CARE HOME ADULTS 18-65
Larklands And Church View St Johns Road Ilkeston Derbyshire DE7 5PA Lead Inspector
Brian Marks Unannounced Inspection 21st September 2005 10:00 Larklands And Church View DS0000002171.V252385.R01.S.doc Version 5.0 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 Larklands And Church View DS0000002171.V252385.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 Adults 18-65. 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. Larklands And Church View DS0000002171.V252385.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Larklands And Church View Address St Johns Road Ilkeston Derbyshire DE7 5PA 01522 560950 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) United Health Limited David Wagstaff Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Larklands And Church View DS0000002171.V252385.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 13th April 2005 Brief Description of the Service: Churchview and Larklands is a purpose built home offering 10 places for adults with a severe learning disability, set in 2 bungalows linked at the rear through the enclosed garden areas. The physical environment of the home was designed with the group of residents in mind, and is spacious and comfortable with a good range of facilities and accesible for people with mobility difficulties. It is close to the town centre of Ilkeston with easy acces to local facilities. The current residents were all admitted as part of the closure of Aston Hall Hospital, near Derby, and all had spent a long time living in the hospital environment; there have been no changes in the resident group since opening in 2000. Because of the high levels of learning disability in the resident group, the home offers an intensive package of support, and the number of staff is accordingly set very high. The initial registration was as a residential home but, with changes in the physical needs of some of the service users, this is now one of a care home with nursing, and a qualified nurse is on duty at all times. Larklands And Church View DS0000002171.V252385.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced visit that took place at the home over a morning. Additionally, time was spent in preparation for the visit, looking at previous reports and other documents. Apart from examining documents, care files and records, time was spent looking around the 2 buildings that make up the home and speaking to staff who were on duty and to the manager. Because all of residents had a lot of difficulties expressing themselves in words, they were not able to contribute directly to the inspection process, but they were observed throughout the visit working with and being cared for by staff. The most important activity of inspection is the careful examination of residents’ individual care records, and 1 was selected for this purpose. The aim of inspection activity during the current inspection year is to assess a service against the ‘key’ National Minimum Standards and these are identified at the beginning of each section of the report. The majority of these keys standards were examined at the last inspection so, for a more complete picture of this service, this report should be read in conjunction with the report dated 12th April 2005. What the service does well:
The staff are a committed group of people and they work hard to make the home a happy and safe environment for the residents to live in. They help each other to care for the residents and to treat each person at the home as an individual with a unique personality. Because they work successfully as a team, the staff are able to deal with difficulties around the home in a calm and consistent way. The nurses, in particular make sure that health problems are attended to properly. Staff are helped to care for the residents successfully by a good system of documents and records. The problems faced by residents are identified in clear care plans and staff use these to all work in the same way. The home is well run because every one has a clear idea about what is needed to keep the residents safe, and to give them the care that they need. The home itself was opened in 2000 and was built with the present group of residents in mind. All of the rooms are large and have been fitted out with good quality furniture that, for some of the residents, is designed to meet special requirements. Equipment has been provided to help staff care for people who have difficulty moving around and this is particularly true in the bathrooms which have had a lot of money spent on their fixtures and fittings. Standards of decoration of the home are good. Larklands And Church View DS0000002171.V252385.R01.S.doc Version 5.0 Page 6 Staff have made efforts to provide interesting and stimulating activities for the residents and, because the home had a lot of staff on duty, they are able to go on outings and to have individual 1-to-1 time. Residents go on holidays, accompanied by staff and this year a number have been planned for foreign destinations. 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. Larklands And Church View DS0000002171.V252385.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Larklands And Church View DS0000002171.V252385.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Detailed individual assessments of needs are carried out at the home so that support can be given consistently, and the welfare and safety of residents maintained. EVIDENCE: Information received from previous inspections and from the examination of case files indicated that residents had extensive assessments of their requirements carried out before they came to the home. The plan for offering care and support is summarised in each resident’s file as a set of ‘action plans’ and ‘risk assessments’, individual to them. The process of assessment had continued after the residents had settled at the home, with additional inputs from outside professionals. The manager had recently received a set of documents that are planned to be introduced at the home as a system of ‘Person Centred Planning’, and this was discussed during the inspection visit. Larklands And Church View DS0000002171.V252385.