CARE HOMES FOR OLDER PEOPLE
Larchwood 133 Yarmouth Road Thorpe St Andrew Norwich NR7 4EF Lead Inspector
Pearson Clarke Unannounced 7 September 2005
th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 I55 s15652 larchwood v248830 070905 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Larchwood Address 133 Yarmouth Road, Thorpe St Andrew, Norwich, NR7 0RF Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01603 437358 01603 702046 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 I55 s15652 larchwood v248830 070905 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Up to forty-eight (48) Older People may be accomodated in the category OP Up to forty-eight (48) Service Users who have a physical disability may be accomodated in the category PD No more then 48 Service Users may be accomodated. Date of last inspection 14th April 2005 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, with or without physical needs. The service has 36 single and 6 shared bedrooms. All the bedrooms have en-suite facilities. 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. Larchwood I55 s15652 larchwood v248830 070905 stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and commenced during the morning. Whilst in the home the inspector toured the premises and spoke to management, staff, service users and visitors to the home. The views of those spoken to have helped inform the judgements made by the inspector. Since the last inspection there has been a change of manager and the inspector has focused on the effect of this change and on known areas of concern relating to service delivery. As such not all standards are inspected on this visit. What the service does well: What has improved since the last inspection? What they could do better:
Larchwood I55 s15652 larchwood v248830 070905 stage 4.doc Version 1.40 Page 6 Larchwood has experienced a number of difficulties in the last few years and in order to function effectively to a consistently good standard there are a number of significant challenges which must be met. The new manager has begun to address issues, however the provider needs to ensure an effective overall management structure is consistently maintained. There is a need to build a cohesive and effective staff team in which all staff work in support of each other and in the interests of those cared for. Staff training needs addressing and the provider must establish a consistent and effective NVQ programme. The home has a high level of dependency and is not staffed to meet that need. Care staffing levels must be improved and the culture of residents having their needs dictated to by staff routine needs addressing. The call bell system is loud and intrusive into quality of life and a new and quieter system is needed. The quality of food needs to be kept under review and some furnishings need replacement. The home has been assessed as a ‘high risk’ home providing care that is not as good as it should be for some time. If the situation does not improve, especially in relation to staffing adequacy, the Commission will serve enforcement notices to bring about change. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Larchwood I55 s15652 larchwood v248830 070905 stage 4.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection Larchwood I55 s15652 larchwood v248830 070905 stage 4.doc Version 1.40 Page 8 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 standard(s) These standards were not assessed on this visit EVIDENCE: Larchwood I55 s15652 larchwood v248830 070905 stage 4.doc Version 1.40 Page 9 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 standard(s) Standards not assessed on this visit EVIDENCE: Larchwood I55 s15652 larchwood v248830 070905 stage 4.doc Version 1.40 Page 10 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 standard(s) 14,15 Current staffing levels make it difficult to deliver a rounded package of care to service users in which they can exercise choice and enjoy emotional support and stimulation. The quality of food can be variable. EVIDENCE: During the time the inspector was in the home he observed an activity session taking place and being led by the homes activity organiser. This was being enjoyed by those taking part and is clearly a useful part of the overall provision. However for the majority of people living there it was either inaccessible to them or not their choice to attend. Many people in care homes do not choose structured activity , but do desire meaningful day to day contact with staff. In talking to the staff on duty the inspector could find no evidence of staff having any opportunity to spend time talking with those they care for or of being able to offer companionship and emotional support. When asked directly about the opportunities to give service users meaningful choice in their daily routine, care staff confirmed that residents had to fit in with their working patterns in order for basic care to be delivered. It was the inspector’s opinion that staff would like to spend more time with those cared for and that they would work differently if more resourses were available. Residents spoken to commended staff for their kindness, but also noted that staff were very busy.
Larchwood I55 s15652 larchwood v248830 070905 stage 4.doc Version 1.40 Page 11 Although the inspection did not focus on meals a number of staff members felt that the quality was variable depending on who was cooking and the inspector would encourage the service manager to keep this under review. Larchwood I55 s15652 larchwood v248830 070905 stage 4.doc Version 1.40 Page 12 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 standard(s) 16 The services recent approach to complaints has been robust and appropriate. This approach needs to be maintained over the longer term. EVIDENCE: Since the appointment of a new manager there is more confidence that complaints and concerns will be taken seriously and acted on. During his time in the home the inspector was able to speak to two different relatives who had each had a need to complain about the service. Both felt that the manager had been approachable had taken them seriously and had responded positively to the issues raised. Larchwood I55 s15652 larchwood v248830 070905 stage 4.doc Version 1.40 Page 13 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 standard(s) 19,22,26 There is evidence of a recent improvement in cleanliness which must be maintained in the interests of those cared for. The homes call bell system is very intrusive and detracts from the residents quality of life. EVIDENCE: The inspector toured most of the home although he did not enter all bedrooms. The service has received complaints relating to cleanliness during the last few months and it was encouraging for the inspector to find that there was no odour in the home and areas seen were clean and generally tidy. The service manager confirmed that they had recently undertaken a thorough clean of the home using contract cleaners and had committed to regular in house audits of the premises. Since the last inspection of the home positive efforts have been made to improve the service entrance area. As such details of staff employed are displayed along with a range of other information. In the interests of security the main door may be locked and notices to this effect are displayed. However these notices were somewhat confusing and when the inspector arrived there was a lengthy wait before gaining admission to the home.
