Inspection on 25/04/06 for Larklands House Care Centre

This inspection was carried out on 25th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 15/09/05

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 Mrs Rhian Williams-Flew Unannounced Inspection 10:00 25 & 28th April 2006 th 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.V294778.R01.S.doc Version 5.1 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.V294778.R01.S.doc Version 5.1 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 ** Post Vacant *** 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.V294778.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th September 2005 Brief Description of the Service: Larklands House Care Centre is a large purpose built home. 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 primarily let as single rooms. The provider advised that the range of fees as of April 2006 were, £497.35 - £1025.00. There are additional charges for Hairdressing; newspapers; chiropody and toiletries. Larklands House Care Centre DS0000011001.V294778.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The accumulated evidence used to inform this report includes a pre-inspection questionnaire completed by the manager of the home; our inspection records; 33 resident surveys; an unannounced site visit on 25 April 2006 and a short notice site visit on 28 April 2006. During the unannounced site visit conversations were held with residents, their relatives and members of staff; observations were made of the delivery of care; a partial tour of the home was made and a 10 sample of case files were case tracked. The manager was present throughout the two site visits undertaken. The first site visit took place between 10.00am and 8.00pm and was conducted by two Inspectors. The second site visit took place between 9.30am and 1.30pm. What the service does well: What has improved since the last inspection? What they could do better: The home must ensure that residents have contracts for their care in the home. All assessments undertaken prior to someones admission to the home Larklands House Care Centre DS0000011001.V294778.R01.S.doc Version 5.1 Page 6 must ensure that the persons needs are within the category of care that the home is registered for. Residents should be included, wherever possible, in their care planning and the care plans should reflect the up-to-date needs and wishes of the residents. The home must act on recommendations by healthcare professionals to refer residents to specific specialists and residents who are entitled to free chiropody services should have access to them. The resident’s wishes with regard to their lifestyle and choices must be respected. Medicines should be administered in a safe way at all times. Members of staff should pay heed to risk assessments when they are in place. Residents who are unable to join the group activities should receive individualised activities to stimulate and interest them. The quality and temperature of food must improve. Members of staff should have sufficient time to ensure that those residents who need assistance with feeding receive it in a timely manner whilst the food is still hot. There should be sufficient crockery and clean cutlery for residents to use. The home must employ sufficient permanent staff to meet the needs of the residents. In addition, a review of staffing ratios should be considered to ensure that all residents received their care in a timely manner. Presently, this is a significant area of concern for the residents who presently live in the home. 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.V294778.R01.S.doc Version 5.1 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 Larklands House Care Centre DS0000011001.V294778.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 4 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The exception being that the home does provide information about the services it can provide. EVIDENCE: Of the resident surveys returned to CSCI during the inspection period approximately 75 indicated that they had received information about the home before they had moved in. For others they indicated that their relatives had made the choice whilst others had no recollection of any information being presented to them. However, approximately 75 of the surveys indicated that the residents had not received a contract for their care in the home. In conversations with a small random sample of residents some of them indicated that they thought the contract had been made with their relatives or the local social services department. In addition, to ensure that residents are involved and make the right choice of home it is important that their needs are fully assessed prior to admission to the home. This is to ensure that the facilities and staff in the home will be able to meet any care needs the people have. Samples of pre-admission Larklands House Care Centre DS0000011001.V294778.R01.S.doc Version 5.1 Page 9 assessments for some of the most recently admitted residents were reviewed. It was found that in recent months at least one person has been admitted with a known diagnosis of Alzheimers and another admitted for palliative care. These admissions indicate that the home is admitting outside their categories of care registration. There has also been a person who could not speak or understand English admitted to the home. There was no evidence in the care plan for this person that the home had made any significant provision to ensure that this persons language needs were appropriately met. In addition, care management assessments from the social services department for some of these clients were also reviewed. These assessments clearly detailed the primary diagnoses of the residents (which were outside the categories of registration) yet the residents were still admitted