Inspection on 11/05/06 for Larchwood Grove

This inspection was carried out on 11th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 24 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Larchwood Grove 10/06/08

Larchwood Grove 01/08/07

Larchwood Grove 13/09/06

Larchwood Grove 01/09/05

Larchwood Grove 17/08/04

Larchwood Grove 20/05/04

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Larchwood Grove 60 Parrock Road Gravesend Kent DA12 1QH Lead Inspector Jo Griffiths Unannounced Inspection 11th May 2006 10:00 Larchwood Grove DS0000023972.V294536.R01.S.doc Version 5.1 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 Larchwood Grove DS0000023972.V294536.R01.S.doc Version 5.1 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 Adults 18-65. 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 Grove DS0000023972.V294536.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Larchwood Grove Address 60 Parrock Road Gravesend Kent DA12 1QH 01474 352722 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) Larchwood Court Limited Miss Janet Aldridge Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Larchwood Grove DS0000023972.V294536.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service Users with a learning disability may also have a physical disability. 18/10/05 Date of last inspection 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 accommodation is provided over 2 floors. There is no lift access to the first floor and therefore people who use wheelchairs cannot accommodate 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 fees charged by the service range from £500 to £1660 per week depending on service users’ levels of dependency. Larchwood Grove DS0000023972.V294536.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit for this key inspection was unannounced and took place on 11th May 2006. The provider/Manager was present and 2 service users were at the home. Larchwood Grove accommodates 4 permanent service users and can provide care for a further 4 service users for periods of respite. Extensive building works are underway to increase the number of bedrooms and to provide more communal facilities. Due to the building works 3 of the permanent service users were being cared for at a caravan near the coast. This was originally booked for 3 weeks but has been extended as the works are not complete. The inspectors were concerned that the home is continuing to take service users on a respite basis whilst the work is being carried out. CSCI were originally informed by the provider that this would not be the case. The provider stated that no further respite arrangements would be made until the major building works are complete. Information was gathered in a number of ways to help the inspectors form a judgement about the service being provided at Larchwood Grove. This included telephone feedback from professionals involved in the home, information received from the provider, a site visit and discussion with staff and service users. The provider remains the registered Manager for both Larchwood Grove and another home in Kent. She has now appointed a new Manager for Larchwood Grove and intends for this person to apply to CSCI for registration. What the service does well: What has improved since the last inspection? What they could do better: Service users must be provided with up to date information about the home and a contract for their care that details any additional costs. They must have a full assessment of their needs and only if the home can meet these needs a Larchwood Grove DS0000023972.V294536.R01.S.doc Version 5.1 Page 6 place should be offered in writing. Service users should be involved in developing their care plan and this should include their needs and wishes for social activities and occupation. The care plans must be kept under review. It is recommended this be done every 6 months. There should be opportunities for service users to make choices about their meals, activities and be involved in the running of the home if they wish. It is recommended that the weekly residents meetings start again. The Manager must provide evidence that she has reviewed the quality of the service and asked service users for their views on this. Service users must be provided with a copy of the home’s complaints procedure. It is accepted that there are building works at the home, but effort must be made to ensure the home can still meet service users’ needs. The temporary kitchen must be kept clean and all food stored properly. Service users should be able to choose to have a single bedroom and they should not have to go outside to access the dining room. Medication must be stored and administered safely and staff should be trained to do this. Any money held on behalf of a service user must be properly accounted for. Risk assessments must be provided for the service users who are currently away from the home and risk assessments for the building works must be completed and available in the home. Staff must not work long hours without a break as service users could be at risk when staff are tired. The Manager must make sure that employment laws are adhered to. Training should be arranged for all staff in key areas of health and safety and any staff helping service users with medication must have proper training. Some advice was given to the Manager about what should be included on training certificates. All staff should be formally supervised. It is recommended that this be done 6 times a year. The Manager must get references from previous employers for the new Manager. An application for registration must be submitted to CSCI immediately as this requirement has been outstanding since 2002. 