Larchwood I55 s15652 larchwood v248830 070905 stage 4.doc Version 1.40 Page 14 It was noted that the chairs in the lounge areas were somewhat shabby with some cushions not matching the chairs and the service is encouraged to consider a programme of replacement and improvement. Once again the inspector was stuck by the highly intrusive nature of the call bell system. The homes system is very loud and the inspector considers it to be a negative influence on peoples quality of life and in the case of people with dementia a potential source of great anxiety and stress. This was discussed with the manager who confirmed that he understood the system was going to be replaced, but could give no timescales for this. Given the uncertainty over timescales a requirement to replace the system or to take action to reduce the level of noise intrusion to an acceptable level is made. Larchwood I55 s15652 larchwood v248830 070905 stage 4.doc Version 1.40 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,30 The service does not have sufficient numbers of care staff to deliver a rounded package of care to residents and as such service users cannot exercise choice. Staff training needs to be given a greater priority. EVIDENCE: This inspection of Larchwood was the second this year and as on the previous occasion the major issue to arise from the visit was staffing levels. The last inspection resulted in a requirement for the provider to review dependency and to justify the levels of staffing found. The Commission has yet to receive any information arising from this exercise, however having considered the findings of the previous inspection and what was found on this visit the inspector is clear that care staffing levels are not adequate to satisfactorily meet the needs of those cared for. The home has approximately 50 of its current occupancy as nursing care, however the remaining residents are generally in the high dependency category resulting in a high level of need throughout the home. As on the previous visit care staff were interviewed and the inspector found them to be almost exclusively feeling under pressure and only able to deliver care in a fashion dictated by routine and not in a manner offering residents any real choice. On both visits the inspector observed call bells to be ringing on a regular basis and staff often being too busy to respond promptly. Staff also reported to the inspector their sense of frustration in relation to the services NVQ programme. In respect of this many have started the process, but the absence of assessors has led to training stopping and general disillusionment with the process. Although this area was not looked at in detail the service is
Larchwood I55 s15652 larchwood v248830 070905 stage 4.doc Version 1.40 Page 16 clearly someway off meeting government targets for qualified staff and a requirement is made. Residents spoken to confirmed that they found the staff to be kind and hard working and the inspector saw positive interactions taking place including a member of the cleaning staff taking time to ensure that a service user could reach their drink. Larchwood I55 s15652 larchwood v248830 070905 stage 4.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32 The service manager is working hard and has achieved success in improving customer relations, however there is a need for a deputy in order to ensure effective overall management. EVIDENCE: Since the last inspection the provider has appointed a new manager, however he is not yet registered with Commission. During the inspection visitors to the home commented favourably about their dealings with the new manager who has clearly worked hard and to good effect to improve the services customer relations. Despite this encouraging start there is clearly much still to achieve and in order to move forward effectively the provider needs to ensure a stable management structure with the appointment of a deputy as a priority. At the time of inspection this post was being re-advertised following the withdrawal of an appointed candidate. In the inspectors opinion the service needs an effective management structure to provide the day to day care management, support and supervision of all of the current care team. Discussion with staff
Larchwood I55 s15652 larchwood v248830 070905 stage 4.doc Version 1.40 Page 18 and management on the day show that there are clearly gaps in the current team with nursing and care staff not working well as a team. Workload for care staff is very high and issues relating to quality of care cannot be improved without more staff and a greater management presence. Larchwood I55 s15652 larchwood v248830 070905 stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 2 15 2
COMPLAINTS AND PROTECTION 2 x x 2 x x x 3 STAFFING Standard No Score 27 1 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 2 2 x x x x x x Larchwood I55 s15652 larchwood v248830 070905 stage 4.doc Version 1.40 Page 20 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 22 Regulation 16 Requirement That the service take action to replace the current call bell system with a quieter less intrusive system. That the Service Provider increase care staffing levels by at least one member of care staff on all shifts during the waking day That the Service Provider submit details of how it will meet government expectations that at least 50 of care staff are trained to NVQ level 2 or above The Service provider must introduce a management structure which allows for the effective management of the home and provides the registered manager with support. Timescale for action By December 2005 by November 2005 By November 2005 By November 2005 2. 27 18 3. 30 18 4. 32 18 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No.
Larchwood Refer to Standard Good Practice Recommendations
I55 s15652 larchwood v248830 070905 stage 4.doc Version 1.40 Page 21 1. 19 that the provider draw up and implement a programme of replacement/repair of furnishings in the home. Larchwood I55 s15652 larchwood v248830 070905 stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection 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
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