CARE HOMES FOR OLDER PEOPLE
Larklands House Care Centre London Road Ascot Berkshire SL5 7EG Lead Inspector
Christine Sidwell Unannounced Inspection 27th November 2006 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 Larklands House Care Centre DS0000011001.V322488.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. Larklands House Care Centre DS0000011001.V322488.R01.S.doc Version 5.2 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), Physical disability (5) of places Larklands House Care Centre DS0000011001.V322488.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 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, £557.00 - £1025.00. There are additional charges for hairdressing, newspapers, chiropody and toiletries. Information about the home can be obtained by contacting or visiting the home. Larklands House Care Centre DS0000011001.V322488.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over a period of four days and included two days in the home. Prior to the visit all previous information about the home was reviewed. Comment cards were distributed by the manager to residents and their families and to other professionals who have contact with the home. Nine families, one general practitioner, two healthcare professionals and a care manager returned the comment cards. The care of four residents was case tracked. Residents, staff, family members and the manager were spoken to on the days of the unannounced visit. The home’s approach to equality and diversity was observed. As part of this unannounced inspection, the quality of information given to people about the care home was looked at. People who use services were also spoken to, to see if they could understand this information and how it helped them to make choices. The information included the service users guide (sometimes called a brochure or prospectus), statement of terms and conditions (also known as contracts of care) and the complaints procedure. These findings will be used as part of a wider study that CSCI are carrying out about the information that people get about care homes for older people. This report will be published in May 2007. Further information on this can be found on our website www.csci.org.uk. What the service does well:
Potential residents are visited prior to their move to the home and their needs are assessed to ensure that the home can meet their needs. In general residents personal, healthcare and medication needs are met in a timely way and in a manner, which protects their privacy and dignity. Residents and their families help to develop their care plans. There is a varied activity programme, with opportunities to go out, which brings interest and diversion to the day. In general the complaints and safeguarding policies and procedures are effective although not all residents feel that their concerns will be addressed. Larklands House Care Centre DS0000011001.V322488.R01.S.doc Version 5.2 Page 6 The rooms are very spacious and residents may bring items of furniture and personal belongings to make the rooms homely. Family and friends are welcome at any time. Recruitment procedures are thorough and the company audits recruitment records regularly to ensure that standards remain high. What has improved since the last inspection? What they could do better:
The information, including the statement of purpose and service uses guide should be updated. All residents should have a contract or statement of terms and conditions of residency to ensure that they are clear about the terms and conditions of their stay. The systems for ensuring clothing is labelled and returned to the correct residents should be improved. The standard of catering is poor and must be improved if residents are to receive nutritious and appetising meals in a timely way. Sufficient crockery should be available to enable residents to have their soup in a bowl if they wish and adapted beakers with lids must be provided for those who need them.