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 DS0000023972.V294536.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Larchwood Grove DS0000023972.V294536.R01.S.doc Version 5.1 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 the following standard(s): 1, 2, 3, 5 Quality in this outcome area is judged to be poor. Service users are not provided with the information they need about the home. Service users do not have their needs fully assessed before moving into the care home. Their needs are not being fully met by the home. EVIDENCE: Service users newly admitted to the home had their needs assessed using a document that addresses all recommended areas except communication. However, these assessments had not been completed fully. Not all service users files were seen as 3 service users were staying away from the home due to the building works. The home has a Service User Guide and Statement of Purpose that were written in 2003. These must be reviewed as the information in both documents is now out of date with regard to facilities and staff. It is recommended that copies be made available to each service user before they arrive at the home. Discussion with service users, other professionals and staff evidenced that generally service users needs are met by the home. However, it was of concern that, due to the building works to improve the home service users have had to move into a caravan. This was supposed to be for 3 weeks but was extended, as the works are not complete. This accommodation, whilst suitable for a holiday, cannot meet the needs of the service users for long Larchwood Grove DS0000023972.V294536.R01.S.doc Version 5.1 Page 9 periods of time. For example, communal space is limited and service users that usually accommodate single rooms are having to share a bedroom. Contracts outlining the care service users will receive were not seen at the visit. The Manager said that some service users had a contract with the home but they were not available for inspection. Larchwood Grove DS0000023972.V294536.R01.S.doc Version 5.1 Page 10 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 the following standard(s): 6, 7, 8, 9 Quality in this outcome area is judged to be poor. Service users do not have an up to date care plan that meets their needs. They are not involved in the running of the home and would benefit from more opportunities to make choices and decisions. Service users have not had any risks to their safety suitably assessed whilst away from the home. EVIDENCE: Each service user had a care plan in place but a number of these had not been kept under review. It was noted that the new style of care planning being used had improved. However, care plans are not easy for staff to follow, as there is a lot of out of date information stored in the files. This could mean service users needs are not properly met by staff. Service users have not been involved in drawing up their care plan and have not signed them. Service users used to have weekly meetings to agree their activities and menus and to participate in the running of the home. This was an opportunity to make choices about the things they wanted to do. There was no evidence Larchwood Grove DS0000023972.V294536.R01.S.doc Version 5.1 Page 11 that these were happening and the newly appointed Manager said that these were not regularly taking place at present. Some service users are reliant on the home to help them manage their money. The records kept are not robust and do not protect service users’ money. One service user had taken money out of the home but this was not recorded. This could lead to unaccounted for money. Service users are also being charged for mileage for use of the company minibus. There is no agreement or policy in place to outline the circumstances under which this will happen. This must be included in the contract if it is to continue and service users should not be charged for trips to health appointments. Risk assessments had been completed for service users for some areas of daily living. There were no risk assessments available for the service users who were being accommodated in the caravan. The Manager said that these had been done but was not able to produce these for inspection. Larchwood Grove DS0000023972.V294536.R01.S.doc Version 5.1 Page 12 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 the following standard(s): 11, 12, 13, 15, 16, 17 Quality in this outcome area is judged to be poor. Service users do not have their social and occupation needs adequately assessed or planned for. They are supported to maintain contact with relatives and to access their local community but this is not reflected in the care plan. Service users rights and privacy within the home are restricted at present due to building works. Service users do not have sufficient opportunity to choose their meals. EVIDENCE: The current service users are not accessing any college or higher education courses and none of the service users have chosen to seek employment. Opportunities for personal development were discussed with the Manager who said that it was planned to support one service user to follow up his interests in computers. Most service users attend a day centre whilst staying at the home. Not all service users had their social needs addressed within the care plan and where a plan of regular activities was in place the daily records did not support that these had always been offered. Larchwood