Inspection on 08/01/07 for Larkhall Springs

This inspection was carried out on 8th January 2007.

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 15/11/05

Larkhall Springs 20/06/05

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 Key Unannounced Inspection 8th January 2007 10:00 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.V326479.R01.S.doc Version 5.2 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.V326479.R01.S.doc Version 5.2 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.V326479.R01.S.doc Version 5.2 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 15th November 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.V326479.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Key inspection was conducted unannounced over 1.5 days and focused on the assessment of key standards. The main purpose of the visit was to check on the welfare of the residents, ensure the premises are well maintained and to examine health and safety procedures. During the site visit, the records were examined, a tour of the premises conducted and feedback sought from residents; staff and visiting health professionals. In addition to key records, surveys were sent to residents in advance of the inspection. Comment cards for relatives and visitors who visit the care home were also received. A number of residents and visitors were also spoken with about the quality of care provided at the home. What the service does well: Staff at Larkhall Springs, continue to provide a high standard of care to the residents. The residents felt that they were well treated as valued equals and their opinions are sought in all sorts of areas of the running of the home. The home is homely and comfortable and provides an appropriate environment to meet the needs of older people. There is a happy atmosphere. Individual aspirations and choice are well supported, monitored and encouraged by both the acting manager and staff employed at the home. It is clear that opportunities exist for residents to participate in a wide range of meaningful activities. Residents were positive about the recreational activities on offer. Visitors are made very welcome and meals are well managed and provide daily variation, nutrition and social contact for people. Larkhall Springs DS0000020360.V326479.R01.S.doc Version 5.2 Page 6 Larkhall remains a well equipped home with a safe standard of accommodation provided for the residents. Personalisation of individual rooms are well promoted. Staff performance and development is well monitored and supported. What has improved since the last inspection? What they could do better: 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. The summary of this inspection report can be made available in other formats on request. Larkhall Springs DS0000020360.V326479.R01.S.doc Version 5.2 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.V326479.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is (excellent, good, adequate or poor). 3,4,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The process of admission of prospective residents is detailed and well planned to enable the residents to make a choice of moving to the home. EVIDENCE: Three residents care files reviewed contained detailed assessment of physical, emotional and social needs before admission to the Larkhall Springs DS0000020360.V326479.R01.S.doc Version 5.2 Page 9 home. Residents spoken with made positive comments about the home and staff. One resident spoken with on the day of inspection stated “ I came to look round with my daughter and saw this room and liked it. I like it here staff are very good and kind to us.” Another resident spoken with stated that they signed a contract at the home. It was agreed that the home provides prospective residents with a written confirmation that their needs will be met in respect of health and welfare after assessment. Staff spoken with demonstrated understanding of the needs of the resident. Larkhall Springs DS0000020360.V326479.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 10, 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home offers care and support to residents throughout their lives and towards the end, it also protects the residents by reviewing their health needs and there is appropriate drug administration. EVIDENCE: Four care files, including that for the individual whose relative was not satisfied with some aspects of the care provided, were reviewed. There was evidence of pre assessment before the residents were admitted to the home. The six care files seen contained individualised care plans in relation to each assessed need and Larkhall Springs DS0000020360.V326479.R01.S.doc Version 5.2 Page 11 gave clear direction to staff to enable them to deliver appropriate care to the residents. Staff spoken with stated that they have access to the care files. These care files were noted to have been reviewed monthly and when needs change. Entries in the daily progress note showed that care provision was being followed as written in the care plan. However, it was noted that for one resident the entries for the monitoring of fluids had not been totalled for the preceding day. This individual was met in their room and stated, “ I am happy here and I like the staff”. These concerns were raised with the manager and acted upon immediately. In regard to how residents perceive their care at the home, one resident stated, “ I am happy here, staff look after me well. I get up when I like and I go to bed when I like.” Another resident stated, “staff are very kind, I look forward to having my bath.” One resident stated staff “respect me and always made sure that the door is closed when I am bathing or using the toilet”. One resident stated, “I signed my care plan.” Written feedback from “Have your say” include “the nursing care is of a high standard and I am very happy with the conditions”, Staff were observed knocking on the doors before going in to the residents rooms to assist them with personal care. The care files viewed had evidence of visits from the health professionals to include General Practitioners (GP) Chiropodists, Opticians and Dentists. Medication administration was not reviewed during this inspection. Staff spoken with were aware of measures to be taken if a resident became terminally ill and in the event of death. Staff also demonstrated awareness of the importance of ensuring that information about residents is kept confidential. Larkhall Springs DS0000020360.V326479.R01.S.doc Version 5.2 Page 12 Larkhall Springs DS0000020360.V326479.