Larklands House Care Centre DS0000011001.V322488.R01.S.doc Version 5.2 Page 7 All staff should have safeguarding training to ensure that residents are fully protected. Staffing levels are adequate to meet service users needs, although the high turnover of staff and the need to ensure that staff have received essential training may potentially mean that residents are cared for by staff who do not know them and may not have the essential skills. All staff should have an induction programme and training records should be updated to reflect this. All staff should have the basic mandatory training. An electrical wiring certificate should be obtained. The call bell system should be repaired or replaced. The standards of food hygiene should be improved in line with the requirements of the environmental health officers report of the 09/10/06. The main kitchen and satellite kitchens must be kept clean. The procedures for handling soiled line must be improved and monitored. Residents who require a hoist should have their own slings to help prevent the potential spread of infection. 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. Larklands House Care Centre DS0000011001.V322488.R01.S.doc Version 5.2 Page 8 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.V322488.R01.S.doc Version 5.2 Page 9 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): 1, 2, 3 and 6 Quality in this outcome area is adequate. This judgement was made using available evidence, including an unannounced visit to the service. Potential residents are visited prior to their move to the home and their needs are assessed to ensure that the home can meet their needs. The information available to them requires updating and not all residents have a contract or statement of terms and conditions of residency to ensure that they are clear about the terms and conditions of their stay. EVIDENCE: There is a statement of purpose and service users guide. The manager said that the statement of purpose and service users guide have been updated recently, although they are not dated. A copy of the service users guide was seen in service users rooms. The statement of purpose and service users guide need updating to reflect the new management appointments to the home and to Southern Cross Healthcare and the contact details of the external agencies, which residents may wish to contact if they have concerns. Larklands House Care Centre DS0000011001.V322488.R01.S.doc Version 5.2 Page 10 The home has been acquired by Southern Cross Healthcare from Ashbourne Homes Limited and the manager is in the process of ensuring that all residents have a Southern Cross Healthcare contract. There are two template contracts/ terms and conditions; one for privately funded residents and one for those who are sponsored by social service department or the local Primary Care Trust (PCT). On the day of the unannounced visit there were fifty residents in the home. Of these thirteen were privately funded and eleven had evidence in their files that they had a contract. Two of the privately funded residents did not have a contract on file but were not well enough for the inspector to talk to. Two other family members were spoken to and they confirmed that they had dealt with a contract on behalf of the residents. The statement of purpose states that for local authority funded service users, a formal contract exists between our home and the Local Authority. However a separate Southern Cross Healthcare terms and conditions of residence will also be issued. Of the thirty-six residents identified as being sponsored by the Local Authority, twenty-seven had contracts issued by Ashbourne Homes Limited. There was no evidence in the files of the other residents that they had been given copies of Southern Cross Healthcare terms and conditions of residence. Eight residents were in the home on an interim basis, having been placed there by the local authority when they became medically fit for discharge from hospital. One resident and his wife were spoken to and said that they were not given a choice of home saying this was where he was sent. They were happy with the home however and were hoping that they could stay but were afraid that they would not have a say in the matter and he would be moved again. They said that they had not been given a statement of terms of residence, although knew a copy of the service users guide was in their room. None of the residents placed on an interim basis had copies of contracts or statements of terms and conditions of residence in their files. The template for the contract, when issued, contains the information specified in the Care Homes Regulations 2001, as amended in September 2006. One family interviewed said that they had signed a contract on behalf of their family member but that the fees had been increased by £500 within six months of her moving to the home. They confirmed that this was in the contract but felt that they were not given any explanation as to why the fees had increased and felt that they had no choice but to pay it as they did not want to move their family member. They thought that they had been given one months notice of the fee increase. At the previous inspection a requirement was made that all service users were assessed prior to moving to the home to ensure that their needs could be met. The care of four service users was case tracked. There was evidence in the care plans that they had been visited by a nurse from the home and a full assessment of their needs made before they moved to the home. There was also evidence that they or their representative had received a letter confirming that their needs could be met. They had all been assessed by the nurse from the local Primary Care Trust for the contribution to their fees in respect of the