Grove DS0000023972.V294536.R01.S.doc Version 5.1 Page 13 The weekly meetings that used to take place where service users could choose activities for the week had not been occurring. It was difficult to see from the care plans and records that service users had been consulted on the activities they wanted or that sufficient activities were offered to ensure service users have fulfilled lives. There was some evidence that community based activities were taking place and service users were leaving for a day trip to the coast at the time of the visit. Service users are supported to maintain contact with their relatives and friends. One service user requested to telephone her Mother and staff offered to support her with this after her trip out. Service users are not able to access all parts of the home at present due to the building works. Some respite service users are required to share a room and therefore have limited privacy. It is planned that once the building works are complete all service users will have access to single bedrooms. Staff include service users in conversations and interact in an appropriate way with them. Service users said they liked the staff and enjoyed being at the home. The Manager had updated the menus since the last inspection and these now offer a balanced diet and include plenty of choice. Advice had been sought from a dietician when planning this and assessments of service users nutritional needs have now been completed. However, records of meals eaten were not up to date and there was no evidence to support that the new menu had been properly implemented. Staff are currently choosing the menu for service users and the weekly shopping is then completed online. The weekly meetings had not been occurring to allow service users the make choices from the menu. Larchwood Grove DS0000023972.V294536.R01.S.doc Version 5.1 Page 14 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 the following standard(s): 18, 19, 20 Quality in this outcome area is judged to be adequate. Service users have their health needs identified and met by the home. Their personal care needs are being met but not kept up to date within the care plan. Service users are at risk from poor management of medication and unsafe storage. EVIDENCE: Service users said that they are happy with the support they receive. Not all service users have a single bedroom and as such their privacy is compromised. Personal care needs have been documented within the care plans, but the care plans have not been kept up to date. This could lead to service users not receiving the correct support. Service users’ healthcare needs are met and documented. Feedback from the Speech and language therapist confirmed that staff implement guidelines and programmes put in place. Service users medication is not stored safely. It is being kept in a filing cabinet within a service users bedroom. This puts the service users at risk and should medication be required in the night the service user will be disturbed. Records for medication given at the day centre were not clear. The Manager said that the day centre hold some medication for the service user. Any medication sent with the service user to the day centre must Larchwood Grove DS0000023972.V294536.R01.S.doc Version 5.1 Page 15 be clearly recorded. Medication training is now planned for staff. The medication policy is not up to date. Larchwood Grove DS0000023972.V294536.R01.S.doc Version 5.1 Page 16 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 the following standard(s): 22,23 Quality in this outcome area is judged to be poor. Service users are not provided with information on how to make a complaint or sufficient opportunities to raise their concerns. Service users are not protected from financial abuse. EVIDENCE: The home has a complaints procedure but this is not made available to service users. It has not been reviewed since 2003. Service users and relatives have not been provided with a copy. There have been no complaints recorded in the home and this may reflect that service users do not know how to make a complaint. Service users are not provided with other opportunities to raise any concerns as the weekly meetings at the home have not been occurring regularly. A complaint was received by CSCI in March 2006 and an additional visit carried out to the home. The nature of the concerns were that communal space was limited and there was no heating. It was found that communal space was temporarily reduced due to building works to improve the home. There was heating in the home, but a number of unsafe additional heaters were found to be in use. These have now been removed. Since the last main inspection an adult protection alert was raised regarding abuse of service users finances. The person involved in this allegation is no longer working at the home and the matter was passed to the police. This is the 2nd allegation of this nature within the home during 2005/2006. Despite this, and requirements made in 2005, it was still found that procedures for Larchwood Grove DS0000023972.V294536.R01.S.doc Version 5.1 Page 17 storing service users money were not robust. Most staff have been trained in the Protection of Vulnerable Adults. Larchwood Grove DS0000023972.V294536.R01.S.doc Version 5.1 Page 18 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 the following standard(s): 24, 25, 27, 28, 29, 30 Quality in this outcome area is judged to be poor. Service users are not currently living in a safe and comfortable environment due to the building works. They do not have access to sufficient private and shared space and do not have suitable facilities to use. EVIDENCE: The home is subject to extensive building works at present. It is planned to add more bedrooms and new communal facilities to the home. Whilst the work is underway there is a significant impact on the lives of the service users. 