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are enabled to maintain links with their families, they are also provided nutritious meals and meaningful activities. EVIDENCE: Care plans reviewed contained a social assessment form which is completed by the resident or their representative on admission to enable the home to plan a suitable activity based on the details given. Records of the residents who participated in activities were noted in the activities book to include residents that declined and reason for decline. One resident spoken with stated I do not like to take part in activities, I am content in my room, I do a lot of reading”. Larkhall Springs DS0000020360.V326479.R01.S.doc Version 5.2 Page 14 Weekly activities displayed on the residents’ notice board included Board Games (Monday) Chair exercise (Tuesday), Cookery (Wednesday), Craft (Thursday), Bingo, Sherry, Games (Friday). Photographs of the Christmas Events were seen displayed at the reception. Residents spoken with stated that the home actively supports them to maintain contact with families, friends and representatives and that visiting time is not restricted. One resident told the inspector that their family visit regularly. “The Vicar or a lay person from the church comes to see us because I find it difficult to get around”. Another resident stated, “Our friends and relatives come to see us”. Other comments made by residents include “My daughter comes to seem me; my son came yesterday. My grandson came to see me the other day” The menu on the day was displayed on the notice board in the dinning room. There was plenty of fresh fruit bowls available from which residents could take their choices. It was also noted that the residents were offered a glass of fruit juice each with their meal. Residents spoken with after lunch stated that they enjoyed their meal. One resident stated, “Food is very good, I can’t eat it all.” Staff were noted interacting with residents at mealtime and residents who needed assistance were helped in a sensitive and dignified manner. Larkhall Springs DS0000020360.V326479.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are enabled to complain and are confident that their complaint will be listened to. Practices at the Home ensure the protection of residents from harm and abuse. EVIDENCE: The Commission for Social Care inspection received a letter from a relative in relation about unsatisfactory personal care of an individual at the home. At a discussion with the acting manager, it was agreed that a copy of the outcome of the investigation be forwarded to the Commission. The Home has appropriate and robust procedures in place for management of complaints. The complaints procedure was noted displayed in the hallway at the entrance. Residents spoken with and responses noted on the comment cards evidenced that residents are aware of whom to complain to. One Larkhall Springs DS0000020360.V326479.R01.S.doc Version 5.2 Page 16 resident stated, “I have no reason to complain”. One resident stated that they are aware of their rights and were enabled to vote using the postal voting system. Staff are aware of the Whistle Blowing policy and would report any bad practices to the Acting Manager without fear of reprisal. There is evidence of staff training in relation to Protection of Vulnerable Adults from Abuse. There is a copy of the Bath and North East Somerset Council policy on The Protection of Vulnerable Adults from Abuse at the Home to ensure that the Home is aware of the protocol to be followed if incidents of abuse occur. Larkhall Springs DS0000020360.V326479.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good . This judgement has been made using available evidence including a visit to this service. The residents enjoy a suitable, safe environment. EVIDENCE: Whilst touring the building the home was found to be clean, warm, and free from offensive odour and suitable for its stated purpose. However, the main lounge artificial lighting was very dim. Residents seating positions in the lounge did present a feeling of relaxation and more of a regimented look. This was discussed with the acting manager and she stated that she would undertake a review of this with the residents. The bedroom of the resident whose relative raised concern in relation to cleanliness was noted to be clean and tidy on the day of inspection. Larkhall Springs DS0000020360.V326479.R01.S.doc Version 5.2 Page 18 Some residents spoken with stated that they felt safe at the home. The laundry was found clean and tidy, there were adequate laundry facilities and the laundry staff met on duty stated that resident’s clothes are placed in individual boxes and are put away by the laundry person. Soiled clothing is washed separately and staff informs the laundry of any infection at the home. Staff were noted wearing aprons and gloves and washing their hands after attending to the residents. This demonstrated that infection control and principles of hygiene is well maintained at the home. The maintenance book was up to date clearly stating jobs/tasks to be carried out, date completed and any relevant comment in relation to outstanding jobs. Larkhall Springs DS0000020360.V326479.