Inspection on 02/05/06 for Larchwood Nursing & Residential Home

This inspection was carried out on 2nd May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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... 11/04/07

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

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 2nd May 2006 Key Visit 09:20 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.V293788.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 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.V293788.R01.S.doc Version 5.1 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 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 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.V293788.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 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. 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 May 2006 and charges the following for care provision: from £338 to £525 per week. Residents are expected to pay extra for hairdressing, chiropody and personal items. Larchwood Nursing & Residential Home DS0000015652.V293788.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 8 ¾ hours and was conducted by three inspectors, including the Commissions Specialist Pharmacist Inspector. During the inspection, Inspectors spoke with residents and staff. Twenty completed questionnaires were received from residents. The views of residents and staff, where appropriate, are reflected in the findings in the report. A tour was made of the building including some of the bedrooms, and the inspectors also looked at care plans, staff files and safety records. At the end of the inspection feedback was given to the Manager and the Regional Manager. A total of 19 requirements were made as a result of this inspection, 3 of which are repeated from the previous inspection. The Commission continues to have serious concerns about the home being able to sustain any kind of improvement as this inspection shows the registered owners have not been consistent with making any significant improvements. Enforcement action will now be commenced to bring about improvement, or if this is not achieved, to cancel the home’s registration. Since this report was written, the Commission have met with Directors and Managers from Bondcare to discuss the homes future. Bondacre have advised the Commission that they are committed to making improvements to the home and have started to put measures in place to address all the issues raised at the visit of 2nd May 2006. Bondcare also advised that the manager had resigned his post, therefore one requirement regarding the homes management has been altered and one has been withdrawn. Timescales for requirements relating to the manager, quality audit and risk assessments have been extended. What the service does well: What has improved since the last inspection? Larchwood Nursing & Residential Home DS0000015652.V293788.R01.S.doc Version 5.1 Page 6 The manager has undertaken a survey with residents looking at the quality of the service provided. A deputy manager has been appointed and although is being rostered as one of the nurses in charge she has begun updating and improving the care plans. The Commission has received fewer complaints about the service, however, this has not completely ceased. The home has recently appointed a second maintenance person who has redecorated some bedrooms and one of the lounges. The manager has produced a list of training the care staff have had, which included some training sessions in basic care practice. What they could do better: The homes service user guide is out of date and too brief to provide residents with enough information for them to make a choice about living in the home. Although the deputy manager has been updating the care plans, not all residents have a care plan and not all care plans have been updated. Staff and residents are not involved with the care plans and staff do not refer to them to ensure they are providing the right care to the residents. Care plans fail to address the residents social and emotional needs and residents were not being properly assessed for the safe use of bedrails. Residents had mixed views about staff treating them with dignity and respect. Medication practices remain poor and have not significantly improved since the previous CSCI medication inspection in November 2005. The Pharmacist Inspector has written a separate report, which is available from the Commission on request. There are not enough staff on duty to provide residents with stimulation, interaction and meaningful occupation. Not much interaction was observed during the inspection and the homes culture is one where residents spend a lot of time in their rooms. There was evidence to suggest that staff had been too busy that morning to assist residents with their drinks. The home has a designated activities co-ordinator who works part time and usually sees selected residents on a group basis. The food is not very good, the Inspectors sampled the lunch on the day of the inspection and found it to be badly cooked and poorly presented. The residents did not enjoy it and some expressed their dissatisfaction with the quality of food provided. Larchwood Nursing & Residential Home DS0000015652.V293788.R01.S.doc Version 5.1 Page 7 Residents are not given enough choice about the food provided. The menu does not offer a choice of main meal. The homes complaints procedure was out of date and not all residents were aware of its existence. Staff expressed difficulties reporting concerns to the manager and regional manager saying they were not listened to and their concerns were not acted upon. The premises were dirty and poorly maintained throughout with bad odours