Inspection on 11/04/07 for Larchwood Nursing & Residential Home

This inspection was carried out on 11th April 2007.

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 Nursing & Residential... 30/10/08

Larchwood Nursing & Residential... 17/10/07

Larchwood Nursing & Residential... 04/09/06

Larchwood Nursing & Residential... 02/05/06

Larchwood Nursing & Residential... 07/09/05

Larchwood Nursing & Residential... 14/04/05

Larchwood Nursing & Residential... 10/11/04

Larchwood Nursing & Residential... 20/04/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Larchwood Nursing & Residential Home 133 Yarmouth Road Thorpe St. Andrew Norwich Norfolk NR7 0RF Lead Inspector Hilary Shephard Key Unannounced 11th April 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Larchwood Nursing & Residential Home DS0000015652.V335941.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Larchwood Nursing & Residential Home DS0000015652.V335941.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Larchwood Nursing & Residential Home Address 133 Yarmouth Road Thorpe St. Andrew Norwich Norfolk NR7 0RF 01603 437358 01603 702046 larchwood@bondcare.co.uk 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) Bondcare (Larchwood) Limited Position Vacant Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48), Physical disability (48) of places Larchwood Nursing & Residential Home DS0000015652.V335941.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Up to forty-eight (48) Older People may be accommodated in the category OP. Up to forty-eight (48) Service Users who have a physical disability may be accommodated in the category PD, who are aged 55 years or over. No more than 48 Service Users may be accommodated. One person with dementia whose name is held on CSCI records may be accommodated. Once this person is no longer resident, the registration reverts to 48 older people. 4th September 2006 Date of last inspection Brief Description of the Service: Larchwood Nursing and Residential Home is owned by Bondcare Ltd and is situated on the outskirts of Norwich, within Thorpe St Andrew. The home lies within easy access of a large supermarket, post office and small local shops. It is a two-storey building with access to the first floor by shaft lift and stairs. The home can accommodate up to 48 older people, 25 with nursing needs and 23 with residential needs. The service has 36 single and 6 shared bedrooms. All the bedrooms have en-suite toilets and washbasins. There is an enclosed patio area with seating and with raised flowerbeds that are accessible to wheelchair users. The home has car-parking facilities at the rear of the premises. The home informed CSCI of its charges in March 2007 and charges the following for care provision: from £281 to £539.80 per week. Residents are expected to pay extra for hairdressing, chiropody, newspapers and personal items. Larchwood Nursing & Residential Home DS0000015652.V335941.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Care services are judged against outcome groups which assess how well a provider delivers care outcomes for people using the service. The key inspection of this service has been carried out using information from previous inspections, information from the providers, the residents and their relatives, as well as others who work in or visit the home. This has included a recent unannounced visit to the home. This report gives a brief overview of the service and the current judgments for each outcome group. A total of 4 requirements, one of which has been repeated on 3 occasions, and 1 recommendation were made as a result of this inspection. This inspection looked at all the key standards and focussed on care outcomes for the people living in the home. A quality survey was sent to the home for them to pass on to residents and their relatives/visitors. It was disappointing that the Commission only received 2 completed questionnaires from residents and 3 from relatives. Because the Commission have had concerns about the level of care provided in the home, a meeting was held with the providers in December 2006. They submitted an improvement plan clearly detailing their plans to improve care outcomes for the people who use their service. This inspection shows considerable improvements made to their systems of working but evidence collected shows the provider is not yet delivering a consistently good standard of care. What the service does well: The majority of the staff are kind and work hard to care for the residents’ well being. Able-bodied residents are allowed to maintain an independent lifestyle. Prospective residents’ needs are assessed before admission and the information gathered is used to help plan how staff are to meet their care needs. Most residents are satisfied with the medical support they receive. Money that is held for residents in the home is managed safely. Larchwood Nursing & Residential Home DS0000015652.V335941.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Residents’ physical, emotional and social care needs are not being met very well. The Commission has serious concerns about the numbers of people with pressure sores and care staff are not using care plans to help them provide care. Some care plans do not contain enough guidance for the correct pressure area care to be given. Nutritional screening for those residents who are very dependent is not adequate and needs to be much more in depth. The knowledge of some staff regarding care of residents pressure areas is out of date and could be potentially harmful. Interaction, stimulation, occupation and activity is poor and many residents receive very little attention in this area during their days in the home. Larchwood Nursing & Residential Home DS0000015652.V335941.