Inspection on 29/10/07 for Larklands House Care Centre

This inspection was carried out on 29th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Larklands House Care Centre 27/11/06

Larklands House Care Centre 25/04/06

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 Mary Williamson Unannounced Inspection 29th October 2007 09:50 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.V353244.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.V353244.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 larkland@schealthcare.co.uk 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.V353244.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th November 2006 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 manager advised that the range of fees as of April 2007 were, £576.73 - £1050.62 per week. There are additional charges for hairdressing, newspapers, chiropody and toiletries. Further information about the home can be obtained by contacting or visiting the home. Larklands House Care Centre DS0000011001.V353244.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first site visit of a key inspection and was unannounced. Mary Williamson who is a Regulation Inspector undertook the inspection. The home manager and the head of clinical care were present at various times throughout the day to assist with the inspection. A tour of the premises was undertaken. Accommodation is arranged over three floors. It was possible to sample various care procedures and standards of care practice throughout the day over the three floors. Records relating to the care of the residents and the management of the home were seen. Diverse needs of residents are recorded in care plans. Activities were observed and the activities coordinator explained the activities undertaken, and demonstrated the monthly newsletter she writes. It was possible to meet with the residents and gather information and feedback about their experience of living in the home. Several relatives were visiting throughout the day and were also able to give their views about the home. Staff were able to confirm the training they undertaken. The kitchen was visited and lunch was observed being served on the first and second floor. The complaints procedure was seen and there have been no complaints since the last inspection. The manager completed an AQAA (Annual Quality Assurance Assessment), which was sent to The Commission for Social Care Inspection prior to the inspection. The CSCI would like to thank the residents, relatives, and the staff team for their help and hospitality during the inspection. Larklands House Care Centre DS0000011001.V353244.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Since the last inspection the home has met or partially met the requirements made. The statement of purpose has been updated. The home now provides sufficient and suitable crockery and cutlery and residents now have the choice of a bowl or cup when having soup. The catering arrangements have improved and the choice and variety of food offered is nutritious and meets the residents dietary needs. Abuse awareness training is undertaken by all staff and is included in induction training. The general management of staff training records has improved, and all training is recorded. Larklands House Care Centre DS0000011001.V353244.R01.S.doc Version 5.2 Page 7 An electrical wiring certificate is now in place. There is a new call bell system in place. Infection control policies and procedures have been improved and staff spoken to had a good knowledge of how to handle and manage soiled lined. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Larklands House Care Centre DS0000011001.V353244.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.V353244.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 has been made using available evidence including a visit to this service. The home has a statement of purpose and service user guide in place, which provides prospective residents with information to help them make a choice about living in the home. The service user guide needs to be updated. Contracts of occupancy need to be improved. Pre admission needs assessments are in place. The home does not provide intermediate care. EVIDENCE: The home has a statement of purpose, service user guide, and residents guide in place. These documents provide prospective residents and their relatives with sufficient information to help them make an informed choice about living in the home. Some of the information in the service users guide and residents guide overlap and need updating for example the new manager details and the new address of CSCI. It is recommended that both documents be consolidated into one to provide residents with more useful information. Larklands House Care Centre DS0000011001.V353244.R01.S.doc Version 5.2 Page 10 All prospective residents have a needs assessment undertaken prior to being admitted to the home in order to determine if individual and specific needs can be met. The home manager or, nurse manager undertakes these needs assessments. Six assessments were randomly sampled and found to be informative, and well maintained. Six contracts of occupancy were requested to be seen as part of the case tracking process. More work needs to be invested in updating these documents, to include the accommodation provided, the amount of fees payable and the method and frequency of payment. One resident did not have a contract of occupancy in place. The home does not provide intermediate care. Larklands House Care Centre DS0000011001.V353244.R01.S.doc Version 5.2 Page 11 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 has been made using available evidence including a visit to this service. Individual care plans outline specific needs of residents. There are satisfactory arrangements in place to meet the resident’s health care needs, although consideration should be given to the staffing levels on the second floor. (See standard 27) The medication policy in place protects the residents. Privacy and dignity of residents are promoted. EVIDENCE: All residents have a care plan in place, six of which were sampled in detail during the inspection. Care plans are written on the basis of the needs assessment, input from the residents, information gathered from relatives, and any other relevant medical reports available. Residents or a designated representative signs the care plans. The qualified staff team, and funding authorities undertake regular reviews of care. Larklands House Care Centre DS0000011001.V353244.R01.S.doc Version 5.2 Page 12 Risk assessments are included in care plans for manual handling, dependency levels, nutritional