the care manager, although this does not always cover all areas. The needs of the residents are being met. EVIDENCE: Residents entering the home have an assessment of their needs by the care manager and a care plan is developed. The Manager stated that no resident will be admitted without a care management assessment and plan. It was discussed with the Manager the benefits of the home carrying out their own assessment to ensure it covers all the areas detailed under standard 2. Through discussion with staff and review of care plans it was evident that the needs of the current residents are being met. Residents spoken with indicated that they were settled and happy in the home. Larchwood Grove H56-H06 S23972 Larchwood Grove V247416 010905 stage 4.doc Version 1.40 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8, 9 Residents have a plan of care that meets their needs although this is not regularly reviewed. They are supported to make their own decisions, take appropriate risks and contribute to the running of the home. EVIDENCE: Each resident has a care plan that details the support they require in all areas of their lives. Some of these care plans have not been reviewed recently and the care plans for respite residents are not always updated at each new admission. The Manager agreed to look at ways to update these with the care manager. Areas of risk for each resident have been assessed and minimised. It remains a recommendation that residents sign and agree their plan where possible. Residents are involved in the running of the home. Every week there is a residents meeting where the plans for the following week are agreed. Residents can contribute to the menus and activity plans. Residents’ bedrooms reflect their own choices. Larchwood Grove H56-H06 S23972 Larchwood Grove V247416 010905 stage 4.doc Version 1.40 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the 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, 17 Residents enjoy a range of activities and leisure pursuits that are appropriate to their interests and needs, although they will benefit from clearer recording and monitoring of these. They are supported to maintain contacts with family and friends. Residents enjoy a healthy diet. EVIDENCE: Residents’ interests are reflected in the weekly activity timetable for the home. At the time of the inspection all residents were out at various activities including day centres, bowling and a walk into the town. The records of the activities that residents participate in do not however, reflect what is actually taking place. At home there are a range of games and crafts to take part in and residents also enjoy cooking sessions and a movie evening. Staff said that residents also enjoy trips to their local pub, but again the records did not support this. Residents’ relatives are welcome to visit at any time. Residents said they enjoy the food and the menu indicates a balanced and nutritious diet. It remains a recommendation that the Manager attend some training in nutrition to help plan the menus. Menus records are not kept consistently. Larchwood Grove H56-H06 S23972 Larchwood Grove V247416 010905 stage 4.doc Version 1.40 Page 11 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 Residents are supported with their personal care in the way they prefer. EVIDENCE: Residents’ personal care needs are detailed in their care plan for staff to follow. All personal care is carried out in private by staff who are trained in how to support the individual, however some manual handling training updates are required for staff. Staff are providing passive movements to one resident based on advice from a physiotherapist, however this programme has not been reviewed for a number of years and requires further input from the physiotherapy team to ensure the needs of the resident are being met appropriately. It is recommended that an alternative option to a baby monitor be sought to ensure the privacy of the resident when other residents are around. Larchwood Grove H56-H06 S23972 Larchwood Grove V247416 010905 stage 4.doc Version 1.40 Page 12 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23 Residents are protected for abuse, neglect and self-harm. EVIDENCE: Since the last inspection a number of staff have undertaken training in the Protection of Vulnerable Adults. Staff spoken with were able to describe the whistle blowing policies. Larchwood Grove H56-H06 S23972 Larchwood Grove V247416 010905 stage 4.doc Version 1.40 Page 13 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27, 28, 29, 30 Residents live in a clean and safe home. They would benefit from refurbishment of some areas of the home and the replacement of carpets. Residents are at some risk from cross infection due to access to the laundry being through the kitchen. EVIDENCE: Residents have their own bedrooms with the exception of one double bedroom that is shared by residents using the home for a period of respite. It must be recorded in the care plan that the residents using this room have agreed to share. Residents’ bedrooms reflect their personal choices and are personalised with their belongings. Some bedrooms and the dining room require replacement of carpets as they are badly stained. One bedroom requires bedside lighting. There are sufficient bathroom facilities in the home although some bathrooms would benefit from refurbishment and the upstairs toilet did not have any hot water. Some mobility aids in the bathrooms require replacement and the Manager stated that this was already in hand for the shower chair. The bath seat in a resident’s en-suite also needs replacing. There is a large lounge that
Larchwood Grove H56-H06 S23972 Larchwood Grove V247416 010905 stage 4.doc Version 1.40 Page 14 leads on to the garden. Since the last inspection garden furniture has been made available for residents use. It remains a concern that the laundry room is accessed through the kitchen, although arrangements have been made by the Manager to carry the laundry around the outside of the building. The Manager stated that building works are due to begin at the home at the end of September 2005. The external woodwork of the building also requires repainting. The garage has a serious water leak and has been condemned for use as an activity room, as it was previously used. This is due to be demolished as part of the building works. Larchwood Grove H56-H06 S23972 Larchwood Grove V247416 010905 stage 4.doc Version 1.40 Page 15 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35, 36 Residents are at some risk due to staff not receiving essential health and safety training. Residents are supported by sufficient numbers of staff that are familiar with their needs and are well supervised. EVIDENCE: Since the last inspection more staff have been recruited and the Manager stated that there are always 3 staff on