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Larchwood Nursing & Residential Home DS0000015652.V335941.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Larchwood Nursing & Residential Home DS0000015652.V335941.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 People who use the service experience good quality outcomes in this area. Prospective residents benefit from receiving detailed information about the home enabling an informed decision to be made about moving in. They also have a full assessment of their care needs before they move in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The visit carried out 4 September 06 found that the manager had almost completed the statement of purpose and service user guide but the December 06 visit found no changes had been made. The manager had not finished updating the service user guide and it was not available to prospective residents. The April 07 inspection found the statement of purpose and service user guide had been updated and was available. The service user guide offers prospective residents useful information about the service they would receive if they came into the home. Larchwood Nursing & Residential Home DS0000015652.V335941.R01.S.doc Version 5.2 Page 10 For people who need to have this information in a different format the information has been made available on audiotape, which is seen as good practice. Pre-admission assessments are completed for prospective residents by the manager or deputy and look at the person’s full range of care needs. The information from this assessment is then used as part of the planning for how the person’s needs are to be met. Larchwood Nursing & Residential Home DS0000015652.V335941.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use the service experience poor quality outcomes in this area. Although significant improvements have been made to care records and medication administration, residents healthcare needs are not being fully met, staff are failing to use the care plans to give care as instructed and some care plans fail to contain accurate guidance. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Some improvements have been made to planning how to care for residents’ healthcare needs since the inspection carried out in May 06. Visits made to the home in September and December 06 show considerable improvements made to care planning but information regarding residents’ emotional and social care needs was omitted. The September and December 06 visits identified that care staff had very little input into planning how to meet residents needs and were not referring to care Larchwood Nursing & Residential Home DS0000015652.V335941.R01.S.doc Version 5.2 Page 12 records as they should when undertaking residents care: indicating they may not be providing consistent care to residents according to their assessed care needs. The April 07 inspection found care records had improved since the previous inspection and contained detail about residents’ whole range of care needs, including emotional and social. Good information has also been recorded relating to residents nutritional needs except for those residents whose health is compromised. Care staff spoken with said they don’t have time to read the care records, which means that they are not carrying out the care instructions that are detailed in these records. One senior care staff stated, “We don’t have time to look at care plans and don’t really know what the care needs are, the nurse gives the instructions”. This inspection found 7 residents had pressure sores, which is a significant increase since previous inspections. The May and September 06 visits did not identify any significant issues with pressure sores and the inspection carried out in December 06 found 2 people had pressure sores. The nurse on duty at that visit indicated limited understanding of linking residents nutritional needs with their risk of developing pressure sores. The Commission has completed an audit of care records relating to the residents who have pressure sores. This audit indicates some staff are using outdated ways of trying to prevent sores developing which are known to be potentially harmful. Care planning guidance was not detailed enough for those residents identified at serious risk of developing pressure sores to receive the appropriate care. Not enough information has been recorded about these residents’ nutritional needs and the assessment tool used is too basic to ensure the appropriate care is given. The equipment provided to residents for the prevention of pressure sores may be inadequate for their level of need and in some cases has been provided too late to ensure the timely prevention of the development of sores. The April 07 inspection found the deputy manager and clinical manager had completed a survey of all residents care needs with particular emphasis on wounds and pressure sores. They updated this audit every month and had identified areas where more training for staff was required. Larchwood Nursing & Residential Home DS0000015652.V335941.R01.S.doc Version 5.2 Page 13 This visit has identified that although care records have improved, care staff are not using them to provide care to the residents and some guidance is still unclear. Medication was inspected during a further unannounced visit on 8 September 06 by the Commission’s specialist Pharmacist