CARE HOMES FOR OLDER PEOPLE
Larkhall Springs Swainswick Gardens Larkhall Bath Bath & N E Somerset BA1 6TL Lead Inspector
Jill Cornelius Unannounced Inspection 15th November 2005 11:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Larkhall Springs DS0000020360.V262567.R01.S.doc Version 5.0 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. Larkhall Springs DS0000020360.V262567.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Larkhall Springs Address Swainswick Gardens Larkhall Bath Bath & N E Somerset BA1 6TL 01225 466266 01225 478939 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) Cedar Care Homes Limited Mr Sony Joseph Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Larkhall Springs DS0000020360.V262567.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. May accommodate 35 Persons aged 50 years and over Staffing Notice dated 08/11/2000 applies Manager must be a RN on parts 1 or 12 of the NMC register Date of last inspection 20th June 2005 Brief Description of the Service: Larkhall Springs is a registered care home providing nursing care for up to 35 people aged 65 years and older. The home is situated in a suburban position and can be accessed by car or bus, which would be required for easy access to local shops and venues. The home is a converted property providing single rooms on two floors and communal space in 3 areas. There is a lift to all parts of the home. Larkhall Springs DS0000020360.V262567.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over one day. The manager was on annual leave and Lizy Varghese RN was the homes representative. The home had one vacancy and one resident in hospital. Opportunity was taken to tour the premises, examine records and talk to staff and residents who were able to do so. All the residents were seen during the inspection. What the service does well: What has improved since the last inspection? What they could do better:
The home should monitor the carpets and chairs for malodours. A Requirement was made in relation to the carpeting in the lounge of the home being deep cleaned or replaced. Larkhall Springs DS0000020360.V262567.R01.S.doc Version 5.0 Page 6 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. Larkhall Springs DS0000020360.V262567.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Larkhall Springs DS0000020360.V262567.R01.S.doc Version 5.0 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 the following standard(s): 1 and 5. Clear, accessible information is available to potential newcomers to the home. EVIDENCE: The inspector saw that the home has a well-written statement of purpose. This document contains all of the required information. Prospective service users are invited to visit the home prior to admission, they are invited to stay for a meal and meet other service users and staff. One new resident and their representatives were consulted and they said that they received a warm welcome. Larkhall Springs DS0000020360.V262567.R01.S.doc Version 5.0 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 the following standard(s): 7, 8, 9, 10 and 11. The health needs of residents are well met with evidence of good multi disciplinary working taking place on a regular basis. Medication is well- managed promoting good health. Personal support is offered in a way that promotes and protects resident’s privacy, dignity and independence. EVIDENCE: The care documentation for six individuals living at Larkhall Springs were viewed. Records were on the whole very comprehensive and reviewed on a regular basis. Care plans incorporated individuals likes, dislikes and needs. Aspects of support including activities of daily living, social, emotional and personal care support were all well recorded. Clear guidelines are in place with care documentation on individuals preferred routines and choices. Larkhall Springs DS0000020360.V262567.R01.S.doc Version 5.0 Page 10 The risk assessments viewed had been recently reviewed and covered areas such as personal care, pressure care, wound care and use of equipment. The inspector saw that when new areas of concern had been identified these had been appropriately risk assessed and recorded. Manual handling profiles and procedures were in place with information about equipment to be used. An RN was asked to give examples of how individuals are able to make choices and to have some control over their lives, she was able to tell the inspector about individuals decisions, all of which cross referenced with information seen in individuals care documents and also what had been observed during the inspection. The home has a very clear policy and procedure for the receipt, storage and administration of medication. The inspector carried out a random audit of the medication held in the home, and no errors were found. It was evident at this inspection that the management and staff spoken with are sensitive to the emotional needs of those living at the home and through observation and discussion demonstrated respect to the wishes of individuals living at the home. The home has a very clear policy and procedure for the care and comfort of the dying, which includes service users personal preferences, staff have supportive links with hospice and other professional staff, the GP and local clergy are readily involved. Larkhall Springs DS0000020360.V262567.R01.S.doc Version 5.0 Page 11 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): 12, 14, 15. Residents are given meaningful opportunities to exercise choice and control over their lives in the home and to have their interests met. Dietary needs of residents are well catered for with a balanced and varied selection of food available that meet individual tastes and choices. EVIDENCE: The inspector witnessed 14 residents enjoying the planned activity of ‘Mr. Renton plays the piano’. There was evidence of a variety of activities, which included bingo, card games, video evenings, “Mac” the dog visits, fire works and celebration party, organised trips, and outside entertainment. A local clergyman carries out pastoral visits and a monthly service. Residents spoken with confirmed their involvement in choosing these activities and their enjoyment of them. The inspector was informed rising and retiring times are indicated by the service users daily and accommodated in balance with assessed needs. The service users spoken with also confirmed this, as did documented evidence in the care plans.