Larklands House Care Centre DS0000011001.V322488.R01.S.doc Version 5.2 Page 11 nursing care that they need. There was also evidence on file that a care management assessment had been undertaken. Two families spoken to confirmed that their family member had been visited prior to moving to the home. The home does not offer intermediate care. Larklands House Care Centre DS0000011001.V322488.R01.S.doc Version 5.2 Page 12 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, 9 and 10 Quality in this outcome area is good. This judgement was made using available evidence, including an unannounced visit to the service. In general residents personal, healthcare are medication needs are met in a timely way and in a manner which protects their dignity. EVIDENCE: The home was found not to be meeting residents health and personal care needs at the last inspection. The new manager said that she had made this a priority of her first three months in post. She had audited the care plans as a means of ensuring that service users care needs were met and had worked with the registered nurses on each floor. The care of four residents was case tracked and other residents were also asked about their care. The home has introduced new care plans and there was a marked improvement on the quality of the documentation since the last inspection. The managers own audit also showed an improvement. All files seen contained an assessment of needs and a care plan. There was evidence in the files seen that families had been involved in care planning. One resident spoken to said that she had agreed her care plan. One family spoken to said that they had agreed the care plan with the staff nurse. There was evidence on the care files of two of the
Larklands House Care Centre DS0000011001.V322488.R01.S.doc Version 5.2 Page 13 residents whose care was case tracked that they had been reviewed by their care manager during the last year. The residents seen were clean and well dressed and their personal care needs had been met. Three of the four residents who were case tracked had care plans, which had been evaluated daily and reviewed monthly. The care plan of one resident who moved to the home four weeks previously was incomplete. There was no photograph, resident profile, new service users checklist nor a record of social and recreational activities. Risk assessments however had been undertaken and a basic care plan had been agreed. The staff said that care plans for new residents were developed over a period of time. There was evidence that residents risk of developing pressure damage had been assessed and monitored regularly. Only one resident had pressure damage, which had developed whilst he was in hospital. He had a care plan in place and the appropriate mattress and cushion. All four residents whose care was case tracked had had nutritional assessments and had been weighed monthly. Two had lost weight and one had supplementary feeds. One residents care plan said that, due to renal failure, his fluids should be restricted to defined amounts related to his urinary output. His fluid balance chart was not complete due to incontinence and it was not possible for the staff to ensure that he was drinking the correct amount of fluids. This must be reviewed by the doctor. Falls risk assessments are undertaken and the staff said that they had access to the local falls clinic for advice. There was evidence that residents who were entitled to free chiropody were seen at the local NHS chiropody clinic. Most residents were seen by a private chiropodist who visits the home. A requirement was made at the last inspection that medicines management be improved. The manager has audited the medication management monthly since her appointment and the audit records show improvement. There are medication policies and procedures in place and records are kept as to medication entering and leaving the home. The medication management system on one floor was examined. No residents on this floor self-administer medication. The homes statement of purpose and service users guide state that they are happy for residents to self medicate if they wish. The staff nurse spoken to said that medicine is not administered covertly and if residents refused medication this would be discussed with the general practitioner and another formulation tried. A sample of medication administration charts were checked and all found to be completed correctly. No controlled drugs were in use on this floor. There is a controlled drugs register. A qualified nurse administers medication. There was no excess medication in the cupboards and a contract is held for the disposal of unwanted medication. The drugs fridge was kept at the correct temperature and medication was labelled when it was opened. Larklands House Care Centre DS0000011001.V322488.R01.S.doc Version 5.2 Page 14 The staff were observed to knock before entering residents rooms. One lady spoken to said that they always called her by full name, which she preferred. The relatives spoken to said that they could always visit their family member in their rooms. Residents wear their own clothes although one family member said that she had sometimes found other residents clothes in her mothers wardrobe. There was a large amount of unlabelled clothing in the laundry suggesting that the systems for ensuring clothing is labelled and returned to the correct residents needs to be improved. The general practitioner spoken to said that he always saw residents in their own rooms. The