Inspection on 20/04/04 for Larchwood Nursing & Residential Home

Care Home For Older PeopleLarchwood Nursing & Residential Home133 Yarmouth Road Thorpe St. Andrew Norwich Norfolk NR7 0RFUnannounced Inspection20th April 2004 Commission for Social Care InspectionLaunched in April 2004, the Commission for Social Care Inspection (CSCI) is the single inspectorate for social care in England. The Commission combines the work formerly done by the Social Services Inspectorate (SSI), the SSI/Audit Commission Joint Review Team and the National Care Standards Commission. The role of CSCI is to: · Promote improvement in social care · Inspect all social care - for adults and children - in the public, private and voluntary sectors · Publish annual reports to Parliament on the performance of social care and on the state of the social care market · Inspect and assess `Value for Money of council social services · Hold performance statistics on social care · Publish the `star ratings for council social services · Register and inspect services against national standards · Host the Childrens Rights Director role.Inspection Methods & FindingsSECTION B of this report summarises key findings and evidence from this inspection. The following 4-point scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The 4-point scale ranges from: 4 - Standard Exceeded (Commendable) 3 - Standard Met (No Shortfalls) 2 - Standard Almost Met (Minor Shortfalls) 1 - Standard Not Met (Major Shortfalls) O or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable. ESTABLISHMENT INFORMATION Name of establishment Larchwood Nursing & Residential Home Address 133 Yarmouth Road, Thorpe St. Andrew, Norwich, Norfolk, NR7 0RF Email address Name of registered provider(s)/company (if applicable) Bondcare (Larchwood) Limited Name of registered manager (if applicable) Application pending Type of registration Care Home No. of places registered (if applicable) 48 Tel No: 01603 437358 Fax No: 01603 702046Category(ies) of registration, with (number of places) Old age, not falling within any other category (48), Physical disability (48) Registration number I070000249 Date first registered 30th July 2002 Was the home registered under the Registered Homes Act 1984? Do additional conditions of registration apply ? Date of last inspectionDate of latest registration certificate 3rd February 2003 YES YES 29/10/03 If Yes refer to Part CLarchwood Nursing & Residential HomePage 1 Date of inspection visit Time of inspection visit Name of inspector Name of inspector Name of inspector 1 2 320th April 2004 09:30 am Hilda StephensonID Code101157Name of inspector 4 Name of specialist (e.g. Interpreter/Signer) (if applicable) Name of establishment representative at the time of inspectionFrances GrayLarchwood Nursing & Residential HomePage 2 CONTENTSIntroduction to Report and Inspection Inspection Visits Brief Description of the Services Provided Part A: Summary of Inspection Findings Inspectors Summary Statutory Requirements/Good Practice Recommendations from last Inspection Conditions of Registration Statutory Requirements/ Good Practice Recommendations from this Inspection Part B: Inspection Methods & Findings National Minimum Standards For Older People: Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management & Administration Part C: Part D: D.1. D.2. D.3. Compliance with Conditions (if applicable) Providers Response Providers Comments Action Plan Providers AgreementLarchwood Nursing & Residential HomePage 3 INTRODUCTION TO REPORT AND INSPECTION Every establishment that falls within the jurisdiction of the Commission for Social Care Inspection (CSCI), is subject to inspection, to establish if the establishment is meeting the National Minimum Standards relevant to that setting and the requirements of the Care Standards Act 2000. This document summarises the inspection findings of the CSCI in respect of Larchwood Nursing & Residential Home. The inspection findings relate to the National Minimum Standards (NMS) for Care Homes for Older People published by the Secretary of State under the Care Standards Act 2000. The Regulations applicable to the inspected service are secondary legislation, with which a service provider must comply. Service providers are expected to comply fully with the National Minimum Standards. The National Minimum Standards will form the basis for judgements by the CSCI regarding registration, the imposition and variation of registration conditions and any enforcement action. The report follows the format of the NMS and the numbering shown in the report corresponds to that of the Standards. The report will show the following: · Inspection methods used · Key findings and evidence · Overall ratings in relation to the standards · Compliance with the Regulations · Required actions on the part of the provider · Recommended good practice · Summary of the findings · Providers response and proposed action plan to address findings This report is a public document. INSPECTION VISITS Inspections are undertaken in line with the agreed regulatory framework with additional visits as required. This is in accordance with the provisions of the Care Standards Act 2000. The report is based on the findings of the specified inspection dates.Larchwood Nursing & Residential HomePage 4 BRIEF DESCRIPTION OF THE SERVICES PROVIDED. Larchwood Nursing and Residential Home is situated on the outskirts of Norwich, within easy access to a large supermarket, post office and local shops. It is owned by the company of Bondcare. 