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 9 Detailed individual plans have been developed at the home so that support can be given consistently, and include the management of risk areas so that the overall welfare and safety of residents is maintained. EVIDENCE: The care records examined indicated that residents have an individual care plan, put together from the assessments that had taken place and was complied as a series of ‘action plans’ and ‘risk assessments’. The care plans cover personal and health care activity, and specific examples of the latter include the management of the resident’s epilepsy and mobility problems; this indicates that support is offered safely and consistently. There was evidence that each element of the care plan is reviewed both by the staff of the home and also external professionals. However this activity had not been carried out very regularly, and resident welfare is potentially put at risk by staff acting on information that is not up-to-date. For the assessment of the other key standard see the inspection report dated 12 April 2005. Larklands And Church View DS0000002171.V252385.R01.S.doc Version 5.0 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17 Residents are assisted to enjoy a varied and healthy diet that is based on their preferences and individual needs. EVIDENCE: Examination of the menus at the home and discussion with staff indicated that a planned menu is provided at the home. This reflects individual resident preferences that have been established over the life of the home and worked into a variety of meals that are based in principles of healthy eating. Fresh ingredients were in evidence in the kitchens and regular food shopping is carried out locally which some of the residents join in with. Specific health needs are reflected within the catering arrangements, such as both weight loss and gain; the diabetic problems of 1 resident are also carefully monitored through diet management. The residents take all their meals together in the dining room and staff are available to give direct assistance to those that need it. For the assessment of the other key standards see the inspection report dated 12 April 2005. Larklands And Church View DS0000002171.V252385.R01.S.doc Version 5.0 Page 11 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 The administration of medicines by staff is well organised and the absence of recording gaps indicated an improvement in practice safety. EVIDENCE: There are no residents who manage their own medicines. The examination of individual care records, of the home’s medicines records and of the 2 clinic rooms indicated that systems of storage and administration operated by staff, are satisfactory, and indicated improvements from the last inspection. For the assessment of the other key standards see the inspection report dated 12 April 2005. Larklands And Church View DS0000002171.V252385.R01.S.doc Version 5.0 Page 12 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 The home has a comprehensive complaints policy and procedure and residents’ interests are supported by outside professionals, family members or an independent advocate. EVIDENCE: The home has a comprehensive complaints policy and procedure that has been centrally developed by the company and regularly updated. A copy of the policy is included in the Service Users Guide, which is given to residents and their representatives, and a summary is also on display at the home. The manager reported that there had been no formal complaints made by anyone within the past 12 months and that an advocate from the local advocacy project has regularly offered support to individual residents. All residents have outside professionals also looking after their interests. For the assessment of the other key standard see the inspection report dated 12 April 2005. Larklands And Church View DS0000002171.V252385.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 The home is equipped, furnished and maintained to a high standard and offers homely and spacious facilities for residents to enjoy. This is both a valued and valuing environment in which to live and work. EVIDENCE: The home was built specifically for this group of residents, and its corridors and rooms are large and it was supplied with a good range of equipment, furniture and fittings that are what could be expected in an ordinary domestic setting as well as specialised equipment for specific individuals. Security against both intruders coming in, and residents going into unsafe places or wandering off, is covered by a number of keypad systems. The home is near the town centre of Ilkeston and the home’s transport offers good access to local amenities. The improvement programme of the home has been continued since the last inspection and 3 of the residents have been supplied with special beds, 1 with a special chair in the lounge and 1 bedroom has been fitted with new non-slip cushion flooring. The home continues to benefit from the services of a maintenance worker who ensures that all repairs are completed quickly and who is also responsible for a number of health and safety activities. The home was observed to be clean, hygienic and free of odours on the day of the inspection and all of the residents were dressed in clean and appropriate clothing.
Larklands And Church View DS0000002171.V252385.R01.S.doc Version 5.0 Page 14 Because of the high standard of the environment of the home these 2 standards are scored as 4. Larklands And Church View DS0000002171.V252385.R01.S.doc Version 5.0 Page 15 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 and 35 The home is well staffed with experienced, skilled and knowledgeable people who are receiving regular training to help them assist residents in more efficient and safe ways. Administrative systems in place do not allow for monitoring of training activities so that priorities can be established and followed through. EVIDENCE: Information available at the inspection indicated that a full complement of nurses was now in post, with both general and specialist qualifications amongst them. There was a good range of skills, knowledge and experience within the staff group to help residents with care and support and this was observed being put into practice during the inspection. Records on staff files showed that 13 care staff had completed or were completing an NVQ qualification at a minimum of level 2, and the manager reported that the required proportion of 50 of staff succeeding by the due date should be achieved. The deputy manager has taken responsibility for organising staff training within the home, and records had been organised into a number of pages within a computerised folder. However it was not possible to fully assess the achievements in key areas and discussion with the manager concluded that the record was not complete. The ability to monitor staff training and set priorities is limited by this. The National Minimum Standards (NMS) recommend that any training provided must reflect the nationally agreed standards of the Learning Disability Award Framework.
