Inspection on 15/09/05 for Larklands House Care Centre

This inspection was carried out on 15th September 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Larklands House Care Centre 29/10/07

Larklands House Care Centre 27/11/06

Larklands House Care Centre 25/04/06

Larklands House Care Centre 08/09/04

Larklands House Care Centre 13/06/04

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

CARE HOMES FOR OLDER PEOPLE Larklands House Care Centre London Road Ascot Berkshire SL5 7EG Lead Inspector Susan Cledwyn-Davies Unannounced Inspection 15th September 2005 10:30 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 Larklands House Care Centre DS0000011001.V249625.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. Larklands House Care Centre DS0000011001.V249625.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Larklands House Care Centre Address London Road Ascot Berkshire SL5 7EG 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) 01344 872121 Ashbourne Homes Limited Mrs Seung Ping Parry Care Home 78 Category(ies) of Old age, not falling within any other category registration, with number (78) of places Larklands House Care Centre DS0000011001.V249625.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th June 2005 Brief Description of the Service: Larklands House Care Centre is a large purpose built home owned by Ashbourne Healthcare Ltd. The home is situated on the main London road and is close to Ascot village centre and Ascot racecourse. Accommodation is provided on three floors with passenger lift access. Each floor has its own dining room and lounge area. All bedrooms are pleasantly furnished and decorated and all have en-suite facilities. the registration includes a large number of double rooms;these are mainly let as singles. The home accomodates people who are frail elderly for long term care and for interim care through the local authority. Larklands House Care Centre DS0000011001.V249625.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place between 10.30am and 6.15pm. Included in the inspection was a partial tour of the home, discussion with the residents, visitors, manager and staff and examination of the records. In discussion with the Manager it was agreed that the term resident would be used instead of service user in this report. What the service does well: 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 House Care Centre DS0000011001.V249625.R01.S.doc Version 5.0 Page 6 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 Larklands House Care Centre DS0000011001.V249625.R01.S.doc Version 5.0 Page 7 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 3 The statement of purpose is in place; the service user guide is being prepared. No resident moves into the home without his or her needs being assessed. EVIDENCE: There is a current requirement that a service user guide be prepared to provide better information for residents in the home. This is being prepared and is almost finished. The requirement is therefore repeated. All residents are assessed prior to admission to the home. The pre-admission assessments are kept within the care plans. There is a good understanding of the needs that can be met in the home. Larklands House Care Centre DS0000011001.V249625.R01.S.doc Version 5.0 Page 8 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 and 10 Each resident has an individual plan of care. Health care needs are met. Medication administration and storage are protected by clear policies and procedures. Residents are treated with respect. EVIDENCE: There has been a review of care plans by a senior nurse from the company. The result of this was a thorough review of care plans in terms of the standards and the proprietor’s policy. Following this care plan training took place and then all care plans have been reviewed, updated and reorganised. It is now much easier to access significant information and comments within the care plans showed that staff were also able to follow through queries more easily. All care plans were updated at the time of the review but some care plans had already not been reviewed monthly. Health care needs are met by two local surgeries. Both of these have weekly surgeries. One GP was seen during the inspection and found the staff were responsive and was positive about the care in the home. Pressure area equipment has been serviced and some new equipment bought. There was only one pressure sore that is improving slowly. Records followed the progress. Larklands House Care Centre DS0000011001.V249625.R01.S.doc Version 5.0 Page 9 The medication administration is by qualified staff. All new qualified staff are given the policy and procedure and their practice checked against this by the Manager or senior staff. The administration records were well maintained. Medication to be disposed of is now managed by the home. An additional contract has been started with the waste disposal company and a specialised storage container is used. This container was kept in the largest treatment room. It was possible to take medicine out of this box therefore it is necessary to lock the box away separately with only limited access by any staff. Larklands House Care Centre DS0000011001.V249625.R01.S.doc Version 5.0 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Residents’ preferences and interests are known and encouraged. Contact with relatives and friends is encouraged. Residents have choice in their lives. Residents have a balanced diet, with a varied choice. EVIDENCE: The activities organiser provides a varied activities programme including outings monthly to local sites of interest. Once a year there is also a cruise arranged. This year the cruise at home is going to Thailand and countries around this. The activities and meals for a week are arranged around this theme ending in a large social and fundraising event. Residents and relatives spoke well of the cruise, enjoying the fun and variety. Visitors came to the home and spoke of being made welcome. Residents have choice in how they spend their day. The activities schedule is displayed for the month. The activities organiser spends time with each new resident to find out about his or her interests and hobbies. Residents have a choice of meals and the place that they eat them. One exception was found in the choice of meals. The meals are balanced and include some fresh food mixed with frozen. Contract caterers provide the food. The menu was seen. The chef provides Larklands House Care Centre DS0000011001.V249625.R01.S.doc Version 5.0 Page 11 two hot choices on the menu and will also prepare other meals if requested e.g. jacket potatoes and chips with something. Staff and residents confirmed this during the visit. There had been some unhappiness with the meals provision and the manager had arranged for a survey to be completed. The results have just been collated and the menus altered. There is a food committee that meets twice a year including the chef, the manager and a group of residents. The committee brings forward suggestions and changes. One resident spoke of the food being slightly improved in the last month. Many enjoyed the meal seen during the visit. A few residents were dissatisfied and this was reported back to the Manager. A factor in this may be that the residents were eating a different roast meat to that which they had chosen. The meal choices had changed because of deliveries and but residents had still been given the choice of the original roast meat. Staff confirmed to residents the wrong choices. In discussion with the chef and