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, with 25 nursing needs and 23 residential needs, within 36 single and 6 shared bedrooms. All the bedrooms have en-suite facilities. There is an enclosed patio area with seating and well maintained raised flower beds, that are accessible to wheelchair users. The home has ample car parking facilities at the rear of the premises.Larchwood Nursing & Residential HomePage 5 PART A SUMMARY OF INSPECTION FINDINGSINSPECTORS SUMMARY (This is an overview of the inspectors findings, which includes good practice, quality issues, areas to be addressed or developed and any other concerns.) This inspection was conducted as an unannounced inspection during the lunch time period. Several service users and relatives spoke to the Inspector and gave some positive comments regarding their care within the home. Choice of Home (Standards 1-6) Standards 1,2,3,4,5,6 were checked and met. The home has a statement of purpose and service users guide in place and these are available for all prospective service users. There has been a change of manager and these details will be included in these documents once registration has been concluded. Service users are encouraged to visit the home prior to admission. Health and Personal Care (Standards 7-11) Standards 7,8,& 9 were checked and met. Service users have a care plan in place to enable personal, social and medical needs are met. The home is supported by local GP practices. Daily Life and Social Activities (Standards 12-15) Standards 12 & 15 were checked and met. The home displays a selection of activities offered during the week. An Activities Co-ordinator arranges the majority of social events. During the inspection there was a quiz with several service users and relatives taking part. Service users were offered a choice from the menu. Complaints and Protection (Standards 16-18) Standard 16 was checked and met. The home has a complaints procedure in place, some service users were aware of this procedure. The manager is currently investigating one complaint, using the homes complaint procedure. Environment (Standards 19-26) Standard 19 was checked and met. The corridors have recently been redecorated with further decoration to be arranged. The home was found to be clean and tidy. Staffing (Standards 27-30) Standards 27 & 30 were checked and met. The home is adequately staffed with experienced and competent staff. The home has a trained nurse on duty over twenty four hours. The manager is also a trained nurse. Bondcare have their own Training Co-ordinator and NVQ and mandatory training has continued. Management and Administration (Standards 31-38) Standard 31 & 36 were checked and met. The manager has introduced supervision sessions with staff. The home has adequate health and safety procedures in place. There were no requirements from this inspection. The standards not assessed on this inspection will be assessed on future inspections.Larchwood Nursing & Residential HomePage 6 Requirements from last Inspection visit fully actioned? If No please list belowYESSTATUTORY REQUIREMENTS Identified below are areas not addressed from the last inspection report which indicate a non-compliance with the Care Standards Act 2000 and accompanying Regulations. The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Regulation Standard Required actions Timescale for actionAction is being taken by the Commission for Social Care Inspection to ensure compliance in regard to the above requirements. RECOMMENDATIONS Identified below are recommendations from the last inspection that have not been implemented No. Refer to Good Practice Recommendations StandardCONDITIONS OF REGISTRATION THAT APPLY (OTHER THAN NUMBERS AND CATEGORY OF SERVICE USERS).Met (Yes / No)Larchwood Nursing & Residential HomePage 7 STATUTORY REQUIREMENTS IDENTIFIED DURING THE INSPECTION Action Plan: The Registered Person is requested to provide the Commission with an Action Plan, which indicates how requirements are to be addressed with the time scale within which such actions will be taken. This action plan will be made available on request to the Area Office.STATUTORY REQUIREMENTS Identified below are areas addressed in the main body of the report, which indicate noncompliance with the Care Standards Act 2000, and accompanying Regulations 2001 and the National Minimum Standards. The Registered Provider(s) is/are required to comply within the given time scales. The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Regulation Standard * Requirement Timescale for action There are no requirements from this inspection visit.RECOMMENDATIONS Identified below are areas addressed in the main body of the report, which relate to National Minimum Standards and are seen as good practice issues which should be considered for implementation by the registered Provider(s). The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Refer to Good Practice Recommendations Standard ** Note: You may refer to the relevant standard in the remainder of the report by omitting the 2-letter prefix e.g. OP10 refers to Standard 10.Larchwood Nursing & Residential HomePage 8 PART BINSPECTION METHODS & FINDINGSThe following inspection methods have been used in the production of this report Direct observation Indirect observation Sampling · Pre-inspection questionnaire · Records · Care plans / Care pathways · Meals · Activities · Other (Specify) `Tracking