to the home. Admitting residents whose needs are outside the category of registration not only has implications of care delivery for these residents but all residents in the home, as the levels of care required are increased and the skill levels of staff to meet specialist needs have to be met. The manager confirmed that this home has not had sufficient permanently employed members of qualified staff or care staff for a number of months. In the resident surveys and in conversations with residents and their relatives it was evidenced that there are insufficient permanent staff who are familiar with the care needs of the people who live in the home. This leads to poor outcomes for residents in their expectations that their care needs will be met. Larklands House Care Centre DS0000011001.V294778.R01.S.doc Version 5.1 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 the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Through case tracking it was possible to evidence how the care plans for residents have been devised and whether they had been reviewed to reflect their up to date needs. From the selected care plans it was concerning to note that they did not wholly reflect the current needs of the residents. For example, a resident’s deteriorating condition had not been noted in their care plan therefore the nutritional needs of the person inaccurately reflected their present condition. Their fluid balance chart had not been completed for 24 hours and their pressure area care chart had not been completed as required by the home’s own guidance. For other residents the health-care advice from GPs and specialist advisers had not been followed through, as referrals to specific specialists had not occurred. It was also evidenced that some residents who should have been receiving free chiropody services were in fact paying for it. The psychological needs of residents were not given sufficient attention. Care plans indicated minimal reference to this need and several residents referred to boredom, loneliness Larklands House Care Centre DS0000011001.V294778.R01.S.doc Version 5.1 Page 11 and low mood. It was observed that the majority of residents remained in their own rooms throughout the day with very little stimulation other than the television. For some residents with identified mental health needs specialist support was not indicated as being available to them. However, the manager did verbally confirm that she had asked for specific assessments for these people. Some residents were asked if they were included in their care planning and the majority commented that they were not. The care plans seen were generalised and not specific enough particularly bearing in mind some of the complex needs of the people concerned. For example, there were no mental health needs assessments; no emotional, social or psychological assessments; no safe bathing assessments; limited cot side risk assessments; inaccurately completed pressure area care records and the daily record notes did not provide detailed information with regard to any identified care plans. Because of the lack of permanent trained staff and care assistants the home is reliant on large number of agency staff. This adds another dimension to the concerns over care plans not accurately reflecting the needs of the residents. It is possible for an agency member of staff not work in the home for three or four days perhaps longer yet, if they were reliant on the care plans seen they would clearly not be able to deliver the care required for the persons up to date needs. The administrations of medicines were observed and significant errors were revealed with regard to the administration of controlled drugs and the administration of previously omitted medication. These errors were brought to the attention of the nurses concerned and the manager. Residents commented that members of staff do afford them privacy and dignity however some commented that their requests for doors to be closed at night are often ignored. The majority of residents spoken with reported that they were awoken by members of the night staff at around 6.30 and this would not be their usual preference but they accepted it as part of living in the home. One resident had made a serious complaint to the home manager on the previous day (which had been acted upon) regarding the behaviour of a nurse who had woken her and proceeded to provide care when she had requested to lie in bed. The nurse was reported to have advised the resident that the time was 8.30 when in fact it was 6.30. During case tracking it was clearly noted in this persons care plan that their preferred time for getting up in the morning was 8.00. A small number of residents were noted to be in the night attire at 15.40. It was not possible to ask them whether this was their preference as they had limited mental capacity. However, a member of staff was asked why people were in their night attire at this time of day and the answer confirmed that it was for the expediency of staff time. Larklands House Care Centre DS0000011001.V294778.R01.S.doc Version 5.1 Page 12 It was noted that some members of staff referred to clients in a pejorative way and could not confirm that they had asked the client whether they preferred this form of address. One resident directly commented, that they are often showered by one person (and the opportunity for a shower only occurs once a week) yet the person knew (and their care plan stated) that at least three members of staff should assist them whilst bathing. The person said that this makes them feel very unsafe and scared in these situations but is reluctant to speak out as they may miss the opportunity for a shower as there are insufficient staff available. Some residents commented in the surveys that the opportunity for bathing was often limited to once a week sometimes less when their preference would be for more frequent baths. Larklands House Care Centre DS0000011001.V294778.