Larkhall Springs DS0000020360.V262567.R01.S.doc Version 5.0 Page 12 The recognised Cora Planner is used to produce an innovative, interesting menu and this has been decoratively displayed. Meal times are appropriately spaced through the day. Larkhall Springs DS0000020360.V262567.R01.S.doc Version 5.0 Page 13 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): 16 and 18. Clear, robust policies and procedures are in place in order to protect individuals from the likelihood of abuse and to promote the raising of concerns. EVIDENCE: The home has a clear and robust complaints policy and procedure; the manager deals with any query that is raised promptly which avoids any serious complaint. No complaints have been received by either the home or the Commission for Social Care Inspection. No staff members at the home are on the protection of vulnerable adults list. No areas of concern were recorded on care documentation. The home also has clear policies and procedures for Adult Protection and Whistle Blowing, staff receive training on Adult Protection during their induction and qualified staff are aware of how to report and alert. Larkhall Springs DS0000020360.V262567.R01.S.doc Version 5.0 Page 14 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): 19, 23, 24 and 26. The home is homely and comfortable and provides an appropriate environment to meet the needs of older people: however, carpets in the lounge require attention to enhance that area. EVIDENCE: There have been no changes in the services and facilities provided at the home since the previous inspection. The location and layout of the home is suitable for its intended purpose. Individual’s rooms had been personalised to reflect their personal taste and preferences, rooms seen were found to be well furnished. One resident highlighted to the inspector that they could not see properly in her room. It was noted that the central light was a 40-watt bulb. The resident was asked if they would prefer a stronger watt bulb in the room. This was then changed by the maintenance staff. No other residents raised this concern.
Larkhall Springs DS0000020360.V262567.R01.S.doc Version 5.0 Page 15 Communal areas are well maintained, homely and comfortable: however, a carpet in the upper lounge was stained and odorous, a staff member explained that it was cleaned regularly. If the carpet is unable to be cleaned thoroughly then it must be replaced. A Requirement was made in relation to this standard. Larkhall Springs DS0000020360.V262567.R01.S.doc Version 5.0 Page 16 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): 27, 30 Staff at the home are well trained and are employed in sufficient numbers to meet the residents needs. EVIDENCE: A random sample of the training records for a range of staff was observed. These evidenced a broad range of skills available amongst the staff team and an on-going commitment to staff training and development. Random checks on the staffing duty rota for the weeks of Nov 17th – 23rd and Nov 24th – 30th showed that the staffing levels were above the minimum level set by the home’s Staffing Notice. Larkhall Springs DS0000020360.V262567.R01.S.doc Version 5.0 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 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): 31, 32, 33, 36 and 37. The home is managed efficiently and in an open way. The relationships between staff and those living at Larkhall Springs are good, creating a warm, supportive environment in which individual’s quality of life is improved. Feedback is actively sought from service users about the service provided. Staff are well supported and monitored. Records are relevant and kept appropriately. Larkhall Springs DS0000020360.V262567.R01.S.doc Version 5.0 Page 18 EVIDENCE: Mr. Joseph the manager has the appropriate RN1 and Care Management qualifications. He has been in the post for over 2 years and has attended relevant clinical update training. Service users and staff spoken with felt they were well supported and that Mr. Joseph was accessible. Residents meetings are held and the minutes were viewed. Residents, visitors and staff made positive comments about the day to day management of the home and gave examples of the ways they have been involved and consulted. Feedback is actively sought from service users about the service provided through anonymous user satisfaction questionnaires. Supervision notes are made and are held securely in the home. They evidenced review of staff performance and development on a regular basis. Evidence relating to record-keeping is detailed above and elsewhere in this report. Larkhall Springs DS0000020360.V262567.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x x x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x 3 3 x 2 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x x 3 3 x Larkhall Springs DS0000020360.V262567.R01.S.doc Version 5.0 Page 20 No 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 OP26 Regulation 23(2) Requirement Hygienically clean the upper lounge carpet or replace it. Timescale for action 13/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP26 Good Practice Recommendations Monitor carpets and chairs for malodours. Larkhall Springs DS0000020360.V262567.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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