care and support Group discussion with service users Individual discussion with service users Group discussion with staff Individual discussion with staff Discussion with management Service user survey Relatives/significant others survey/feedback Visiting professionals survey / feedback Tour of premises Formal interviews Document reading Additional inspection information: Number of service users spoken to at time of inspection Number of relatives/significant others the inspectors had contact with Number of letters received in respect of the service CRB check for the responsible individual seen CRB check for the manager seen Certificate of registration was displayed at the time of the inspection Certificate of registration accurately reflected the situation in the service at the time of inspection Total number of care staff employed (excluding managers) Total number of staff with nursing qualifications employed Date of inspection Time of inspection Duration of inspection (hrs) YES YES NO YES YES YES YES NO YES YES YES YES YES YES NO YES NO YES NO YES 10 2 X NO NO YES YES 31 5 20/4/04 12.00 2.5Larchwood Nursing & Residential HomePage 9 The following pages summarise the key findings and evidence from this inspection, together with the CSCI assessment of the extent to which the National Minimum Standards for Care homes for older people have been met. The following scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The scale ranges from: 4 - Standard Exceeded 3 - Standard Met 2 - Standard Almost Met 1 - Standard Not Met (Commendable) (No shortfalls) (Minor shortfalls) (Major shortfalls)0 or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable.Larchwood Nursing & Residential HomePage 10 Choice of HomeThe intended outcomes for the following set of standards are: · · · · · · 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.Standard 1 (1.1 ­ 1.3) The registered person produces and makes available to service users an up to date statement of purpose setting out the aims, objectives, philosophy of care, services and facilities, and terms and conditions of the home; and provides a service users guide to the home for current and prospective residents. The statement of purpose clearly sets out the physical environmental standards met by a home in relation to standards 20.1, 20.4, 21.3, 21.4, 22.2, 22.5, 23.3 and 23.10: a summary of this information appears in the homes service users guide. Range of fees charged From (£) 315 To (£) 418Any charges for extrasYESIf yes, please state what the extras are: 3 Key findings/Evidence Standard met? The home has a statement of purpose and service users guide available for prospective service users. The new manager is compiling a large print and an audio tape of both these documents, and should be commended.Larchwood Nursing & Residential HomePage 11 Standard 2 (2.1 ­ 2.2) Each service user is provided with a statement of terms and conditions at the point of moving into the home (or contract if purchasing their care privately). 3 Key findings/Evidence Standard met? Service users receive a copy of the terms and conditions of residence on admission to the home. The contract now includes the room number that is to be occupied by the service user. A sample of the terms and conditions were seen and found to be satisfactory.Standard 3 (3.1 ­ 3.5) New service users are admitted only on the basis of a full assessment undertaken by people trained to do so, and to which the prospective service user, his/her representatives (if any) and relevant professionals have been party. 3 Key findings/Evidence Standard met? All prospective service users are visited either in their own home or hospital by the manager to undergo a general assessment to ensure the home can meet their needs. Assessment details are included within the care records after admission. Assessment documents from the placing agencies are also included within the care records and found to be detailed and informative. Standard 4 (4.1 - 4.4) The registered person is able to demonstrate the homes capacity to meet the assessed needs (including specialist needs) of individuals admitted to the home. 3 Key findings/Evidence Standard met? The new manager has initiated some changes within the home. A trained nurse is on duty over the twenty four period and new training has been recently introduced to ensure the nurses continue to develop their professional development. One care staff has developed her role to undertake and arrange social activities. The manager discussed further plans for future development with care staff skills. Standard 5 (5.1 ­ 5.3) The registered person ensures that prospective service users are invited to visit the home and to move in on a trial basis, before they and / or their representatives make a decision to stay; unplanned admissions are avoided where possible. 