families spoken to said that they were welcome at any time and families were seen in the home throughout the day of the unannounced visit. Larklands House Care Centre DS0000011001.V322488.R01.S.doc Version 5.2 Page 15 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 and 15 Quality in this outcome area is adequate. This judgement was made using available evidence, including an unannounced visit to the service. There is a varied activity programme, with opportunities to go out, which brings interest and diversion to the day. The standard of catering is poor and must be improved if residents are to receive nutritious and appetising meals. EVIDENCE: The service users spoken to said that they had a choice as to how they spent their day. Meal times are at set times although the carers spoken to said that a light meal could be provided at other times if a resident was out. Some but not all care plans seen had evidence of residents likes and dislikes. There is a good activities programme for those who wish and are able to participate. On the day of the unannounced visit an outing had been arranged for a smell group, which the residents were looking forward to. The activities coordinator has made a number of improvements to the programme since the last inspection. She meets with all residents on a daily basis taking them fruit and delivering the mail. In this way she is able to spend a little time with each resident ascertaining what they would like to do. The programme of activities, which is varied, then reflects this. Some residents however are unable to participate in communal activities and they were observed to spend the day in their rooms with the television on although they may not have been able to see it. There was little happening in the lounges on the floors. Although the
Larklands House Care Centre DS0000011001.V322488.R01.S.doc Version 5.2 Page 16 organised activities are very good there is a need to engage the carers in supporting residents to participate in everyday activities on a daily basis on each of the floors. The family members spoken to said that they were welcome at any time and families were seen to come and go throughout the day. The statement of purpose is clear that family involvement is encouraged. The home does not manage residents moneys on their behalf. The service users guide gives the contact details of external agencies who may give support to residents. The residents spoken to were not happy with the standard of the catering. On the day of the inspection there was an agency cook who was endeavouring to provide the main meal in line with the menu plan. There had been some confusion as to whether residents choices had been ordered the day before and the gas cooker was not working effectively. Lunch was an hour late and residents were left sitting in the dining room. When lunch arrived it was cooked although not browned as the cooker did not reach a sufficiently high temperature. An immediate requirement was made that the cooker be repaired and The Commission for Social Care Inspection received notification form the organisation the next day that this had been complied with. There were also insufficient condiments and beakers with lids to ensure that the tables could be laid properly and that those who needed adapted beakers could have them. Soup was served in a cup although this was not to the liking of all residents and some would have preferred a soup bowl. One resident was upset that the tables were not set correctly and felt that staff needed training in this area. The carers spoken to were aware of those residents who needed a special diet. Larklands House Care Centre DS0000011001.V322488.R01.S.doc Version 5.2 Page 17 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 and 18 Quality in this outcome area is adequate. This judgement was made using available evidence, including an unannounced visit to the service. In general the complaints and safeguarding policies and procedures are effective although not all residents feel that their concerns will be addressed. All staff should have safeguarding training to ensure that residents are fully protected. EVIDENCE: Southern Cross Healthcare has a complaints procedure. This is described in the statement of purpose and the service users guide. A complaints log is kept and action plans are developed to address complaints. The relatives spoken to said that they were aware of the complaints procedure although they had not used it. One service users spoken to said that she had complained in the past and that her issue had only partly been dealt with. She had not put her complaint in writing. The Commission for Social Care Inspection for Social Care inspection has not been notified of any complaints since the last inspection. There is a protection of vulnerable adults policy and procedure in place. Twenty-three of the forty- staff members (including ancillary staff) had had Protection of Vulnerable Adult training. The manager stated that more training opportunities were being arranged. All staff should receive this training. The Commission for Social Care Inspection has received one notification of an investigation into the care of a resident undertaken by the local authority under safeguarding procedures. The organisation cooperated and took the appropriate action following this investigation. Larklands House Care Centre DS0000011001.V322488.R01.S.doc Version 5.2 Page 18 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): 19, 22, 24 and 26 Quality in this outcome area is adequate. This judgement was made using available evidence, including an unannounced visit to the service. Residents rooms