in some areas. Despite the manager saying at the previous inspection that he was to audit the premises, the standard of cleanliness has not improved. Furniture was tatty and in need of replacement. The enamel on one bath had worn to such an extent that a strip of rust was visible. There is no planned maintenance programme for replacement of worn items, repair or redecoration of the home. The call bell remains noisy and intrusive and staff took a long time to answer calls. Staff have not been given opportunities to undertake NVQ training therefore none of the staff have achieved this qualification. New staff have not received induction training and there was no evidence on their files to suggest this had been arranged or had taken place. The home is failing to follow safe recruitment practices and is allowing staff to start working in the home without having completed proper checks. The manager has not yet set up systems for supervising and appraising care staff, induction training is not in place and he has only just completed a quality survey. Residents said they see very little of the manager and one resident had not seen him at all during his stay in the home. The manager had knowingly admitted a resident outside the homes category of registration. The responsibilities of the deputy manager need to be made clear as it is not possible for her to undertake nursing duties in conjunction with the duties expected of her as deputy manager. Please contact the provider for advice of actions taken in response to this inspection. Larchwood Nursing & Residential Home DS0000015652.V293788.R01.S.doc Version 5.1 Page 8 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Larchwood Nursing & Residential Home DS0000015652.V293788.R01.S.doc Version 5.1 Page 9 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.V293788.R01.S.doc Version 5.1 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 3 The quality of this outcome group is adequate, however it is poor in some areas. Pre-admission information is poor and does not asisst residents in making an informed choice about the home. Residents needs are assessed before admission by the manager using a basic format. EVIDENCE: The manager visits residents before admission and completes a basic assessment of care needs, which is kept in the residents care plan. Residents are provided with brief information about the home before admission, but the document omits essential information needed to help potential residents make a choice about living in the home. This Service Users Guide is out of date and does not include all the information as required by the standard or regulation. A requirement has been made about the homes Statement of Purpose and Service Users Guide. Larchwood Nursing & Residential Home DS0000015652.V293788.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Not all residents have a plan of care, and not all of their needs have been assessed. Guidelines for social and emotional needs are poor and do not provide enough information for these needs to be met. Not all residents feel they are treated with respect. Medication administration and management remains poor. EVIDENCE: Care plans were inspected and the deputy manager has been in the process of updating them since January 2006. Most of the care plans contained good assessments and guidelines for staff enabling them to address the residents physical care needs. Care plans did not contain sufficient detail about residents’ emotional and social needs for these needs to be properly met. Risk assessments for use of bedrails are inconsistent and do not always properly assess risks to the residents. Larchwood Nursing & Residential Home DS0000015652.V293788.R01.S.doc Version 5.1 Page 12 One resident had been admitted to the home in July but did not have a completed care plan. This person has significant care needs, which have not been assessed, and are therefore not being addressed. This person also has dementia and the home is not registered to care for people with dementia. Staff have very little involvement in the care plans and it was clear from discussions with staff that the care plans are not being used to help them meet the residents identified needs. There was no evidence that residents are involved with their care plans, those spoken with were not aware there was information being recorded about them. Residents said they were satisfied with the medical care they received from their GP and said they could see their GP when they needed to. Residents views were mixed about the staffs intervention, some said the staff were good at helping them and some said they had to wait a long time for staff assistance. Some residents said staff treated them with respect and some said they did not. Comment cards received from residents indicated they were satisfied with the care and the staff but on discussion it was clear their views were different. The interactions seen between residents and staff were so brief it was not possible to observe them being treated with respect. Medication was inspected by the Commissions specialist Pharmacist Inspector who found little evidence of any significant improvement in administration and management of medication. Several further requirements and recommendations were made as a result of his inspection. A copy of the separate Pharmacy Report has been submitted to the provider and is available on request. Requirements have been made regarding care plans, medication, risk assessments and privacy and dignity. Larchwood Nursing & Residential Home DS0000015652.V293788.