assessment, use of bed rails, and Waterlow score skin assessments. The head of care stated that there were three residents in the home with a pressure sore. These are being managed and treated with input from the tissue viability nurse and advice from the GP surgery. The home has a good supply of pressure relieving equipment in place for the prevention and management of pressure sores including profile beds, air mattresses, and pressure relieving cushions. All residents are registered with local GP’s who visit the home weekly or more frequently if required. It was possible to talk with a visiting GP during the inspection. Chiropody is available six weekly at an additional charge. The head of care stated that the NHS however funds chiropody for residents with diabetes. Dental treatment is arranged in a local practice. During the inspection one resident missed his appointment, as the taxi the home had ordered did not have wheelchair access. A further appointment was arranged for next month. A domiciliary optician visits the home every six months or on request. The home has a medication procedure in place and all staff administer medication in accordance with this procedure and the NMC (Nursing and Midwifery Council) Code of Professional Conduct. Medication procedure was observed on the ground floor. Boots the chemist supplies the medication to the home mainly in blister pack format. They also undertake regular audits of medication the most recent being 2/10/2007, when all was satisfactory. The medication recording charts were seen and are well maintained. There is an approved list of homely remedies in place, which has been signed by the GP on 17/10/2007. Controlled medication is stored and administered in accordance the procedures in place. Privacy and dignity is promoted and staff were observed to knock on bedroom doors prior to entering. There was good interaction between staff and residents and staff were seen to address residents in a polite and caring manner. Larklands House Care Centre DS0000011001.V353244.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, and 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The activity arrangements in place meet the individual and collective needs of residents. Family and community links are maintained, and the nutritional needs of residents are being met. EVIDENCE: The home has an activities coordinator in post who organises a wide and varied activities programme. She produces a monthly newsletter, which includes themed activities and home news. A sample of the October activities includes a fancy dress Halloween party, trips out to Hollywood Bowls, and a fish and chip lunch, clothes show, entertainer, pat the dog, and two residents birthdays. There are also a variety of daily activities such as bingo, armchair keep fit, old films, quiz, music, giant crossword, and games. The activities coordinator stated that a small budget is provided for activities and that she organises fund raising events throughout the year to subsidize this. There is a hairdressing service three times a week and manicures are also arranged. Larklands House Care Centre DS0000011001.V353244.R01.S.doc Version 5.2 Page 14 Spiritual needs are supported and there is a church service held monthly when the local minister attends. Visits from various clergy can be arranged on request. Family links are maintained and relatives and friends are welcome to visit at any reasonable time. Relatives stated that they are kept informed of any change to care and any social events in the home. The menus were seen and are varied and seasonal. These are displayed in all dining areas of the home and include all meals for individual days. Residents may choose a cooked breakfast if required but most of the residents spoken to stated that they did not have an appetite for this. There is a choice of two main meals for lunch and several supper dishes. Residents all commented that the food was excellent. Food is prepared in the main kitchen located in the basement and sent by service lift to all three serving areas on three floors. Staff were observed feeding several residents that required help and support to eat. The kitchen was visited and was clean and orderly. All the catering team have a current food hygiene certificate. All the required documentation relating to food legislation is in place. Larklands House Care Centre DS0000011001.V353244.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedure and the abuse awareness procedures in place protect the residents living in the home. EVIDENCE: The home has a complaints procedure in place. This is available to all residents and their relatives. A copy of this procedure is displayed in the reception area. Relatives stated that they were aware of this procedure but have not yet used this. There have been no complaints since the last inspection. The home also has an abuse awareness policy in place, and a copy is available at the nurse’s station on all three floors. All staff receive training in this policy during induction training. The staff spoken to throughout the day confirmed that they had attended this training. They also stated that if an incident of abuse was suspected they would not hesitate to report this. Larklands House Care Centre DS0000011001.V353244.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 24, and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is suitable for its stated purpose. Residents live in a comfortable, and well -maintained home. The standard of cleanliness and hygiene is good. EVIDENCE: Accommodation is arranged over three floors, which are all assessable by lift access. Each floor has its own dining room and lounge, which are decorated to a good standard and comfortably furnished. The lounge areas are used for group activities at various times. The home has been adapted to meet the mobility needs of residents. There are assisted bathrooms provided on each floor, toilets have raised seats and grab rails fitted throughout the home. Several hoists and stand aids are also in use. A new call bell system has been fitted since the last inspection. Larklands House Care Centre DS0000011001.V353244.R01.S.doc Version 5.2 Page 17 Some resident’s bedrooms were seen. These are spacious, well decorated, and comfortably furnished. Residents are encouraged to bring items of personal furniture with them if they wish. Bedrooms have been personalised to reflect individual personalities and interests. Personal telephones can also be installed. The laundry was visited and is equipped to meet the requirements of the home. The laundry assistant was on leave and the head of housekeeping was overseeing the laundry duties. There is an infection control policy in place and the inspector was informed that all staff have training on infection control during induction training. Arrangements are in place for the regular collection of clinical waste. Larklands House Care Centre DS0000011001.V353244.