are spacious and provide a comfortable and homely environment. The maintenance of essential systems and infection control procedures should be improved if residents are to be assured of a safe environment in which to live. EVIDENCE: The pre-inspection questionnaire submitted by Southern Cross Healthcare showed that there were no changes to the premises since the last inspection. The information related to maintenance showed that a regular servicing and maintenance programme was in place. The electrical wiring test had been undertaken in the middle of 2006 although a report had not been issued. The organisation should ensure that the electrical wiring is tested and a certificate received. The emergency call system had also been tested in October 2006. On the day of the inspection the call bells were not functioning and the service engineer was called. There were some doubts as to whether it could be repaired. The organisation must ensure that there is an effective emergency call system in place. The Environmental Health Officer had visited on the 9th
Larklands House Care Centre DS0000011001.V322488.R01.S.doc Version 5.2 Page 19 October 2006 and had left a number of requirements, which had only been partially met by the time of the unannounced visit undertaken on the 27th November 2006. The manager stated that an action plan had been agreed. A copy of this action plan with clear timescales for achievement must be forwarded to the Commission for Social Care Inspection. The grounds were tidy and attractive and some ground floor residents had attractive patio outlooks. Residents rooms are spacious. Many are registered as double rooms but are currently being used as single rooms. The manager indicated that Southern Cross Healthcare had decided to provide only single rooms unless there was a specific need for a double room. They were generally well decorated and residents were encouraged to personalise their rooms. Many were very homely and inviting. The home has a number of adaptations to meet the needs of residents. At the last inspection a requirement was made that sufficient hoists were to be available to meet the needs of residents. The manager stated that there are now two hoists on each floor although residents share the slings that are used with the hoists. This is not good practice and a potential cross infection risk. Residents should have individual slings for use with the hoists. There are infection control policies and procedures in place. The staff were observed to wash their hands and tabards were worn when serving meals. The laundry was clean and tidy on the day of the unannounced visit. The laundress described the procedures for handling soiled laundry. Soiled laundry should be put in a red alginate bag, which is then put in the washing machine intact and a sluicing wash undertaken, followed by a full wash. She had concerns that the carers did not always put soiled laundry in the red bags but this was sometimes put in the normal laundry bags. She also said that pads were sometimes put in the red bags, which damaged the machines. She said that this had been raised and that the problem had improved over the last few weeks. There had been a flood in the laundry that morning, which the manager and maintenance man said was due to the sitting of an external soak-away. This should be addressed by the organisation. Larklands House Care Centre DS0000011001.V322488.R01.S.doc Version 5.2 Page 20 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 and 30 Quality in this outcome area is adequate. This judgement was made using available evidence, including an unannounced visit to the service. Staffing levels are adequate to meet service users needs, although the high turnover of staff and the need to ensure that staff have received essential training may potentially mean that residents are cared for by staff who do not know them and may not have the essential skills. EVIDENCE: The staffing levels have improved since the last inspection and there are now eleven qualified nurses to cover all shifts. There are twelve members of staff to cover the three floors during the day and eight at night. The turnover of staff however is high and twenty-eight members of staff have left since the last inspection. Morale amongst the staff was low on the day of the unannounced visit as they felt that they were being paid less since Southern Cross Healthcare took over. The manager and the company were discussing this with staff in order to allay their fears. The care team are supported by a catering and housekeeping team although there was a vacancy for a chef and housekeeping staff on the day of the visit. Fourteen of the twenty-four care staff hold the National Vocational Qualification in Care at Level 2 or above. The home meets the standard that 50 of staff hold this qualification. The recruitment records of four members of staff were examined. All had the required documentation, with the exception that the POVA first check which is undertaken before a full Criminal Records Bureau disclosure is undertaken for three staff members was not held on file. These checks were subsequently