Inspector following up requirements made at the May 06 visit. His visit identified some improvements. However; there remained areas of significant concern regarding the administration of medication. Five incident reports received from the home since September 2006 indicate concerns regarding the practices of some registered nurses employed at the home which were unsafe and placed the health and welfare of residents at risk. Three of these errors occurred following the serving of the enforcement notice. It is understood that action has been taken by the home against these staff to prevent these errors occurring. An enforcement notice regarding medication was issued to the provider by the Commission in November 06 as inspection visits and notifications showed they had failed to ensure medication was being given safely. The pharmacy inspector completed an inspection on 5 December 2006 of compliance against the Statutory Requirement Notice issued on 7 November 2006 regarding medication. His conclusion was that evidence found during inspection demonstrates that the home has made improvements in the safe management and administration of medicines. There remained concerns regarding the homes ability to ensure medicines were available at all times. The April 07 inspection found medication was in good order. Nursing staff complete stock check audits of medicines for every resident after every medicine round to ensure they do not run out of medicines. These records showed this system was working. One nurse was observed administering medicines was seen to do this safely and properly. One medication administration record (MAR) noted many occasions where the resident was refusing to take her medicines and the records show this issue had been referred to the GP for advice. One other record showed another resident was refusing to take her medicines, particularly antibiotics. Although the appropriate recording codes were used Larchwood Nursing & Residential Home DS0000015652.V335941.R01.S.doc Version 5.2 Page 14 the MAR did not indicate any GP involvement. Care records also failed to show any referral to GP for this issue. The April 07 visit found majority of residents (33) in their rooms so it was difficult to see how staff were maintaining peoples dignity as there were few interactions seen. However, one member of staff had limited understanding about maintaining peoples dignity, but did know about respecting their privacy and spoke about giving people choices and respecting their wishes. The majority of staff were observed treating residents with respect, however, one member of senior staff was observed to ignore a resident when he spilled his drink at lunchtime. He was notably upset but the staff failed to give any reassurance or acknowledgement. The providers improvement plan submitted in December 06 states they have risk assessments for prevention of pressure sores which are completed monthly, equipment is obtained prior to admission and as required by an existing resident and a monthly pressure area audit is to commence and tissue viability advise will be obtained as required. It is clear that some of these actions are taking place, but evidence suggests that those very frail and dependent residents are not receiving the care they require. A requirement has been made regarding healthcare needs and dignity. Larchwood Nursing & Residential Home DS0000015652.V335941.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service continue to experience adequate quality outcomes in this area. People who use the service are not provided with enough stimulation and interaction to enable them to enjoy their lifestyles and staff are not very good at meeting their emotional and social needs because they are too busy and too focussed on attending to physical care tasks. The food has improved and residents are enjoying their meals more. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The visit carried out in September 06 found a lack of interaction, activity and stimulation for residents, mostly for those who stayed in their rooms, which is usually 90 of residents. The December 06 found some improvements made and staff were much better at interacting with residents and caring for their emotional and social needs. Larchwood Nursing & Residential Home DS0000015652.V335941.R01.S.doc Version 5.2 Page 16 The April 07 visit found this had deteriorated and residents were not receiving adequate stimulation, interaction and staff were not meeting their emotional or social care needs very well. Observations carried out during this visit showed the majority of residents continue to spend most, if not all their time in their rooms, very few residents were seen to be using the communal areas of the home. Residents spoken with had mixed views about the activity provision in the home. One very able-bodied person was happy and content and said he spends a lot of time in the courtyard garden, but other more disabled and dependent residents said they were often bored and the staff were OK but didn’t have time to sit and chat with them. Staff spoke of how they sit and chat with residents if they have time, but this did not happen every day, they tried to encourage residents to join in with the activities but they mainly focus on residents’ physical needs. The activity person was not very good at interacting with one of the residents who showed signs of being confused. This resident was not included in the game of bingo and was left to play with a napkin she thought was her bingo card. No effort was made by the activity person or staff