3 of the permanent residents of the home are staying in a caravan near the coast. This was originally planned as a 3-week holiday whilst the boiler was replaced, but it has been extended due to incomplete works. Service users had been away from the home for over 6 weeks. There was no evidence available at the visit to the home to confirm that this had been planned effectively. (See management section). Currently there are insufficient bedrooms for service users. The bedrooms of some of the permanent service users are being replastered. The Manager has taken in some respite service users who are required to share a room. This was discussed with the Manager as CSCI were originally informed by her that no respite service would be offered until the building works are complete. This is because their needs cannot be fully met and the home is not providing a Larchwood Grove DS0000023972.V294536.R01.S.doc Version 5.1 Page 19 comfortable environment at this time. There is a temporary kitchen/diner in a porta-cabin in the front driveway. This is not very clean, but staff are attempting to cope with this as a temporary measure. Food was stored incorrectly and not labelled in the fridge. There is no access to the garden and service users have to go outside to access the kitchen/diner. One Service user said that they did not like the noise from the building works and it was noted by the inspectors that this was very intrusive. Service users are being supported to go out during the day due to the levels of noise. Larchwood Grove DS0000023972.V294536.R01.S.doc Version 5.1 Page 20 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 Quality in this area is judged to be poor. Service users are not supported by staff that are supervised by the Manager. They do not benefit from a fully trained staff team. Service users are at risk due to the long hours staff are working. Service users are protected by recruitment procedures for care staff. EVIDENCE: Staff files were inspected and evidenced that sufficient checks were being made for care staff. However, the provider was asked to get references for the new Manager as the provider had relied on her own knowledge of the individual. Staff training has been provided in some areas, but not all staff have received training in medication, manual handling, POVA and first aid. Training certificates need to detail the areas covered in the course and the Manager must hold details of the trainer’s own qualifications. The Manager was advised to contact the trainer to request this. The Manager said that most staff had completed or registered for an NVQ. Staff were being required to work extremely long hours. Staff that were supporting the service users in the caravan at the coast were being regularly rostered to work from 2pm on Day 1 until 2pm on day 4 without a break. This is 72 hours without a break as staff are required to sleep over. The safety implications of this were discussed with the Manager and she confirmed she Larchwood Grove DS0000023972.V294536.R01.S.doc Version 5.1 Page 21 would cease this practice immediately. The Manager was advised to refer to the Working Time Regulations. Staff supervision has not been taking place. There were no records available to support that care staff were being regularly supervised and supported on an individual basis but some staff meetings had taken place. These had been mainly used to discuss the support needs of service users. Larchwood Grove DS0000023972.V294536.R01.S.doc Version 5.1 Page 22 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 42 Quality in this area is judged to be poor. Service users do not benefit from a well run home. They are not supported by a Manager who can provide sufficient time to the home to manage effectively. Service users are at risk from some poor procedures and have not had risks to their safety assessed and minimised. EVIDENCE: The Manager was not able to evidence that careful planning had been used to arrange suitable accommodation for service users whilst the building works were underway. The Manager said that risk assessments had been completed but these were not available for inspection. Care Managers and CSCI had not been informed of the extended stay away from the home for service users and there was no evidence of consultation with service users around this. Staff resources are being poorly managed putting service users at risk. It has been a requirement since 2002 that the registered Manager/provider must appoint a new Manager to the home as she cannot continue to be Larchwood Grove DS0000023972.V294536.R01.S.doc Version 5.1 Page 23 registered for both Larchwood Grove and another home in Kent. 2 managers were recruited in 2004/05 but neither were in post very long as the were found to be unsuitable for the role. A new Manager has been appointed and has been in post for 5 months. CSCI have not received an application for registration and the provider has not taken up suitable references for the new Manager. It is the responsibility of the provider to properly assess the quality of candidates and recruit suitable people to work at the home. The provider has a social work qualification and stated that she had just finished the Registered Managers Award (RMA). A copy of the certificate