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Residents are not provided with enough stimulation, interaction or occupation, food is poorly cooked and presented and residents are not enabled to make choices about their lifestyles. EVIDENCE: Residents were spoken with who said they spent most if not all of their time in their rooms. During the inspection there were very few residents seen in the lounges or dining areas. Out of twenty completed comment cards from residents, four said they were not satisfied with the activities provided, four said they were satisfied sometimes and ten said they were satisfied. When spoken with residents said there was not much to do although the home has an activities co-ordinator. Larchwood Nursing & Residential Home DS0000015652.V293788.R01.S.doc Version 5.1 Page 14 The activities co-ordinator works three afternoons per week and was observed instructing care staff to bring named residents into the dining area. A small group of residents then enjoyed taking part in a quiz, after this, the activities co-ordinator sat with two of these residents for the remainder of her shift. There was very little evidence of interaction with the residents who remained in their bedrooms apart from care staff carrying out personal care tasks. Staff said they had little time to spend talking to the residents. One resident told inspectors that he likes to go to the local shops on his own and goes out at weekends with his daughter. Residents said they got up when the care staff helped them, they had a bath once a week and the routine was the same every day. Residents said they chose what time they went to bed. Residents said they had not been consulted about their interests or asked their opinion of the service provided. There was no evidence of a choice of meal and residents had mixed views about the food, most saying it was not very good. The inspectors joined residents for lunch and found that the meal was badly cooked and poorly presented and clearly not enjoyed by the residents who left most of it. The residents who did not eat much of the lunch were not offered an alternative. Some staff were aware of the residents food likes and dislikes and some clearly were not, giving residents food they had previously expressed a dislike for. There was little evidence of any fresh fruit or vegetables being offered, although the manager said they were provided. There were plenty of frozen and tinned vegetables available. Requirements have been made regarding interaction and food. Larchwood Nursing & Residential Home DS0000015652.V293788.R01.S.doc Version 5.1 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The home has an incorrect complaints procedure and not all residents are aware of who to go to with their concerns. Residents are not protected from harm because although staff understand about reporting issues they are not confident enough to report any. EVIDENCE: The home has a complaints procedure, included in the Service Users Guide but it was out of date and incorrect. Residents said they would discuss their concerns with the staff or the deputy manager, however one resident said she did not know who to complain to and did not have any information about how to make a complaint. One resident said they had been in the home for 5 months and had not seen or spoken with the manager. Staff said they were not confident their concerns would be listened to or acted on and gave examples of reporting a serious issue they said had been ignored. Staff said they felt intimidated by the manager and the regional manager and were not comfortable about discussing issues with them. Some staff have received training in the protection of vulnerable adults. Requirements have been made regarding complaints and adult protection. Larchwood Nursing & Residential Home DS0000015652.V293788.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Residents are living in a home that is dirty, shabby and poorly maintained. EVIDENCE: The home was very dirty and although there were three cleaners on duty, the home remained dirty throughout the time they were on shift. On the day of the inspection there were contract cleaning staff in the home. The regional manager advised that this was because they had ongoing issues with the cleanliness of the home, which they were trying to address. It should be noted that prior to the previous inspection (undertaken September 2005) the manager said the home had undergone a thorough clean by contract cleaners. The manager had said then that regular audits were to take place of the premises. Larchwood Nursing & Residential Home DS0000015652.V293788.R01.S.doc Version 5.1 Page 17 There is no evidence to support this has been done and it is clear that the standard of cleanliness in the home has not improved. There were offensive odours in the corridor outside room 16. Many comments received by residents state the home is in need of proper cleaning. The home looked shabby and poorly maintained and there is no formal plan of refurbishment, redecoration or maintenance although the manager informed Inspectors there was one. The owners have recently employed someone to redecorate and the areas painted so far look much better. Furniture throughout the home was stained and very worn looking and the regional manager advised that there were plans to replace six armchairs and some others in the future. Care staff were observed using a wheelchair with badly damaged wheel and Inspectors asked the manager to remove it. The enamel on the bath in bathroom 5 had worn away to the extent that a strip of rusting metal was visible along the bottom and the baths surface was extremely rough. When Inspectors discussed this with the regional manager he said he would have it repainted. The ground floor shower room is not easily accessible to residents with reduced mobility, as they have to step into it, which reduces their ability to choose their preferred way of bathing. The previous inspection identified the call bell system to be very loud and intrusive and required the registered provider to replace it. They have not replaced the system, however, the manager stated the volume has been decreased. The call system remains loud and intrusive. Requirements have been made regarding cleanliness, maintenance, furniture renewal and repeated regarding the call system. Larchwood Nursing & Residential Home DS0000015652.V293788.