to include this resident in any interaction. During the afternoon 2 care staff were seen to interact well for a short while with the residents who were sitting in one of the lounge areas. Those who could interact with staff were clearly enjoying their bingo game. The food and mealtime experience for residents had improved at the December 06 inspection. Before that, previous inspections showed the food to be badly cooked and not always enjoyed by residents. The April 07 inspection found little change to meals and the dining experience since the December 06 inspection except for the layout of the dining room. Care staff served pre-plated meals to residents from a heated trolley and when asked, none of the residents could remember what they had ordered. A menu was available on the tables but it was not referred to. Lunch was taken in silence and once care staff had served the meal all except one left the room. One staff remained to assist a resident with her lunch and another resident was left without her meal whilst others ate theirs. Larchwood Nursing & Residential Home DS0000015652.V335941.R01.S.doc Version 5.2 Page 17 The meal served looked well prepared and was nicely presented. Residents all looked like they enjoyed their lunch and one person said it was good. The activity person came in during lunch and put on some music (without asking residents if that was what they wanted) and then left the room. It would have been good practice for a member of staff to sit with residents to generate conversation and make the dining experience a pleasurable one thus turning it into a social activity. Information from provider received in March 07 indicates the cook and 2 kitchen staff have left since July 06. The provider’s improvement plan received in December 06 indicates they will make mealtimes a more social event and will present the dining areas in a more attractive layout. This is partly achieved, but mealtimes have failed to become a social event. This improvement plan also states that more residents are utilising the communal areas rather than remaining in their rooms but the provider has not offered their intentions for improving residents social care needs. The requirement made at the previous 3 visits regarding interaction and stimulation is repeated. Larchwood Nursing & Residential Home DS0000015652.V335941.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience adequate quality outcomes in this area. The home have developed policies and procedures for safeguarding residents and advise them how to complain, but because of the ongoing adult protection issues the Commission is not entirely confident the provider currently delivers good care outcomes in this area. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The September 06 visit found the complaints policy had been updated and displayed in the reception area of the home but was not yet in residents rooms and residents spoken with were unsure of who to take their concerns to. The December 06 visit found the complaints procedure has been placed in all residents’ rooms. One resident spoken with was unsure of its existence, but said she would speak to the “top girls” if there was a problem. Some residents are unable to read the complaints procedure because of their illnesses and other factors so the home must ensure all residents are enabled to raise concerns. A complaint was received by the Commission in November 06 from a relative regarding the care of a resident. The manager employed at the time failed to Larchwood Nursing & Residential Home DS0000015652.V335941.R01.S.doc Version 5.2 Page 19 manage the complaint well and failed to investigate within Bondcares policy and the complainant was not satisfied with the response. The manager resigned her position shortly after and the complaint was fully investigated by the Clinical Director. At the September 06 visit, staff said they would refer concerns to the nurse in charge, however the nurse in charge was unsure of how to manage a serious abuse issue, but said she would refer to the manager. The nurse in charge was spoken with at the December 06 visit who confirmed that the deputy had spoken with her regarding her responsibilities about safeguarding the residents and she was clear about that. She also confirmed she was attending training in that area later that month. Training for staff in safeguarding adults had been arranged following the previous inspection and the Providers improvement plan received Dec 06 indicates all care staff have received this and will receive yearly refresher training. Two referrals to the adult protection unit have been made since the previous visit and are currently being investigated by social services, the home and CSCI. At the April 07 visit, the acting manager said she was clear about her role and responsibilities regarding safeguarding residents and staff spoken with said they would recognise signs of abuse and would report any concerns to the manager or deputy. Residents spoken with said they would speak with the deputy if they had any concerns, one resident was unsure of who she would speak with and said she would be reluctant to discuss her concerns with the manager as she didn’t know her well enough. Residents confirmed they knew who the new manager was and one said she visits him every day. Comments from relatives state: “They acted on my concerns but failed to notify me.” And “I go to the manager [Karen] who always responds.” Larchwood Nursing & Residential Home DS0000015652.V335941.