should be sent to CSCI once received. The new Manager has just begun the RMA. The registered Manager has not attended any other training updates recently. Feedback from relatives and other professionals confirms that the continued practice of the provider directly managing both the homes has an impact on the quality of the service. The provider is not able to spend sufficient time in both homes to enable her to manage effectively. An application to register a suitable Manager for Larchwood Grove must be received. Policies are available within the home but the majority of these have not been reviewed since they were written in 2003. Policies are not made available to service users. The Manager was not able to produce certificates to evidence that safety checks have been made within the home or that mobility equipment had been serviced. Records of fire alarm testing were seen. Risk assessments have not been completed within the home for the building works and the temporary kitchen/diner is not hygienic. Some windows on the first floor have not been fitted with safety restrictors. The Manager said that a quality assurance exercise had been carried out but evidence of this could not be produced. The Manager must ensure that systems are in place to monitor practices in the home. Particular consideration must be given to auditing medication and finances as these systems were identified as needing to be more robust. A copy of the recent quality assurance exercise must be sent to CSCI. This must include the views of service users. Larchwood Grove DS0000023972.V294536.R01.S.doc Version 5.1 Page 24 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 Standard No Score 1 1 2 2 3 1 4 x 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 1 ENVIRONMENT Standard No Score 24 1 25 1 26 x 27 3 28 2 29 3 30 2 STAFFING Standard No Score 31 x 32 3 33 1 34 2 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 1 2 1 x LIFESTYLES Standard No Score 11 3 12 2 13 3 14 x 15 3 16 2 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 x 1 1 1 2 x 2 x Larchwood Grove DS0000023972.V294536.R01.S.doc Version 5.1 Page 25 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 YA39 Regulation 24(1) Requirement The Registered person shall develop a system for reviewing the quality of the service. This requirement has not been met since made at the inspection on 29/09/03. 2 YA35 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 fully met since made at the inspection on 04/11/02. Some staff still require training or updates. 3 YA6 15((2b) The registered person shall keep the service users plan under review. 31/05/06 26/05/06 Timescale for action 26/05/06 Larchwood Grove DS0000023972.V294536.R01.S.doc Version 5.1 Page 26 This has not been met following the last inspection. 4 YA42 13(4c) 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, All food opened and stored in the fridge must be dated. This was not met following the last inspection. 5 YA17 17(2) schedule 4 (13) 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. This was not met following the last inspection. 6 YA1 5(2) and 6 The registered person shall keep under review and, where appropriate, revise the statement of purpose and the service user’s guide and notify the Commission and service users of any such revision within 28 days. In that the Service User Guide and Statement of Purpose must be Larchwood Grove DS0000023972.V294536.R01.S.doc Version 5.1 Page 27 26/05/06 26/05/06 02/06/06 reviewed. The Service User Guide must be provided to service users. 7 YA2 14(1acd) The registered person shall not provide accommodation to a service user at the care home unless, so far as it shall have been practicable to do so, (a) the needs of the service user have been assessed by a suitably qualified or suitably trained person; (c) there has been appropriate consultation regarding the assessment with the service user or a representative of the service user; (d) the registered person has confirmed in writing to the service user that having regard to the assessment the care home is suitable for the purpose of meeting the service user’s needs in respect of his health and welfare. In that, all service users must have a full assessment of their needs. They must be involved in the assessment and informed in writing of the outcome. Assessments should include communication needs. 8 YA24 23(2a) The registered person shall having regard to the number and needs of the service users ensure that DS0000023972.V294536.R01.S.doc 26/05/06 19/05/06 Larchwood Grove Version 5.1 Page 28 the physical design and layout of the premises to be used as the care home meet the needs of the service users. In that, service users must only be admitted to the home, whether for respite or a permanent placement, if the environment is suitable to their needs. The Manager must evidence that the environment meets the needs of the service users at present due to the building works. 