Larklands And Church View DS0000002171.V252385.R01.S.doc Version 5.0 Page 16 For the assessment of the other key standard see the inspection report dated 12 April 2005. Larklands And Church View DS0000002171.V252385.R01.S.doc Version 5.0 Page 17 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 The manager and his deputy are qualified nurses and need to apply their skills to the development of a future plan for the home, in order to ensure that life for the residents is as good as it can be. Safety of the home is well managed, but there is need for further training for staff in the important subjects that are required by the law. EVIDENCE: The manager and his deputy are both nurses with a learning disability qualification and have extensive experience of a variety of residential services. The manager is currently completing a Registered Manager’s course (NVQ4) with a training agency. The company have a quality monitoring system based on monthly audits by the home’s line manager and copies of these reports have regularly been sent to CSCI. An annual plan had been developed for the home, as required at the last inspection, but this document was very brief and did not relate activities to the aims and objectives of the home, as outlined in the home’s Statement of Purpose, and did not indicate any inputs by the staff group or any timescales Larklands And Church View DS0000002171.V252385.R01.S.doc Version 5.0 Page 18 for achievement. There are no other formal systems of consultation and quality assurance in place for the home. The examination of records and observations around the home indicated that systems for the management and monitoring of health and safety had been properly maintained. However the training records (mentioned in the last section) did not indicate that staff, particularly those recently appointed, had received training in important aspects of health and safety practices. A manager from an associated home, a qualified trainer in safe moving and handling techniques, was providing regular training in that subject on a regular basis. Larklands And Church View DS0000002171.V252385.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 Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X X X Standard No 22 23 Score 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X X 2 X Standard No 24 25 26 27 28 29 30
STAFFING Score 4 X X X X X 4 LIFESTYLES Standard No Score 11 X 12 N/A 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 2 X X 2 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Larklands And Church View Score X X 3 X Standard No 37 38 39 40 41 42 43 Score 2 X 2 X X 2 X DS0000002171.V252385.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Yes 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 YA6YA9 Regulation 15 (2) Requirement The registered person must ensure that all elements of the resident’s care plans – action plans and risk assessments – are reviewed regularly and at least every 6 months. The target of 50 of all care staff achieving an NVQ at a minimum of level 2 must be completed by the due date. The planned training activities for staff must be recorded in a form that allows for easy monitoring and review. A copy of this must be forwarded to CSCI for examination. (Previous timescale of 30/06/05 not met). The registered manager of the home must achieve an NVQ in management and care at level 4 by the due date. The registered person must redevelop a cycle of annual planning that covers all aspects of the running of the home. (Previous timescales of 31/03/05 and 31/07/05 not met). The registered person, must
DS0000002171.V252385.R01.S.doc Timescale for action 31/12/05 2 YA32 18 (1), 19 (5) 18 (1) 31/12/05 3 YA35 31/12/05 4 YA37 9 (2) 31/12/05 5 YA39 24 (1-3) 31/12/05 6 YA42 13 (4,5), 31/03/06
Page 21 Larklands And Church View Version 5.0 18 (1) provide all staff with instruction/training in relation to manual handling, emergency first aid and food hygiene. (Previous timescale of 31/03/05 and 30/09/05 not met). 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 2 3 Refer to Standard YA14 YA35 YA39 Good Practice Recommendations The need for a second vehicle at the home should be reviewed and arranged. Any training provided by staff should reflect the guidelines of the Learning Disability Award Framework (LDAF). Systems for consultation and surveying the views of all parties interested in the running of the home should be developed and implemented as part of the development of a quality assurance programme for the home. A copy of the financial plan for the home should be available for inspection. 4 YA43 Larklands And Church View DS0000002171.V252385.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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