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use the service experience good quality outcomes in this area. Residents’ benefit from living in a home that is comfortable, homely and pleasant smelling. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The September and December 06 visits found considerable improvements made to the general décor. Many areas have been repainted and new furniture for use in the lounges and dining rooms has been bought. The duties of the cleaning staff have been changed to cover the afternoons, however the home remained dirty at the September visit, but was much improved at the December visit with the exception of the kitchen which had food debris under appliances and around the floor edges. Larchwood Nursing & Residential Home DS0000015652.V335941.R01.S.doc Version 5.2 Page 21 Offensive odours were noted at the September visit, but had improved significantly at the December visit. The small courtyard garden in the centre of the home was neglected and the December visit found work has commenced to improve this area. The December 06 visit showed a bath with a visible strip of rusting metal directly down the middle remained in use despite a requirement being made at the May 06 inspection for it to be replaced. This questions the quality monitoring the providers have been doing as it is clear this bath has been damaged for more than 6 months but continues to be used. The April 07 inspection found the home was clean, again with the exception of the kitchen. It was pleasantly decorated and free from offensive odours. Some bedrooms have been redecorated and one resident said he thought his room was very nice and was pleased with the new décor. Significant effort has been made to make the lounges and dining areas comfortable and homely. The damaged bath has been painted to cover the exposed metal and the clinical director advised a new one will be purchased. One toilet was noted not to have a lock fitted. A new maintenance person has been employed who has made significant improvements to the courtyard garden. This area has been cleaned and tidied and now offers residents a pleasant area in which to sit. One resident commented on how much nicer it looked and another enjoyed looking out at it during the day. A requirement has been made regarding the cleanliness of the kitchen. Larchwood Nursing & Residential Home DS0000015652.V335941.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 People who use the service experience adequate quality outcomes in this area. Although there are sufficient numbers of staff on duty, they are not meeting the residents’ entire range of care needs and there are not enough care staff currently qualified to NVQ 2 to ensure that residents receive good care outcomes in this area. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Observations made during the September 06 visit showed staff were busy but were attentive and answered call bells quickly. They had difficulty meeting residents social and emotional needs and residents commented that sometimes they were left wet for long periods, sometimes the staff take a while to answer the buzzer, staff are very good but take a long time to answer call bells. Observations showed care staff were kind to residents and had a good understanding of their needs. Because the two previous visits to the home identified residents were not receiving enough input from staff to meet their physical, emotional and social care needs an enforcement notice regarding staffing was issued on 18 October Larchwood Nursing & Residential Home DS0000015652.V335941.R01.S.doc Version 5.2 Page 23 2006. The provider was given a month to improve care outcomes in these areas. The December 06 inspection found sufficient staff on duty to meet the residents’ needs. A further analysis was made of the staffing levels, which found that on some occasions there were more staff on duty than required because of staff induction and on 3 occasions there were insufficient staffing levels. The Commission considered the enforcement notice regarding staffing numbers was met because evidence gathered at this visit showed improvement in the way staff were meeting the residents’ needs. The April 07 visit showed there were 33 people living in the home on the day of the inspection. Duty rosters and observations showed there were sufficient numbers of care staff on duty throughout the day, but observations showed that residents were not receiving enough stimulation or occupation and their entire rage of care needs were not being met. The nurse on duty during the September 06 visit had difficulty understanding spoken English and was unable to competently discuss appropriate use of specific wound dressings for residents although said had done a wound care course last year. This had improved at the December 06 visit because she had received training and input from the deputy manager, but she still lacked knowledge about relating nutrition to care pf pressure areas. Information received from the provider in March 07 indicates out of 17 care staff employed, 2 have NVQ2 and 12 are working towards it. This information also indicates that staff have received mandatory health and safety training and some training in basic care practice. One member of staff discussed what she had learned from this training. One new member of staff confirmed she had undergone induction training using a booklet format which one of the senior care staff had worked on with her. Residents spoken with during the April visit had mixed views about the staff. Some said they were good, some said they usually do what they ask them but sometimes they