subsequently with the Manager it was agreed that residents should be correctly aware of the meal choices. There are dining rooms and servery areas on each floor. The meal was kept hot here and served to the residents on that floor. Residents are able to eat in their room or in the communal dining room. There were different practices when serving on the ground and first floor. On the ground floor 2 staff served meals while one member of staff assisted residents to eat. The meals for residents needing help were served as required and kept hot in the hot plate. On the first floor all meals were served including to those residents who needed help and then residents needing help were assisted last. The meal would then be cold. The manager agreed that the practice should be the same and that residents should be eating hot food and not sitting in front of a meal unable to help themselves. Larklands House Care Centre DS0000011001.V249625.R01.S.doc Version 5.0 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Residents and their relatives are confident that their complaints will be listened to and acted upon. There is an awareness of the need to protect residents from abuse. EVIDENCE: There is a complaints policy and procedure in place. The complaints record was seen and noted one complaint investigated since the last inspection. There is a positive approach by the manager to complaints. There is an outstanding protection of vulnerable adults investigation. This is awaiting a Coroners court in the neat future. Larklands House Care Centre DS0000011001.V249625.R01.S.doc Version 5.0 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 23 and 26 The decoration and furnishings are satisfactory. Individual rooms reflect different interests and tastes. The house is clean and tidy. EVIDENCE: The decoration and furnishings are satisfactory. There is a programme of replacement of worn carpeting and furniture and redecoration. Recently there has been some new carpeting provided. In the tour a number of the individual rooms were seen. Each room included personal items and some had own furniture. The house was clean and fresh smelling. In discussion with house keeping staff there were new cleaning products being used. COSSH guidelines to give advice in case of an accident with these products were not yet displayed. These were obtained but not accessible. Larklands House Care Centre DS0000011001.V249625.R01.S.doc Version 5.0 Page 14 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, 28 and 30. There is sufficient staff on duty. Staff are receiving NVQ training. Staff training is taking place but it is not possible to ensure that all staff have received mandatory training. EVIDENCE: The manager and staff understand the need for further training. Once the three current staff taking NVQ 2 have completed their training then the home will have achieved 50 of care staff with this training. The staff rota reflected the current staffing levels. By observation and in discussion with staff there were sufficient staff but there were times when staff were moved from one floor to another during the middle of a shift. The rota showed that this did not happen more than once a week. There was a comment from one relative that the staffing levels were sometimes low and staff too busy. This comment was discussed with the manager. There was no direct evidence of low staffing levels during the visit. The manager is asked to observe staffing levels and ensure that there is an adequate amount of staff. During the visit there was staff training taking place on moving and handling. The training records demonstrated that mandatory training took place but did not demonstrate that all staff had received this training. The record shown demonstrated that a number of care staff had not received mandatory training. This record had only been made from 1st April and the manager was sure that more staff had received the training but that the record was not updated. The Larklands House Care Centre DS0000011001.V249625.R01.S.doc Version 5.0 Page 15 home needs to ensure that all staff receive the mandatory training so that care practice is safe. English learning is being provided for staff from abroad. Larklands House Care Centre DS0000011001.V249625.R01.S.doc Version 5.0 Page 16 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, 33, 35, 36 and 38 The manager is experienced and provides a good role model to staff. EVIDENCE: The manager is experienced and has a care qualification. She is in the process of taking NVQ 4 in management and the registered managers award. She has completed a number of modules. The care manager is changing. There was also discussion about providing a senior nurse on each floor as well as a care manager with an overall view. The senior nurse will help to ensure updating of care plans and good organisation at meal times. This would be very positive. There is an annual development plan that was seen. Resident surveys have taken place about the food provided. The manager is using the results to improve the service. Larklands House Care Centre DS0000011001.V249625.R01.S.doc Version 5.0 Page 17 Records of staff supervision were seen. There was one individual supervision noted for each member of staff. In addition each member of staff has an annual appraisal. In discussion with staff some were had had supervision, some were unaware. This supervision record is from April and the minimum noted in the standards is to have supervision six times a year. It is important that supervision takes place to ensure that staff competency and training is monitored. Team meetings take place 6-8 weekly and staff confirmed that these meetings were useful. There is a good awareness of health and safety. Servicing of systems and equipment take place. Fire precautions are maintained. Larklands House Care Centre DS0000011001.V249625.R01.S.doc Version 5.0 Page 18 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 2 X 3 X x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X 3 X X 2 STAFFING Standard No Score 27 3 28 3 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 x 3 Larklands House Care Centre DS0000011001.V249625.R01.S.doc Version 5.0 Page 19 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 2 3 4 Standard 1 7 9 15 Regulation 5 17 16 16 Requirement That the service users guide be completed and given to each service user. This is repeated. That all care plans be reviewed monthly. That the disposed of medication be kept securely. That the correct menu choices are given to residents and that all residents including those having assistance receive hot meals. That COSSH guidelines be displayed by cleaning stores. That all staff receive mandatory training and that the manager is able to clearly demonstrate the training received by each member of staff. That all staff receive individual supervision six times a year. Timescale for action 01/11/05 01/10/05 01/10/05 01/10/05 5 6 26 3o 23 18 01/10/05 01/11/05 7 36 18 01/04/06 Larklands House Care Centre DS0000011001.V249625.R01.S.doc Version 5.0 Page 20 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 Refer to Standard 31 31 Good Practice Recommendations That the manager completes the NVQ 4 in management. That the senior cover in the home includes a senior nurse on each floor. Larklands House Care Centre DS0000011001.V249625.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Berkshire Office 2nd Floor 1015 Arlington Business Park Theale, Berks RG7 4SA 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. 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