Inspection on 20/06/05 for Larkhall Springs

This inspection was carried out on 20th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Larkhall Springs 20/08/07

Larkhall Springs 08/01/07

Larkhall Springs 15/11/05

Larkhall Springs 11/01/05

Larkhall Springs 11/06/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Larkhall Springs Swainswick Gardens Larkhall Bath Bath & N E Somerset, BA1 6TL Lead Inspector Jill Cornelius Unannounced 20 June 2005 09:30 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. Larkhall Springs D56_D05_S20360_larkhallsprings_V233937_200605Stage4.doc Version 1.30 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 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 N Care Home with Nursing 35 Category(ies) of OP Old age (35) registration, with number of places Larkhall Springs D56_D05_S20360_larkhallsprings_V233937_200605Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 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 11-Jan-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 D56_D05_S20360_larkhallsprings_V233937_200605Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over one day. 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. Three of the residents had visitors who gave their views to the inspector. What the service does well: What has improved since the last inspection? What they could do better: Supervision records need to evidence performance issues have been followed up or concluded. Larkhall Springs D56_D05_S20360_larkhallsprings_V233937_200605Stage4.doc Version 1.30 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 D56_D05_S20360_larkhallsprings_V233937_200605Stage4.doc Version 1.30 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 Larkhall Springs D56_D05_S20360_larkhallsprings_V233937_200605Stage4.doc Version 1.30 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) 1, 3 and 5 Residents have relevant information about the home. The admission process is generally well managed however, at the time of inspection there was an inappropriate placement for a service user out of category. The manager is addressing this. EVIDENCE: The Statement of Purpose has been reviewed and updated. The pre admission assessments examined were found to contain sufficient details. One new resident and their representatives said that they received a warm welcome. Relatives said they were informed of their loved one’s day to day progress in settling at the home by the manager. Larkhall Springs D56_D05_S20360_larkhallsprings_V233937_200605Stage4.doc Version 1.30 Page 9 Larkhall Springs D56_D05_S20360_larkhallsprings_V233937_200605Stage4.doc Version 1.30 Page 10 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) 7, 8, 9 and 10 Residents are looked after well in respect of their health and personal care needs. Residents or their representatives are involved in care planning. The medication is well - managed promoting good health. Personal support is offered in a way that promotes and protects residents’ privacy, dignity and independence. EVIDENCE: Reviews of care needs are undertaken monthly and each aspect of the person’s care needs are considered. Consultation with residents and/or their representatives during review processes continues to be in place. A visitor commented that access to other health professionals was promptly sought for their relative and that this gave them a sense of security for their loved one. Administration of medication was seen and considered to be safe. Larkhall Springs D56_D05_S20360_larkhallsprings_V233937_200605Stage4.doc Version 1.30 Page 11 Observation during the inspection showed care and anciliary staff displayed sensitivity and respect in their interactions with residents’. They were seen to knock on doors and wait for a response before entering and spoke to residents in a respectful way. Residents spoken with said this was usual practice. Larkhall Springs D56_D05_S20360_larkhallsprings_V233937_200605Stage4.doc Version 1.30 Page 12 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) 12, 14 and 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 service users are well catered for with a balanced and varied selection of food available that meets service users’ tastes and choices. EVIDENCE: Rising and retiring choices are documented during the assessment and referred to in the care plans. It was evident from the photographs displayed that friends and relatives are involved in social events in the home. During the inspection residents were observed in a reminiscence and general discussion group. One resident stated “it is nice to be able to have a topical discussion, I enjoy it greatly”. Those unable to participate were observed having one to one involvement with carers at different times in the day. Everyone who commented on the food, said how “good it was”. Menus are balanced and interesting, and a flexible enough to accommodate individual Larkhall Springs D56_D05_S20360_larkhallsprings_V233937_200605Stage4.doc Version 1.30 Page 13 preferences. Staff see each person individually the day before, and ask for their choices. Larkhall Springs D56_D05_S20360_larkhallsprings_V233937_200605Stage4.doc Version 1.30 Page 14 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, 