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good . This judgement has been made using available evidence including a visit to this service. The staffing level at the home is sufficient to meet the needs of the residents. Staff receive training and are competent, however, training on challenging behaviour has not been provided to protect the residents. EVIDENCE: Evidence from staff rota and discussion with the manager showed that the home has a sufficient staffing level to meet the needs of the residents. Residents spoken with stated that staff are kind, attended them when they rang the bell and treated them with respect. The home operates a key working system to enhance the resident/staff relationships. Larkhall Springs DS0000020360.V326479.R01.S.doc Version 5.2 Page 20 Staff have attended training to include Dementia Awareness, Protection of Vulnerable Adults from Abuse, Basic Food Hygiene, First Aid and Control of Substances Hazardous to Health. It was also noted that some staff members have achieved National Vocational Qualification (NVQ) at level 2 and 3. One staff member spoken with confirmed that they were currently undertaking NVQ at level 3. The recruitment policy and procedure in relation to recently appointed staff was satisfactory. Larkhall Springs DS0000020360.V326479.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 34, 36, 37, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The views of family and friends are sought on how the home is run. Staff are regularly supervised. Residents’ best interests are not consistently safeguarded by the home’s record-keeping practices. The safety of the building for service users and staff is well promoted but the health and welfare of residents is not consistently promoted and protected. Larkhall Springs DS0000020360.V326479.R01.S.doc Version 5.2 Page 22 EVIDENCE: The atmosphere at the Home on the day of inspection was positive and welcoming. Staff were noted interacting with residents in an informal and friendly manner. Staff spoken with stated that staff work as a team and that the Acting Manager has good leadership qualities. These have enabled staff to provide quality care and to support the residents. Residents spoken with made positive comment about the acting Manager, Mrs Jane Mbanacele. One resident stated that Jane is kind, “she comes to see us. I would go complain to the manager if I have any concerns.” One comment card received from a health professional states “ I regard Larkhall Springs as a very well run home”. “The new manager seems to be very capable and she has sat and chatted with me several times asking my opinion on how the home is for me”. “ I am happy with the care and love my father receives. The staff are always kind and caring to all residents” At a discussion, the Acting Manager stated that she had recently completed Manual Handling Training for Trainers Course to enable her to train and update staff routinely and when necessary. The manager also stated that she recently attended First Aid training update to ensure that residents, staff members and visitors are protected in medical emergencies Staff supervision was reviewed. Evidence from the records viewed showed that some staff had received group supervision others on a one to one basis. Staff spoken with confirmed this and had said Larkhall Springs DS0000020360.V326479.R01.S.doc Version 5.2 Page 23 that they were looking forward to one to one supervision with the Acting Manager. One to one supervision will afford them the opportunity to express their opinion about the services provided at the home and to discuss areas of concern in relation to residents’ care. This will be focused again at the next inspection process. Health and Safety records showed that the home had undertaken generic risk assessments of vulnerable areas of the home. Other health and safety records are up to date. At the time of inspection there was a problem with the plumbing down to the laundry storage area. This was actioned with risk assessments and an action plan. Accidents were noted to be properly recorded and reviewed as required. Discussion relating to the use of informing the Commission for Social Care Inspection through the Reg 37’s forms were discussed. The fire log-book was noted to be up to date and evidence from records and confirmation from staff showed that staff have attended fire drills. Quality assurance for the Home was reviewed. The Acting Manager stated that the home audits it quality of service using different tools. These include leaflets for feedback from health professionals, relatives and residents; one to one discussions with residents following any concerns raised are resolved as soon as possible; Medication audit; Residents’ money audit; Risk assessment of individual residents and general risk assessment of the home; staff supervision; care plan reviews monthly and when required; monthly health and safety checks; discussions at residents’ and staff meetings. The most recent resident’s meeting was on 23/10/06, issues discussed include Food, Activities, Day Care, Night Care and general matters. The home has policies and procedures to include Protection of Vulnerable Adults from Abuse, Medication, Whistle Blowing, Manual Handling and Infection Control. These have recently been updated. Larkhall Springs DS0000020360.V326479.R01.S.doc Version 5.2 Page 24 Residents’ documented information was noted to be securely locked away. Larkhall Springs DS0000020360.V326479.R01.S.doc Version 5.2 Page 25 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 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 Larkhall Springs DS0000020360.V326479.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? no 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 OP8 Regulation 12(1)(a) Requirement Timescale for action 08/01/07 Attention to fluid intake and output monitoring would enhance the health and tissue viability of vulnerable people. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Larkhall Springs DS0000020360.V326479.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. 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