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. An exception being that the group activities that are available are enjoyed by those who can participate. EVIDENCE: The activities programme was seen and it was noted that the majority of planned events occur in the afternoons. These are primarily group activities held in one of the lounge areas. Only a limited number of clients are able to attend the sessions. These findings were supported by the surveys completed by residents. Of the residents who did attend the sessions they commented favourably on the variety of activities available. Residents who could not attend the sessions talked of boredom and little to do but watch television. It was noted throughout the period of the site visit that televisions were left on in peoples rooms whether they were watching it or asleep. A number of residents said they did not have a particular interest in the programme they were watching. Even during the early evening when residents were in bed asleep with their bedroom lights off their televisions were still on. There was evidence from the care plans and from comments by residents that the activities coordinator visited them occasionally (it appeared that the average was once every 10 to 14 days) but this was primarily for a short chat or to run a specific errand. Some residents were unable to offer Larklands House Care Centre DS0000011001.V294778.R01.S.doc Version 5.1 Page 14 comment because of their cognitive impairment. The care plan of one resident who had cognitive impairment was reviewed to see if any specific activities for her needs were provided but this was not apparent. The quality of the food observed was below average. It was noted that cauliflower was mid-brown in colour, the milk pudding had uncooked rice grains within it making it unappetising. The food was also barely warm once the residents received it. These observations were borne out by the comments from the residents and their relatives. They commented that it was nothing unusual for food to be presented in such a way. From the resident surveys received the highest dissatisfaction scoring was around food and its presentation. The food is delivered to the dining room areas in tureens, which are then placed on a hot plate but without any lids. This therefore means that any heat the food may have had on leaving the kitchen is not retained. Residents also commented that on occasions what they have seen advertised on the menus is not served. They reported that this particularly occurs at weekends and this was often when the poorest quality food is served. A considerable number of clients are supplementing their dietary needs by purchasing their own food, which they keep in their rooms. Residents and their relatives also commented about the lack of crockery and dirty cutlery. Dirty cutlery was observed during the serving of lunch and members of staff were going from floor to floor to find spare crockery. The manager confirmed there had been shortages but she had replenished supplies. There appeared to be insufficient staff available for residents who needed assistance with feeding thus, their food was cold by the time they were offered it. It was also observed that some clients had food placed in front of them which they had barely touched before it was taken away. One resident was being assisted with feeding by another persons relative as they could see that the staff had so many other people to feed. The manager commented that the external contractors (Eurest) were due to complete their contract by the beginning of June and the provider of the care home intended to employ their own staff. It is understood that a chef has now been appointed and the catering assistants have been given clearer job descriptions. Larklands House Care Centre DS0000011001.V294778.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been in the post since January 2006. From residents comments and evidence from completed surveys they feel that the manager does respond to complaints made. She is considered to be approachable and willing to listen. Residents and their relatives also noted that where necessary she has also taken appropriate action to deal with their complaints. Some clients expressed anxiety about speaking out for fear of repercussions although, none could evidence that such events had occurred. Residents and relatives spoken with were able to demonstrate an understanding of the complaints procedures and this finding was supported in the majority of surveys completed. The home does have a whistle blowing policy and a protection of vulnerable adults policy. Of the permanent staff spoken with they were familiar with both policies. Larklands House Care Centre DS0000011001.V294778.R01.S.doc Version 5.1 Page 16 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, 22 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is situated over three floors and is serviced by two passenger lifts. Residents and staff commented that the lifts do fail from time to time. One staff member told of her recent experience of being trapped in a lift for a number of hours. The home does have a service contract for the lift. The residents live in a safe and well maintained environment. The manager reported that the home is now compliant with the recommendations of the fire service and they are anticipating the return of the Fire Officer during the month of May 2006. Work was in progress to improve and extend the patio area of the home as there is very little garden space for the residents to enjoy. Presently, all of the double rooms within this home are used for single occupancy. There are insufficient hoists within the home and this has been an ongoing difficulty for some time. During