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The number of staff on duty was not sufficient to meet the assessed needs of residents. The staff employed are competent and skilled to do their jobs. The recruitment procedures protect the residents living in the home. EVIDENCE: The duty rotas were seen for all floors and indicated that staff are allocated according to the number or residents for example one member of staff to five residents. This practice was not satisfactory on the second floor. Relatives and staff spoken to stated that the number of staff on duty was not sufficient to meet the residents needs. The inspector observed that a high percentage of residents on this floor have high mobility and dependency needs and require two staff to undertake moving and handling techniques. This left only the qualified nurse alone on several occasions to answer call bells and administer medication, resulting in call bells left ringing for long periods of time and residents not being supervised appropriately. This practice also put staff under pressure at meal times to feed residents and relied on relatives and activity staff to help support residents with feeding. A discussion took place between the home manager and the inspector regarding her responsibilities to meet the assessed needs of residents and to promote safety. A requirement has been made accordingly. Larklands House Care Centre DS0000011001.V353244.R01.S.doc Version 5.2 Page 19 Staff training and development is ongoing. All staff undertake induction training, which is done, in house with the home manager, senior nurse and specialists when necessary. Staff spoken to confirmed the training they had undertaken and this was also seen on individual training files. Mandatory training is also in place including manual handling, first aid, food hygiene, fire safety, and infection control. NVQ training is in place and several staff having completed NVQ Level 3, and more are currently undertaking Level 2 and 3. Staff have formal supervision ever two months. The home has a recruitment policy in place. Three staff files were seen. These contained all the required employment documentation including a completed application form, two written references, an employment history and CRB (Criminal Records Bureau) disclosure. There are procedures in place to check and verify PIN numbers for qualified staff. Larklands House Care Centre DS0000011001.V353244.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed in the best interests of residents. Health, safety and welfare or residents and staff are promoted. EVIDENCE: The home was functioning well. The home manager has been in post since September 2006 and was due to have her “fit person interview” with the Commission for Social Care Inspection three days following the inspection. She has over ten years experience in managing homes and has a Registered Managers Award (RMA) and an NVQ level 4 in management. She also has the support of a senior clinical nurse and an administrator. Larklands House Care Centre DS0000011001.V353244.R01.S.doc Version 5.2 Page 21 Systems are in pace to monitor quality assurance. Regulation 26 visits are undertaken by the line manager monthly, and reports retained in the home for information. The manager undertakes monthly audits, which are validated by the operations manager. Residents meetings take place every two weeks, and staff meeting are undertaken monthly. Resident’s surveys are undertaken in the form of a written survey and findings recorded in the main office and reports sent to the home. Resident’s financial interests are safeguarded. The home does not act as an appointee for any resident. Small amounts of resident’s personal money are overseen by the administrator for sundries including newspapers, hairdressing and chiropody. Records are kept of all financial transactions. Health, safety, and welfare of residents and staff is promoted and protected. The home has a wide range of health and safety policies and procedures in place. Staff confirmed that they had undertaken training in health and safety during their induction and samples of good practice were observed throughout the inspection. Risk assessments are in place for all identified risks and safe working practice. Fire safety is observed in the home and the maintenance department have the responsibility for overseeing the testing and recording of the fire alarms weekly, and the mandatory fire safety training for staff. There is a contract in place for the maintenance of fire fighting equipment and emergency lighting. Accidents are reported in a satisfactory manner and acted upon appropriately. Larklands House Care Centre DS0000011001.V353244.R01.S.doc Version 5.2 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 2 2 3 X X X 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 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 X 3 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Larklands House Care Centre DS0000011001.V353244.R01.S.doc Version 5.2 Page 23 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 Timescale for action 30/11/07 2. OP2 5(3) The service user guide and the residents guide should be one document, as information in both documents overlap and is confusing. This document should also include the manager details, the change of address of the Commission of Social Care Inspection. All residents should have a 30/11/07 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. 30/11/07 3. OP2 5(1) 4. OP27 18(1)(a) The registered person must 30/11/07 ensure that staff are employed in sufficient numbers to meet the assessed needs of the residents living in the home. Larklands House Care Centre DS0000011001.V353244.R01.S.doc Version 5.2 Page 24 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 Refer to Standard OP19 Good Practice Recommendations It is recommended that the kitchen on the on the second floor is redecorated, as the wall behind the wash hand basin is water stained, that the hot water dispenser is replaced and the hot plate is kept clean. Larklands House Care Centre DS0000011001.V353244.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way 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 © 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.V353244.R01.S.doc Version 5.2 Page 26 - 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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