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Residents emotional and social needs are not being met because staffing levels are too low and residents care is compromised because staff have not received adequate induction or training. By failing to follow proper recruitment practices, the home is not protecting residents from harm. EVIDENCE: There were 6 care staff and one nurse on duty in the morning and 4 plus one nurse in the afternoon of the inspection. The inspectors saw lots of undrunk cups of tea and juice in residents’ bedrooms during the morning indicating staff had not assisted residents with drinks. Residents physical care needs were mostly addressed except for being given drinks, but their emotional and social care needs were not being met as care staff said they did not have enough time to spend with the residents. There were adequate numbers of cleaning staff employed during the week, but they only work mornings and this number reduces to one at the weekends and bank holidays. The level of cleaning they have done has been ineffectual. Larchwood Nursing & Residential Home DS0000015652.V293788.R01.S.doc Version 5.1 Page 19 The manager supplied a dependency levels assessment he had completed in November 2005 to judge the numbers of staff required and at that time he felt the staffing levels were adequate. This has not been updated which makes it difficult for the manager to accurately assess residents dependencies and provide the correct numbers of care staff to meet their needs. None of the staff have had any NVQ training and the deputy manager hopes to provide some training to care staff when she is given time to do this. Staff files were inspected and showed that two staff had no references, one staff had commenced before receipt of POVA first, one reference from a staffs previous employer had been supplied by the member of staff and one member of staff had commenced before the home was in receipt of both references. There was no record of staffs induction and staff said there was no proper formal induction. The manager has produced a training matrix, which indicates some staff have received training in basic care practices. Requirements have been made regarding training, induction, staffing levels and recruitment practices. Larchwood Nursing & Residential Home DS0000015652.V293788.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The manager has not made significant improvements to the service during his employ. Residents safety and well-being is compromised by a poor environment. The home has a good quality survey tool. Larchwood Nursing & Residential Home DS0000015652.V293788.R01.S.doc Version 5.1 Page 21 EVIDENCE: The manager has been employed at the home since May 2005, however he has not yet applied to become registered with the Commission. The manager has since resigned his post and has left the home. The manager advised that he had wanted to focus on care provision in the home and this had delayed his application, however there is a lack of evidence to support this. Despite being in the home for a year, the manager has failed to set up induction, supervision and appraisal systems, and failed to implement a process for updating and improving care plans until the deputy manager commenced in January 2006. Recruitment practices are poor and the premises remain dirty and in a poor state of repair. The manager has knowingly admitted a resident with dementia who is outside the homes category of registration. The manager said that a recent quality survey had been undertaken, indicating he had not set this up soon after commencement. The manager appointed a deputy manager in January 2006 but the roster indicates she is performing the duties of a nurse rather than deputy manager and the manager confirmed that this is standard practice throughout the company. The manager has not allocated any time for her to set up training and supervision sessions for staff nor for updating and improving the care plans which she is currently doing in her own time. The regional manager said the deputy manager would provide cover for the manager in his absence and would not be required to perform nurse duties at the same time. This was not the case at the start of the inspection when the manager was away from the home and the deputy manager was undertaking nursing duties. Access to policies and procedures is made via the manager and staff felt unable to approach him about accessing them. The manager and regional manager were reluctant to make these available in the staff room, however, they said they would think about providing copies. A recent quality survey has been completed and the manager plans to compile feedback with the deputy manager and quality manager within the company. The survey they have used is good and has been well thought out. Larchwood Nursing & Residential Home DS0000015652.V293788.R01.S.doc Version 5.1 Page 22 The manager advised that the regional manager visits the home on a regular basis and completes audits of the service provided. The homes safety records were inspected and were in good order. The manager was unable to locate risk assessments for the building and is required to submit these and the fire risk assessment to the Commission by the end of May 2006. It was not