the course of the inspection the Larklands House Care Centre DS0000011001.V294778.R01.S.doc Version 5.1 Page 17 manager advised and evidenced that an additional hoist has been ordered but no delivery time had been identified. The majority of the premises were clean and free from odour however, there were exceptions in some areas of the home. The residents perceive the home as comfortable. Larklands House Care Centre DS0000011001.V294778.R01.S.doc Version 5.1 Page 18 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, 29 & 30. Quality in this outcome is poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are insufficient permanent members of staff in this care home to meet the needs of the residents who live in it. At the time of the inspection there were 4 vacancies for registered nurses however, a Deputy Manager is due in post within a matter of weeks and another registered nurse has been appointed and is due to arrive shortly, leaving two full-time vacancies to fill. Presently, there are 3 practice placement nurses working in the home. These people are qualified nurses but are not yet registered to work in this country. They are therefore required to work under the supervision of a registered nurse. During the inspection it was revealed that one of these nurses had been working unsupervised for a number of weeks. The manager accepted that this was her error. In addition, there are 300 hours of care staff vacancies per week. The manager confirmed that active recruitment is underway and she is hopeful that 3 people will accept the offer of employment. In addition to this she confirmed that she is still looking to recruit 4 other care staff. The shortfall in permanent staff is presently being covered by bank and agency staff. Whilst the home had covered the shortfall in the number of permanent staff it was evident from the comments of the staff, residents and relatives as well as observed practice that the care needs of the residents was greater than the staff are able to meet. For example, people waiting to be fed so that their food Larklands House Care Centre DS0000011001.V294778.R01.S.doc Version 5.1 Page 19 becomes cold; residents with high nursing needs and/or needs beyond the category of registration that require considerable staff attention; staff changing residents into night clothes during the afternoon for expediency; residents being woken by the night staff; residents commenting that they went to bed before the night staff come on as they might be waiting a lengthy period of time before the nurse was able to assist them; residents commenting that call bells were not answered promptly. Indeed, it was observed that one client had used his call bell on six occasions before a carer enquired from the corridor area if the person was alright. These unanswered calls were reviewed by the manager on the “call logging” device in the home and she confirmed the delay in the response times to the resident. Additionally, the resident surveys received by CSCI included many comments about the lack of staff time. For example, they are really stretched, the carers cannot always get to the resident when called upon to attend, I wish there was a bit more time for TLC on top of the basics, would like more help with eating and drinking, this home needs more staff; bell system is very poor, night staff very slow to respond. It is therefore indicated that not only does this home require permanently employed members of staff it should consider reviewing the staffing levels allocated to meet the needs of the residents who live in the home. The qualified members of staff have no formal (paid) handover period between shifts. Consistent, good quality care delivery is dependent on good communication between members of staff. Not having a handover period where changes to care needs can be verbally communicated can lead to errors occurring and information being missed. As the home presently has a significant number of agency and bank staff who, might work infrequent shifts the need for clear communication is important. The manager confirmed that all staff do attend the statutory training required and regular training sessions are held to up date practice. The home has not achieved the target of 50 of the care staff having an NVQ 2 by the end of 2005. However, the manager was able to demonstrate that a training organisation is due to start a contract of learning from the 11 May 2006 until 13 July 2006 for staff to undertake NVQ 2 & 3 training. A significant number of care staff had asked to attend the course. Recruitment records were reviewed and found to meet the standard. The manager acknowledged that she had recently conducted an audit of people working in the home as to whether they had up to date documentation to work in this country. During this audit 13 were identified as needing to have up to date information. 8 have provided the evidence; 2 have appointments to show the evidence and 3 have left the employment of their own volition. Larklands House Care Centre DS0000011001.V294778.R01.S.doc Version 5.1 Page 20 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 & 38. Quality in this outcome is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The present manager has only been in post since January 2006. The previous manager resigned in November 2005. There has been no Registered Manager in this home since this time. During the inspection the Service Manager, Elizabeth Gallagher verbally confirmed that the directors of the company had agreed to employ another manager. The plan is that he work alongside the existing manager and is due to start employment on 15.5.06 subject to the statutory employment checks. Ms Gallagher wants the two managers and the new deputy manager (due to start beginning of May 2006) to work together as a team to implement changes in all aspects of the deficits in the home. The company also want all the care plans for clients to be changed to Southern Cross formats. Larklands House Care Centre DS0000011001.V294778.R01.S.doc Version 5.1 Page 21 A fully completed PIQ has been received and detailed information was included. The home does have quality assurance systems in place and various audits from these systems were seen. A random sample of maintainance records were reviewed and some were found to be a month out of date. In addition, the bath temperature for one residents room was 55c. Apparently, this had been a resident request of the handyman which he had agreed to without recourse to the manager, any risk assessments or company policies. Once highlighted the water valve was reset and the manager advised the handyman of the company protocols. Larklands House Care Centre DS0000011001.V294778.