3 Key findings/Evidence Standard met? Service users are invited to visit the home prior to admission. If this is not possible, relatives are invited in their place. Some service users who spoke to the Inspector stated that they had visited the home and stayed for a meal or to take part in the days activities. The home does take emergency admissions although an initial assessment is still carried out beforehand.Larchwood Nursing & Residential HomePage 12 Standard 6 (6.1 - 6.5) Where service users are admitted only for intermediate care, dedicated accommodation is provided together with specialised facilities, equipment and staff, to deliver short term intensive rehabilitation and enable service users to return home. 0 Key findings/Evidence Standard met? This is not applicable to Larchwood.Larchwood Nursing & Residential HomePage 13 Health and Personal CareThe intended outcomes for the following set of standards are: · · · · · The service users health, personal and social care needs are set out in an individual plan of care. Service users make decisions about their lives with assistance as needed. Service users, where appropriate, are responsible for their own medication, and are protected by the homes 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.Standard 7 (7.1 ­ 7.6) A service user plan of care generated from a comprehensive assessment (see Standard 3) is drawn up with each service user and provides the basis for the care to be delivered. 3 Key findings/Evidence Standard met? Service users have a written care plan and this is drawn up with either the trained nurse if they have nursing needs, or the key worker if they have residential needs. Each care plan contains health, personal and social needs and short term goals. Risk assessments to reduce falls, washing and dressing, nutritional and pressure sore reduction are in place to allow staff to implement a safer lifestyle. The care plans contained daily records and were reviewed on a monthly basis A sample of care plans were seen and found to be satisfactory. Standard 8 (8.1 ­ 8.13) The registered person promotes and maintains service users health and ensures access to health care services to meet assessed needs. No. of incidents where service users have been taken to Accident and Emergency during last 12 months No. of service users with pressure sores at time of inspection (from information taken from care notes) X X3 Key findings/Evidence Standard met? th This standard was met at the previous inspection on 29 October. Examining care plans indicated that the health needs of service users continued to be monitored.Larchwood Nursing & Residential HomePage 14 Standard 9 (9.1 ­ 9.11) The registered person ensures that there is a policy and staff adhere to the procedures for the receipt, recording, storage, handling administration and disposal of medicines, and service users are able to take responsibility for their own medication if they wish, within a risk management framework. 3 Key findings/Evidence Standard Met? There is no change to the medication. The trained nurses administers all medication to service users. There were no service users who self medicate during the inspection, although a locked facility is provided in each bedroom to allow this. A sample of the MAR sheets were found to be satisfactory. Medication is stored securely. The Controlled Drugs were not checked on this occasion. The home has the relevant medicines policies in place.Standard 10 (10.1 ­ 10.7) The arrangements for health and personal care ensure that service users privacy and dignity are respected at all times, and with particular regard to: personal care giving, including nursing, bathing, washing, using the toilet or commode, consultation with, and examination by, health and social care professionals, consultation with legal and financial advisors, maintaining social contacts with relatives and friends, entering bedrooms, toilets and bathrooms, and following death. 0 Key findings/Evidence Standard met? This standard was not inspected on this occasion.Standard 11 (11.1 ­ 11.12). Care and comfort are given to service users who are dying, their death is handled with dignity and propriety, and their spiritual needs, rites and functions observed. 0 Key findings/Evidence Standard met? This standard was not inspected on this occasion.Larchwood Nursing & Residential HomePage 15 Daily Life and Social ActivitiesThe intended outcomes for the following set of standards are: · · · · 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.Standard 12 (12.1 ­ 12.4) The routines of daily living and activities made available are flexible and varied to suit service users expectations, preferences and capacities. 3 Key findings/Evidence Standard met? The home has a general flexible routine around meal times. The Social Co-ordinator organises activities during the day, taking into account a variety of service users interests, hobbies and disabilities. During the inspection a quiz had been organised with several service user and relatives taking part. Service users commented that they enjoy taking part with some of the organised activities. The care plans record individual hobbies and social activities. Some service users continue with outside interests, and go out with relatives or staff when the weather improves. Standard 13 (13.1 ­ 13.6) Service users are able to have visitors at any reasonable time and links with the local community are developed and/or maintained in accordance with service users preferences. 0 Key findings/Evidence Standard met? This standard was not inspected on this occasion.Standard 14 (14.1 ­ 14.5) The registered person conducts the home so as to maximise service users capacity to exercise personal autonomy and choice. 0 Key findings/Evidence Standard met? This standard was not inspected on this occasion.Larchwood Nursing & Residential HomePage 16 Standard 15 (15.1 ­ 15.9) The registered person ensures that service users receive a varied, appealing, wholesome and nutritious diet, which is suited to individual, assessed and recorded requirements, and that meals are taken in a congenial setting and at flexible times. 