17 and 18. Arrangements for protecting residents and responding to concerns are satisfactory. Staffs knowledge and understanding of Adult Protection issues provides a safe environment to protect service users from abuse. Residents are supported to exercise their legal rights. EVIDENCE: Residents’, visitors and staff comments showed that people feel comfortable discussing any concerns with senior staff or management. Training for the Protection of Vulnerable Adults is in place and updated regularly. This reinforces the staffs’ awareness and promotes safe practices with the residents’ at Larkhall Springs. Staff spoken with confirmed the benefit of this training. Residents spoken with said how they had been able to attend the polling station locally for the election. One resident said that “their post is delivered to them promptly in the am” Larkhall Springs D56_D05_S20360_larkhallsprings_V233937_200605Stage4.doc Version 1.30 Page 15 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, 20, 22, 24, 25 and 26. A clean, comfortable and safe standard of accommodation where personalisation of rooms is encouraged is provided for the residents. EVIDENCE: The environment is well maintained and suited to residents needs. The home is decorated and furnished to a standard that creates a comfortable and homely ambience. The residents’ bedrooms looked very homely, as residents are able to bring in small items of furniture and personal possessions with them. All areas of the home smelled pleasant and were cleaned to a high standard. Larkhall Springs D56_D05_S20360_larkhallsprings_V233937_200605Stage4.doc Version 1.30 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 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, 28, 29 and 30. Staffs’ at the home are well trained and supported and employed in sufficient numbers to meet the residents’ needs. Staff morale is high resulting in an enthusiastic workforce that works positively with service users to improve their quality of life. EVIDENCE: Staffing levels notice comply with the Staffing Notice requirements and the training programme incorporates the NTO training targets. Eight of the care staff hold NVQ2, 3 hold NVQ3 and 2 have commenced level NQ3. This momentum needs to be sustained if the standard is to be reached by end of 2005. Other training is currently being planned and will further support the staff in providing for the varied needs of the residents. This is supported by Cedar Care Group’s training manager. The four staff files looked at during the inspection showed that the manager has worked hard on improving the overall standard of information held on staff. Staff spoken with conveyed high morale and enthusiasm for their work. Larkhall Springs D56_D05_S20360_larkhallsprings_V233937_200605Stage4.doc Version 1.30 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, 33, 35, 36 and 38. The home is managed efficiently and in an open way but there needs to be better familiarisation with the category of registration. On observation of care files one resident was admitted out of category. Staff are appropriately supervised. Secure facilities are provided for the safe keeping of money and valuables on behalf of the residents. The health, safety and welfare of residents and staff are promoted and protected. EVIDENCE: 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. Larkhall Springs D56_D05_S20360_larkhallsprings_V233937_200605Stage4.doc Version 1.30 Page 18 All supervision notes are now kept in the home as previously required following the last inspection. However, the manager needs to ensure the outcome of performance issues, once concluded, is recorded. Lost items were observed in the safe. Discussion took place in the relation of holding items over a period of 3 months. When this time period has passed without ownership the items need to be handed in to the Police, as lost items. The records of tests to the fire safety equipment were in good order and health and safety issues were well managed. Larkhall Springs D56_D05_S20360_larkhallsprings_V233937_200605Stage4.doc Version 1.30 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 3 x 2 x 3 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 3 13 x 14 3 15 3 COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 x x x x x x x x Larkhall Springs D56_D05_S20360_larkhallsprings_V233937_200605Stage4.doc Version 1.30 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 3 Regulation 14 Requirement a) the manager to refamilerise with catergorys of Larkhall Springs.b) the manager to re familerise with the process of variation Timescale for action From 20/06/05 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 36 Good Practice Recommendations Ensure the outcome of performance issues, once concluded, is recorded. Larkhall Springs D56_D05_S20360_larkhallsprings_V233937_200605Stage4.doc Version 1.30 Page 21 Commission for Social Care Inspection 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 © 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 Larkhall Springs D56_D05_S20360_larkhallsprings_V233937_200605Stage4.doc Version 1.30 Page 22 - 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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