9 YA5 5(1c) The registered person shall produce a written guide to the care home which shall include a standard form of contract for the provision of services and facilities by the registered provider to service users. In that all service users must be provided with a copy of the contract for their care in the home. 10 YA23 The registered person shall make arrangements, 17(2) schedule 4, 8 by training staff or by and 9(a) other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. In that, service users money must be safeguarded and robust systems for recording any money deposited with the Larchwood Grove DS0000023972.V294536.R01.S.doc Version 5.1 Page 29 02/06/06 13(6) 26/05/06 home must be put in place. Any charges made to service users for use of vehicles must be agreed in the contract and accurate records kept of the payments made. 11 YA9 13(4b) The registered person shall ensure that any activities in which service users participate are so far as reasonably practicable free from avoidable risks. In that, a copy of the risk assessments for the service users staying at the caravan must be forwarded to CSCI and a copy retained in the home. 12 YA12 16(2n) The registered person shall having regard to the size of the care home and the number and needs of service users consult service users about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation including, having regard to the needs of service users, activities in relation to recreation, fitness and training. In that, service users must be consulted on their social needs and these planned for in the care plan. Records must reflect actual activities taking place. Larchwood Grove DS0000023972.V294536.R01.S.doc Version 5.1 Page 30 26/05/06 02/06/06 13 YA25 12(4a) 23(2f) The registered person shall make suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users. In that, service users should be offered the use of single bedrooms. 01/07/06 14 YA17 12(2) The registered person shall so far as practicable enable service users to make decisions with respect to the care they are to receive and their health and welfare. In that, the Manager must evidence that service users are supported to make choices from the menu. 26/05/06 15 YA20 13(2) The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. In that, medicines must be stored and administered safely. Suitable arrangements for medication given at day centres must be made. All staff that administer medication require a competency based training course. The medicine policy must be reviewed. 12/05/06 Larchwood Grove DS0000023972.V294536.R01.S.doc Version 5.1 Page 31 16 YA22 22(5) The registered person 12/05/06 shall supply a written copy of the complaints procedure to every service user and to any person acting on behalf of a service user if that person so requests. The registered person shall having regard to the number and needs of the service users ensure that there is adequate sitting, recreational and dining space provided separately from the service user’s private accommodation. In that suitable and clean dining space must be provided for service users and they should not be required to walk outside to access it. 02/06/06 17 YA28 23(2g) 18 YA30 23(2d) 16(2j) The registered person shall having regard to the number and needs of the service users ensure that all parts of the care home are kept clean and reasonably decorated. In that, the temporary kitchen must be kept clean and hygienic. 17/05/06 19 YA33 12(1a) 18(1a) 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 service users. In that, staff must not work excessive hours 12/05/06 Larchwood Grove DS0000023972.V294536.R01.S.doc Version 5.1 Page 32 without a proper break as they may put service users at risk when they are tired. The Manager must adhere to relevant employment legislation including the working time regulations. 20 YA34 19(1b) The registered person shall not employ a person to work at the care home unless subject to paragraphs (6), (8) and (9), he has obtained in respect of that person the information and documents specified in paragraphs 1 to 9 of Schedule 2. In that, proper references must be taken up by the provider in respect of the new Manager. 21 YA35 18(1c(i)) 01/07/06 The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform including structured induction training. In that, the manager must obtain evidence of the qualifications of any trainer who will be training care staff. Training certificates Larchwood Grove DS0000023972.V294536.R01.S.doc Version 5.1 Page 33 26/05/06 should be signed and detail what was covered by the course and whether any tests or exams were passed. 22 YA36 18(2) The registered person shall ensure that persons working at the care home are appropriately supervised. In that staff must be supervised and records of supervision kept. 23 YA37 8(1b(iii)) The registered provider 17/05/06 shall appoint an individual to manage the care home where the registered provider is not, or does not intend to be, in fulltime day to day charge of the care home. In that, an application for registration must be submitted for a suitable Manager. This requirement has been ongoing since 04/11/02. The provider has appointed 2 previous managers but both were dismissed before they could be registered. 24 YA42 13(4a) The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. In that, risk assessments Larchwood Grove DS0000023972.V294536.R01.S.doc Version 5.1 Page 34 31/05/06 02/06/06 for the environment must be reviewed. Windows on the first floor should be assessed and if required have safety restrictors fitted. 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 YA7 Good Practice Recommendations It is recommended that service users meetings be reintroduced as an opportunity for service users to make choices about the menus and activities. It would also give service users a way of raising any concerns about the service and sharing their views. It is recommended that all policies for the home be reviewed. 2 YA40 Larchwood Grove DS0000023972.V294536.R01.S.doc Version 5.1 Page 35 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 Larchwood Grove DS0000023972.V294536.R01.S.doc Version 5.1 Page 36 - 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!