don’t. All except one member of care staff were observed to treat residents appropriately and with kindness and care. Comments received from people who completed the Commissions survey in March 07 were: “Staff don’t always listen, they chat amongst themselves” I Larchwood Nursing & Residential Home DS0000015652.V335941.R01.S.doc Version 5.2 Page 24 wish they wouldn’t hoover during mealtimes” “As the next of kin and only relative, I live far away and am not contacted or kept up to date at all by the home” The staff I encounter are always very jolly and seem to know my mothers needs.” Three comments were made about the difficulties residents and relatives experience when trying to communicate with staff whose first language is not English. The September 06 visit showed that recruitment practices had improved significantly and the April 07 visit showed this continued. There were however, errors made by allowing second references for two newly appointed staff to be made out as “to whom it may concern” references and neither of which were dated. Accepting these types of references is not good practice, as the authenticity of them cannot be guaranteed. A recommendation has been made regarding references. Larchwood Nursing & Residential Home DS0000015652.V335941.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 People who use the service experience adequate quality outcomes in this area. Residents benefit from improved quality monitoring and being more involved in the running of the home but residents receive poor outcomes in health and personal care and have lacked the benefit of stable and consistent management for a considerable amount of time. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Over the past two years, the provider has struggled to maintain consistency of competent management in the home. The current manager commenced in March 07 and has experience in managing a residential care home. Over the past year the management of the home has mainly been carried out by the Larchwood Nursing & Residential Home DS0000015652.V335941.R01.S.doc Version 5.2 Page 26 deputy with management support from clinical directors and regional managers. The September 06 visit found the previous manager working with the deputy setting up systems for induction, supervision and care planning and quality monitoring. Records of residents’ monies showed they were being managed safely and appropriately. Some safety issues were noted in the home during the September visit regarding damaged radiators and hot water temperatures that were too hot. The December 06 visit showed that radiators in the corridors had been fitted with proper covers making them safer, but some in other areas remained exposed creating a potential hazard for residents. A particular concern was noted with the radiator casing in one of the bathrooms removed leaving exposed pipes that were accessible to residents. Hot water temperatures had improved and were at a safer temperature than at the previous visit. The April 07 visit found improvements had been made to the safety of the premises. The new maintenance person confirmed he completes regular safety checks on the fire alarms and hot water temps and there were no areas of poor safety noted in the home. The April 07 visit found that the clinical manager had completed a quality audit between December 06 and February 07 in which residents and relatives were asked to complete a questionnaire. This showed that there was a good response and many positive comments were made about the home. Where negative comments were made the home had advised in a feedback report their intentions for improvement. The feedback report was made available to everyone by being displayed in the entrance of the home. The manager advised that monthly residents and relatives meetings were being held and they had so far had 2 of these and a comment from a relative states: “Larchwood holds meetings with residents and relatives. This helps to keep us informed of matters concerning the home.” Larchwood Nursing & Residential Home DS0000015652.V335941.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Larchwood Nursing & Residential Home DS0000015652.V335941.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? One 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 OP8 Regulation 12 (1, 2) 13 (4,c) Requirement Timescale for action 31/05/07 2 3 OP10 OP12 12 (4, a) 12 (1, a) 16 (2, m) 4 OP26 23 (2, d) People who use the service must receive appropriate care and treatment relating to their physical, emotional and social needs. People who use the service must 31/05/07 be treated with respect and dignity by all staff all of the time. People who use the service must 31/05/07 be provided with appropriate activities, interaction, stimulation and meaningful occupation according to their individual needs and wishes. Repeated for 3rd time. Most recent deadline of 31/03/07 not met. In order to prevent residents 31/05/07 from being at risk from ill-health due to poor hygiene practices, the kitchen must be kept clean. Larchwood Nursing & Residential Home DS0000015652.V335941.R01.S.doc Version 5.2 Page 29 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 OP29 Good Practice Recommendations References for prospective staff that cannot be authenticated should not be accepted. Larchwood Nursing & Residential Home DS0000015652.V335941.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Nursing & Residential Home DS0000015652.V335941.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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