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 1 1 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 2 X X X 2 STAFFING Standard No Score 27 1 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Larklands House Care Centre DS0000011001.V294778.R01.S.doc Version 5.1 Page 23 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 OP3 Regulation 14 Requirement Timescale for action 31/05/06 2 OP4 14 3 OP7 15 4 OP7 13(4)(c) The Registered Person and home manager should not provide accommodation to any prospective residents unless their needs have been fully assessed to ensure that the home can meet their needs within their category of care registration and the staffing complement of the home. The Registered Person and home 31/05/06 manager must confirm in writing to the residents or their representative that the home is capable of meeting their needs. The Registered Person and home 30/06/06 manager must ensure that residents or their representatives are consulted in any care plans that are devised or reviewed for individual residents. The home manager should also ensure that the care plans are up to date and reflect the current care needs of the residents. They should also be specific and detailed to ensure consistency in care delivery. The Registered Person and home 30/06/06 DS0000011001.V294778.R01.S.doc Version 5.1 Larklands House Care Centre Page 24 5 OP8 13(1)(b) 6 OP9 13(2) 7 OP10 12(4) 8 OP12 16(2)(n) 9 OP15 16(2)(g)& (i) 10 OP22 23(2)(n) manager must ensure that care is delivered with regard to any risk assessment that have been created to protect the residents. The Registered Person and home manager must ensure that residents are promptly referred to specific specialist for their health care needs, this includes free chiropody services were this is relevant. The Registered Person and home manager must ensure that there are robust systems in place to ensure that medicines are administered safety and correctly and that staff adhere to these systems. The home manager must ensure that staff members respect resident’s wishes with regard to their privacy and dignity. Resident choice about times of going to bed, rising from bed, the closing of doors, how often they are bathed and by who, terms of address, the right to remain in day clothes during the day time hours must be adhered to. The home manager must facilitate the provision of activities for all residents who live in the home to ensure that their social and psychological needs are met. The home manager must provide sufficient crockery and cutlery for the residents needs. It should also be clean. The quality of food must be nutritious, appetising and served at the correct temperature. The home manager must ensure that there are sufficient hoists and equipment within the home to meet the needs of the residents who live there. DS0000011001.V294778.R01.S.doc 31/05/06 31/05/06 31/05/06 30/06/06 31/05/06 31/05/06 Larklands House Care Centre Version 5.1 Page 25 11 OP27 18(1)(a)& (b) 12 OP31 9 The registered person and home 30/06/06 manager must ensure that there are sufficient permanently employed qualified and care staff to meet the needs of the residents. In addition, they must ensure that there are sufficient members of staff allocated to the care home to meet the needs of all the residents. This includes all aspects of care delivery, for example, personal care; assistance with feeding; socialisation and psychological support. The registered provider must 30/06/06 ensure it appoints a manager who has the qualifications, skills and experience to apply to be the registered manager of the home. This home has not had a registered manager since November 2005. 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 OP2 OP26 OP27 Good Practice Recommendations The home manager ensures that the residents or their representatives are provided with a written contract or statement of terms and conditions. The home manager ensures that all areas of the home are free of odours. The home manager ensures that qualified members of staff have a formal handover period between shifts so that the current care needs of the residents can be verbally communicated. This should improve the consistency in the delivery of care. The home manager continues to strive to achieve the target of 50 of care staff having achieved an NVQ 2 DS0000011001.V294778.R01.S.doc Version 5.1 Page 26 4 OP28 Larklands House Care Centre 5 OP38 qualification. The home manager should ensure that all members of staff comply with risk assessments and company protocols with regard to the maintenance procedures in the home. Larklands House Care Centre DS0000011001.V294778.R01.S.doc Version 5.1 Page 27 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. Extracts may not be used or reproduced without the express permission of CSCI Larklands House Care Centre DS0000011001.V294778.R01.S.doc Version 5.1 Page 28 - 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. 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