duty during the day. This was evident at the time of the inspection. Staff have undertaken further training since the last visit including POVA and managing swallowing difficulties. There are still some staff without manual handling training and it was of concern that the 2 night workers have still not received training in 1st Aid or Food Hygiene. Some staff are working in the kitchen without Food Hygiene training. The manager stated they had received an in-house induction to the kitchen but records of this were not available. It was not possible to inspect staff files at this time, as they were not accessible. The Manager stated that these would be available at the next inspection. Staff spoken with confirmed that they have received supervision sessions and the Manager stated that these had begun for all staff. Larchwood Grove H56-H06 S23972 Larchwood Grove V247416 010905 stage 4.doc Version 1.40 Page 16 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39, 42 Residents are supported by a Manager who has a clear understanding of their needs. They benefit from a reasonably well run home, but are not yet consulted on their views. There are some health and safety risks to residents at Larchwood. EVIDENCE: The Manager who has been working at the home for a number of years, has been in post as the Manager since June 2005 and has applied for registration with CSCI. She has begun work toward the Registered Managers Award so far completing 2 units. There is not yet a system for reviewing the quality of the service at the home and obtaining the views of the residents. This was discussed with the Manager who is planning to address this as part of the RMA. Some water temperatures throughout the home were high and it was advised that these be checked and serviced by the handyman to reduce the risks of scalding to residents. The need to risk assess redundant water outlets (the upstairs shower) regarding Legionnaires disease was discussed. Some
Larchwood Grove H56-H06 S23972 Larchwood Grove V247416 010905 stage 4.doc Version 1.40 Page 17 containers of food in the fridge had been opened and not dated so staff were unable to tell how long it had been in there. As discussed under standard 35 not all staff have received training in essential areas of health and safety, particularly fire and 1st Aid. The Manager must address this urgently. It is recommended that the fire procedure be displayed in symbol format in the home for residents to understand. Larchwood Grove H56-H06 S23972 Larchwood Grove V247416 010905 stage 4.doc Version 1.40 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 2 3 x x Standard No 22 23
ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 3 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 2 2 3 3 2 2 Standard No 11 12 13 14 15 16 17 x 2 3 3 3 x 2 Standard No 31 32 33 34 35 36 Score x x 3 x 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Larchwood Grove Score 2 x x x Standard No 37 38 39 40 41 42 43 Score 3 x 2 x x 1 x H56-H06 S23972 Larchwood Grove V247416 010905 stage 4.doc Version 1.40 Page 19 YES 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 YA24 Regulation 23(2)(bd) Requirement The Registered person shall ensure that the premises are kept in a good state of repair. In that, the bathrooms must be well maintained, the outside woodwork of the building requires painting and some carpets need replacement. The garage must also be repaired or demolished. This requirement has not been met following the last inspection. 2. YA39 24(1) The Registered person shall develop a system for reviewing the quality of the service. This requirement has not been met following the last inspection. 3. YA35 YA42 13(4)(5) 23(4)(d) 16(2j) The registered person shall make arrangements for staff training. In particular relation to Moving and Handling, fire safety, food hygiene and 1st Aid. This requirement has not been met following the last inspection.
Larchwood Grove H56-H06 S23972 Larchwood Grove V247416 010905 stage 4.doc Version 1.40 Page 20 Timescale for action Action plan to be submitted to CSCI by 30/10/05 Action plan to be submitted to CSCI by 30/10/05 Action plan to be submitted to CSCI by 30/10/05 4. YA6 15((2b) The registered person shall keep the service users plan under review. The registered person shall, having regard for the number and needs of the service users, ensure that equipment ia maintained in good working order. In that the bathrooms aids must be reviewed and replaced following occupational therapy advice. The registered person shall ensure that uneccessary risks to the health and safety of service users are identified and, as far as possible, eliminated. In that, water temperatures must be regulated and checked according to HSE guidance. The redundant shower must not present a risk of legionella. All food opened and stored in the fridge must be dated. 5. YA29 23(2c) Action plan to be submitted to CSCI by 30/10/05 Action plan to be submitted to CSCI by 30/10/05 6. YA42 13(4c) Action plan to be submitted to CSCI by 30/10/05 7. YA17 17(2) The registered person shall maintain in the care home the records specified in schedule 4. In that, records of all food provided must be maintained in sufficient detail to evidence a balanced diet. The registered person shall make suitable arrangements to prevent infection, and the spread of infection at the care home. In that, the laundry must be resited to avoid access via the kitchen. Action plan to be submitted to CSCI by 30/10/05 8. YA30 13(3) Action plan to be submitted to CSCI by 30/10/05 Larchwood Grove H56-H06 S23972 Larchwood Grove V247416 010905 stage 4.doc Version 1.40 Page 21 9. 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 YA6 Good Practice Recommendations It is recommended that residents or their representatives sign to agree the care plan. This remains a recommendation from the last inspection. 2. YA35 It is recommended that staff undertake training in nutrition. This remains a recommendation from the last inspection. 3. 4. 5. 6. YA2 YA25 YA12 YA18 The Manager should ensure the assessments cover the items listed under standard 2. The Manager must evidence that residents occupying the double bedroom have both agreed to do so. It is recommended that records of all activities residents participate in are maintained to enable monitoring. It is recommended that the physio programme be reviewed by a qualified physiotherapist. It is also recommended that an alternative to the baby monitor be sought to maintain residents privacy. It is recommended that the fire procedure be displayed in symbol format for residents. Bedside lighting should be provided for all residents. 7. 8. YA42 YA26 Larchwood Grove H56-H06 S23972 Larchwood Grove V247416 010905 stage 4.doc Version 1.40 Page 22 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
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