3 Key findings/Evidence Standard met? The meals are included in the service users guide. The menu is displayed in the dining room and annexe. Service users have a choice from the menu. The cook caters for a variety of special diets, including soft diets and any service users who require assistance with their meals are helped in a discreet manner. The menu has been adapted since the previous inspection to cater for the more frail service users. Snacks and drinks are offered at regular intervals throughout the day. The home has a variety of dining areas or service users can stay in their own room if they wish.Larchwood Nursing & Residential HomePage 17 Complaints and ProtectionThe intended outcomes for the following set of standards are: · · · 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.Standard 16 (16.1 ­ 16.4) The registered person ensures that there is a simple, clear and accessible complaints procedure which includes the stages and time-scales for the process, and that complaints are dealt with promptly and effectively. No. of complaints made to the home during last 12 months No. of these complaints fully substantiated No. of these complaints partly substantiated No. of these complaints not substantiated No. of these complaints not yet resolved No. of complaints sent direct to CSCI Percentage of complaints responded to within 28 days 1 0 0 0 1 1 X 3 Key findings/Evidence Standard met? The home has a complaints procedure and this is displayed and included within the service users guide. Service users who spoke to the Inspector were aware that they could complain about the service and to whom, but preferring to speak to staff or the Manager. The Manager is investigating one complaint presently using the homes own complaints procedure.Larchwood Nursing & Residential HomePage 18 Standard 17 (17.1 ­ 17.3) Service users have their legal rights protected, are enabled to exercise their legal rights directly and participate in the civic process if they wish. 0 Key findings/Evidence Standard met? This standard was not investigated on this occasion.Standard 18 (18.1 ­ 18.6) The registered person ensures that service users are safeguarded from physical, financial or material, psychological or sexual abuse, neglect, discriminatory abuse or self harm, inhuman or degrading treatment, through deliberate intent, negligence or ignorance, in accordance with written policies. The home has an Adult Protection procedure (including Whistle Blowing) which complies with the Public Disclosure Act 1998 and the Department of Health Guidance No Secrets No. of staff referred for inclusion on POVA lists Key findings/Evidence This standard was not inspected on this occasion. Standard met? YES X 0Larchwood Nursing & Residential HomePage 19 EnvironmentThe intended outcomes for the following set of standards are: · · · · · · · · 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.Standard 19 (19.1 ­ 19.6) The location and layout of the home is suitable for its stated purpose; it is accessible, safe and well maintained; meets service users individual and collective needs in a comfortable and homely way and has been designed with reference to relevant guidance. 3 Key findings/Evidence Standard met? The home was found to be clean and fairly tidy when the Inspector visited. The corridors highlighted in the previous report have recently been redecorated. The manager has a plan in place for further redecoration and refurbishment for the next six months. The many communal lounges and dining rooms were in use during the visit, although some service users preferred to stay in their rooms. The lounges remain unchanged since the previous inspection. The gardens were tidy, with one service user enjoying the outdoor patio area. Standard 20. (20.1 ­ 20.7) In all newly built homes and first time registrations the home provides sitting, recreational and dining space (referred to collectively as communal space) apart from service users private accommodation and excluding corridors and entrance hall amounting to at least 4.1 sq. metres for each service user. 0 Key findings/Evidence Standard met? This standard was not inspected on this occasion.Larchwood Nursing & Residential HomePage 20 Standard 21 (21.1 ­ 21.8) Toilet, washing and bathing facilities are provided to meet the needs of service users. 0 Key findings/Evidence Standard met? This standard was not inspected on this occasion.Standard 22 (22.1 ­ 22.8) The registered person demonstrates that an assessment of the premises and facilities has been made by suitably qualified persons, including a qualified occupational therapist, with specialist knowledge of the client groups catered for, and provides evidence that the recommended disability equipment has been secured or provided and environmental adaptations made to meet the needs of service users. 