Larklands House Care Centre DS0000011001.V322488.R01.S.doc Version 5.2 Page 21 located and the dates showed that showed that they had been undertaken before the staff member started work. Southern Cross Healthcare audit the recruitment files regularly. The last audit was undertaken in September 2006 and staff were asked to provide missing information. The manager said that new staff have an induction programme although the training records did confirm this. One new member of staff was spoken to and confirmed that she had commenced an induction programme but that this had not yet been completed. The training records were not up to date and although progress has been made with training since the manager was appointed, there remains a need for all staff to have the basic mandatory training with annual updates. Larklands House Care Centre DS0000011001.V322488.R01.S.doc Version 5.2 Page 22 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, 33, 35 and 38 Quality in this outcome area is adequate. This judgement was made using available evidence, including an unannounced visit to the service. An experienced manager has been appointed to bring improvements to the home for the benefit of residents. Procedures to ensure residents and staff health and safety should be improved if residents and staff are to be protected from harm arising from their care or work. EVIDENCE: The manager has been appointed within the last three months. She is an experienced manager and a Registered Nurse. She has had eleven years experience caring for the elderly. There are clear lines of accountability in the home. The staff spoken to said that she was making changes in the home to the benefit of the service users. Southern Cross Healthcare has a quality assurance programme, which the manager has begun to implement with regular audit of care plans, medication and recruitment. She holds an evening surgery for relatives who cannot visit during the day. She is planning a service
Larklands House Care Centre DS0000011001.V322488.R01.S.doc Version 5.2 Page 23 users and family questionnaire. Although not all requirements of the previous report had been met most have and considerable improvement has been made since the last inspection. There are systems in place to hold small amounts of personal allowance for residents. Receipts are given for all money held on behalf of residents and for any expenditure incurred. There are health and safety policies and procedures in place. Minutes of health and safety meetings and generic risk assessments were not seen on this occasion. There are manual handling policies and procedures in place and manual handling equipment available. Not all staff had had manual handling training with annual updates and this must be addressed. Although there are qualified nurses on duty, no members of staff held up to date first aid qualifications and this should be addressed. The maintenance records were generally up to date with the exception of the electrical safety certificate, which must be obtained. Food hygiene standards should be improved. The satellite kitchens were not clean on the day of the unannounced visit and the correct procedures for testing the temperature of foods at critical points had not been put into place. Larklands House Care Centre DS0000011001.V322488.R01.S.doc Version 5.2 Page 24 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 1 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 X X 2 X 3 X 1 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 1 Larklands House Care Centre DS0000011001.V322488.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4 Requirement The statement of purpose must be updated to provide up to date information in respect of the information detailed in Schedule 1 of the Care Homes Regulations 2001 All residents should have a statement of terms of conditions of stay, which includes the fees payable and by whom. Where a local authority has made arrangements for the care of a resident the registered person must give the service users a copy of the agreement specifying the arrangement made. 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. This is an unmet requirement of the previous inspection and a new timescale has been set. All staff should have Protection of Vulnerable Adult training.
DS0000011001.V322488.R01.S.doc Timescale for action 31/01/07 2 OP2 5(3) 31/01/07 3 OP2 5(1) 31/01/07 4 OP15 16(2)(g)& (i) 31/12/06 5 OP18 13(6) 28/02/07 Larklands House Care Centre Version 5.2 Page 26 6 7 OP19 OP19 23(2) 16(2)j 8 9 10 11 12 13 14 OP22 OP26 23(2)c 13(3) 13(3) 18(1)c 18(1)c 13(5) 16(2)j OP26 OP30 OP30 OP38 OP38 An electrical wiring certificate must be obtained The requirements, relating to food hygiene, of the environmental health officers visit of the 09/10/06 must be implemented in full The call bell system must be in working order. The procedures for handling soiled linen must be improved and the improvement monitored. Residents should have their own hoist slings All staff should have an induction programme, which is recorded and monitored. All staff should have the basic mandatory training and accurate training records kept. All staff should have manual handling training. The satellite kitchens must be kept clean and a safe system for monitoring the storage and serving of food in these areas must be implemented. 31/12/06 31/12/06 31/12/06 31/12/06 31/01/07 31/01/07 31/01/07 31/01/07 31/12/06 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 OP10 OP12 Good Practice Recommendations Laundry arrangements should be improved to ensure that all clothing is labelled and returned to the correct resident. Everyday activities involving all staff should be provided on the nursing floors for those residents who are unable to participate in organised activities. The siting of the external soak away should be reviewed to prevent flooding of the laundry. 3 OP19 Larklands House Care Centre DS0000011001.V322488.R01.S.doc Version 5.2 Page 27 Larklands House Care Centre DS0000011001.V322488.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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
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