possible to inspect monies held for residents, as the person who manages this was unavailable. Requirements have been made regarding the homes management, quality reporting, staff supervision and risk assessments. Larchwood Nursing & Residential Home DS0000015652.V293788.R01.S.doc Version 5.1 Page 23 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 2 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 X X X X X X 1 STAFFING Standard No Score 27 1 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X X 1 X 2 Larchwood Nursing & Residential Home DS0000015652.V293788.R01.S.doc Version 5.1 Page 24 Are there any outstanding requirements from the last inspection? Three are repeated from the previous 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 OP1 Regulation 4, 5 Requirement Timescale for action 31/08/06 2. OP7 15, 17 3. OP8 7, 13 The registered person must ensure that the Statement of Purpose and Service User Guide are updated. The registered person must 31/07/06 ensure that: • Care plans are drawn up for every resident. • All care plans are reviewed and updated. • All care plans contain assessments and guidelines relating to residents social and emotional needs. • Care plans are drawn up in conjunction with the residents and/or their representatives. • Staff are aware of the care plans and use them to meet residents assessed care needs. The registered person must 31/07/06 ensure that proper risk assessments are completed for the use of bedrails, which are only to be used if they are appropriate to the assessed DS0000015652.V293788.R01.S.doc Version 5.1 Larchwood Nursing & Residential Home Page 25 4. OP9 5. OP10 6. OP12 7. OP15 8. OP16 9. OP18 10. OP19 needs of the residents. The registered person must ensure that all requirements made by the Pharmacist Inspector are complied with by the agreed timescales. 12 The registered person must ensure that all staff treat the residents with respect and dignity at all times. 12, 16, 18 The registered person must ensure that appropriate activities, interaction, stimulation and meaningful occupation are provided for all residents. 16 The registered person must ensure that all residents receive a suitable, balanced, wholesome, nutritious diet, which is varied, properly prepared and suitable for their needs. Residents must be provided with adequate quantities of food and must be given a choice of main meal. 22 The registered person must ensure the complaints procedure is up to date, accurate and available to all residents and their representatives. 13 The registered person must ensure that staff are encouraged and supported to raise concerns and made aware they are protected by the homes whistle blowing policy. 23 The registered person must ensure that: • The décor of the home is improved throughout. • Any stained and worn carpets and flooring is replaced. • All stained and worn furniture is replaced. • The bath in bathroom 5 is replaced and the bathroom is redecorated. • The shower room on the 13 DS0000015652.V293788.R01.S.doc 16/05/06 31/05/06 30/06/06 31/05/06 31/05/06 31/05/06 30/11/06 Larchwood Nursing & Residential Home Version 5.1 Page 26 11. OP26 12. OP27 13. OP28 14. OP29 ground floor is made accessible to all residents. • The call bell system is replaced by one that is less intrusive. Repeated, deadline of 1/12/05 not met. • A plan of routine maintenance and renewal of the fabric and decoration of the home is produced and implemented. 16, 23 The registered person must ensure that a good standard of cleanliness is maintained throughout the home and it is kept free from offensive odours. 18 The registered person must ensure staff are provided in sufficient numbers to enable the residents complete range of care needs to be met. This includes the need for effective management. Repeated, deadline of 1/11/05 not met. 18 The registered person must ensure that NVQ training is provided for all care staff and that at least 50 of them commence this by September 2006. Repeated, deadline of 1/11/05 not met. 13, 17, 19 The registered person must ensure pre-employment checks are carried out for all staff and that staff do not commence until the home is in receipt of the following: • Two satisfactory written references, including one from their immediate previous employer. • A clear POVA first check Staff must be supervised by a designated person until a satisfactory enhanced CRB is received. DS0000015652.V293788.R01.S.doc 30/06/06 31/05/06 01/09/06 01/06/06 Larchwood Nursing & Residential Home Version 5.1 Page 27 15. OP30 18 16. OP31 9, 10 17. OP33 24 18. OP36 18 19. OP38 23 The registered person must ensure that all newly appointed staff are provided with induction based on the Skills for Care induction standards. The registered person must ensure the appointed manager can demonstrate he/she is competent and has sufficient experience, skills, qualifications and expertise to effectively manage the home. The registered person must ensure the Commission is supplied with a copy of the current quality audit report. The registered person must ensure that a system for staff supervision and appraisal is put in place and that staff receive a minimum of six supervision sessions per year. The registered person must supply the Commission with current risk assessments of the building, including the homes fire risk assessment. 01/06/06 31/10/06 30/09/06 31/07/06 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Larchwood Nursing & Residential Home DS0000015652.V293788.R01.S.doc Version 5.1 Page 28 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Nursing & Residential Home DS0000015652.V293788.R01.S.doc Version 5.1 Page 29 - 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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