0 Key findings/Evidence Standard met? This standard was not inspected on this occasion.Larchwood Nursing & Residential HomePage 21 Standard 23 (23.1 ­ 23.11) The home provides accommodation for each service user which meets minimum space as prescribed Total number of single bedrooms with at least 10 sq.m usable space or additional compensatory space Pre-existing homes only (1 April 2003) - single bedrooms below 10 sq.m usable space or additional compensatory space Total number of wheelchair users accommodated for in rooms at least 12sq.m Total number of wheelchair users accommodated for in rooms at less than 12sq.m Total number of shared rooms at least 16 sq.m Total number shared rooms less than 16 sq.m Percentage of places within single rooms: 100 80 - 99 Less than 80 Total number of single bedrooms Total number of single rooms with en suite Total number of double rooms Total number of double rooms with en suite Key findings/Evidence This standard was not inspected on this occasion. NO YES NO 36 36 6 6 Standard met? 0 X XX X X XLarchwood Nursing & Residential HomePage 22 Standard 24 (24.1 ­ 24.8) The home provides private accommodation for each service user which is furnished and equipped to assure comfort and privacy, and meets the assessed needs of the service user. 0 Key findings/Evidence Standard met? This standard was not inspected on this occasion.Standard 25 (25.1 ­ 25 8) The heating, lighting, water supply and ventilation of service users accommodation meet the relevant environmental health and safety requirements and the needs of individual service users. 0 Key findings/Evidence Standard met? This standard was not inspected on this occasion.Standard 26 (26.1 ­ 26.9) The premises are kept clean, hygienic and free from offensive odours throughout and systems are in place to control the spread of infection, in accordance with relevant legislation and published professional guidance. 0 Key findings/Evidence Standard met? This standard was not inspected on this occasion.Larchwood Nursing & Residential HomePage 23 StaffingThe intended outcomes for the following set of standards are: · · · · 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 homes recruitment policy and practices. Staff are trained and competent to do their jobs.Standard 27 (27.1 ­ 27.7) Staffing numbers and skill mix of qualified/unqualified staff are appropriate to the assessed need of the service users, the size, the layout and purpose of the home, at all times. Number of staff /hours in respect of service user needs based on guidance recommended by Department of Health. Personal Nursing Care No. service users High No. staff hours X X X needs allocated No. service users Medium needs No. service users Low needs No. of staff hours required No. of full time equivalent first level registered nurses No. of care staff No. of ancillary staff X X X No. staff hours allocated No. staff hours allocated No. of staff hours provided X X X X X X5 31 113 Key findings/Evidence Standard met? The care, nurse, catering and domestic hours were not calculated during this visit. The rota indicated that :7/8 care staff and 1 trained nurse was on duty in the morning 5care staff and 1 trained nurse in the afternoon and evening, reducing to 3 care staff and 1 trained nurse overnight. During week days the manager is on duty with support from the administrator.Larchwood Nursing & Residential HomePage 24 Standard 28 (28.1 ­ 28.3) A minimum ratio of 50 trained members of care staff (NVQ Level 2 or equivalent) is achieved by 2005, excluding the registered manager and/or care manager, and in care homes providing nursing, excluding those members of the care staff who are registered nurses. No. care staff (excluding registered nurses) with NVQ level 2 or equivalent of care staff with NVQ level 2 Key findings/Evidence This standard was not inspected on this occasion. X X Standard met? 0Standard 29 (29.1 ­ 29.6) The registered person operates a thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. 0 Key findings/Evidence Standard met? This standard was not inspected on this occasion.Standard 30 (30.1 ­ 30.4) The registered person ensures that there is a staff training and development programme which meets the National Training Organisation (NTO) workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users. 3 Key findings/Evidence Standard met? The manager has continued with the comprehensive induction programme for new staff. Trained nurses are supported to update their skills with a selection of study days and training courses. Care staff attend mandatory training and the staff noticeboard showed evidence of future training events.Larchwood Nursing & Residential HomePage 25 Management and AdministrationThe intended outcomes for the following set of standards are: · · · · · · · · 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 homes record keeping policies and procedures. The health, safety and welfare of service users and staff are promoted and protected.Standard 31 (31.1 ­ 31.8) The registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. 2 Key findings/Evidence Standard met? There has been a change of manager during the last month. The new manager is Frances Gray, who is a trained nurse and has several years working with older people within the private sector. She will be undergoing the registration process to become the registered manager. Standard 32 (32.1 ­ 32.7) The registered manager ensures that the management approach of the home creates an open, positive and inclusive atmosphere. 0 Key findings/Evidence Standard met? This standard was not inspected on this occasion.Standard 33 (33.1 ­ 33.10) Effective quality assurance and quality monitoring systems, based on seeking the views of service users, are in place to measure success in meeting the aims, objectives and the statement of purpose of the home. 0 Key findings/Evidence Standard met? This standard was not inspected on this occasion.Larchwood Nursing & Residential HomePage 26 Standard 34 (34.1 ­ 34.5) Suitable accounting and financial procedures are adopted to demonstrate current financial viability and to ensure there is effective and efficient management of the business. 0 Key findings/Evidence Standard met? This standard was not inspected on this occasion.Standard 35 (35.1 ­ 35.6) The registered manager ensures that service users control their own money except where they state that they do not wish to or they lack capacity and that safeguards are in place to protect the interests of the service user. Number of service users subject to Power of Attorney processes Number of service users subject to Enduring Power of Attorney processes Number of service users subject to Guardianship Orders Key findings/Evidence This standard was not inspected on this occasion. Standard met? 0 X X XStandard 36 (36.1 ­ 36.5) The registered person ensures that the employment policies and procedures adopted by the home and its induction, training and supervision arrangements are put into practice. 4 Key findings/Evidence Standard met? The manager has recently commenced formal supervision sessions with the trained nurses and care staff, to be continued on a monthly or two monthly basis whichever is applicable to each individual. A sample of the documents were seen and these sessions are recorded taking into account training needs, personal goals and adapting new skills. This should be commended.Larchwood Nursing & Residential HomePage 27 Standard 37 (37.1 ­ 37.3) Records required by regulation for the protection of service users and for the effective and efficient running of the business are maintained, up to date and accurate. 0 Key findings/Evidence Standard met? This standard was not inspected on this occasion.Standard 38 (38.1 ­ 38.9) The registered manager ensures so far as is reasonably practicable the health, safety and welfare of service users and staff. 0 Key findings/Evidence Standard met? This standard was not inspected on this occasion.Larchwood Nursing & Residential HomePage 28 PART C(where applicable)COMPLIANCE WITH CONDITIONSCondition Compliance The home is a registered care home with nursing for older people.YESComments Evidence was collected by examining care records, discussion with staff and service users.Condition Maximum to be accommodated no more than 48.ComplianceYESComments There were 46 service users in residence on the day of inspection.Condition CommentsComplianceCondition CommentsComplianceLead Inspector Second Inspector Locality Manager DateHILDA STEPHENSON GILLIAN WARRENSignature Signature SignatureLarchwood Nursing & Residential HomePage 29 Public reports It should be noted that all CSCI inspection reports are public documents.Larchwood Nursing & Residential HomePage 30 PART DD.1PROVIDERS RESPONSE TO IDENTIFIED STATUTORY REQUIREMENTSRegistered Persons comments/confirmation relating to the content and accuracy of the report for the above inspection.We would welcome comments on the content of this report relating to the Inspection conducted on 20th April 2004 and any factual inaccuracies: Please limit your comments to one side of A4 if possible Providers comments and any action plan are available at the Area Office, where these have been submitted.Larchwood Nursing & Residential HomePage 31 Action taken by the CSCI in response to provider comments: Amendments to the report were necessary NOComments were received from the provider Provider comments/factual amendments were incorporated into the final inspection report Provider comments are available on file at the Area Office but have not been incorporated into the final inspection report. The inspector believes the report to be factually accurateYESNote: In instances where there is a major difference of view between the Inspector and the Registered Provider both views will be made available on request to the Area Office. Please provide the Commission with a written Action Plan by 8th June 2004 which indicates how requirements are to be addressed and stating a clear timescale for completion. This will be kept on file and made available on request. You will also note that the Commission has identified in the inspection report good practice recommendations and it would be useful to have some indication as to whether you intend to take any action to progress these. D.2 Status of the Providers Action Plan at time of publication of the final inspection report: Action plan was required NOAction plan was received at the point of publicationAction plan covers all the statutory requirements in a timely fashion Action plan did not cover all the statutory requirements and required further discussion Provider has declined to provide an action planOther:Larchwood Nursing & Residential HomePage 32 D.3PROVIDERS AGREEMENT Registered Persons statement of agreement/comments: Please complete the relevant section that applies.D.3.1 I of confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date(s) and that I agree with the requirements made and will seek to comply with these. Print Name Signature Designation Date Or D.3.2 I of am unable to confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date(s) for the following reasons:Print Name Signature Designation Date Note: In instance where there is a profound difference of view between the Inspector and the Registered Provider both views will be reported. Please attach any extra pages, as applicable.Larchwood Nursing & Residential HomePage 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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