CARE HOMES FOR OLDER PEOPLE
Larks Leas Milldown Road Blandford Dorset DT11 7DE Lead Inspector
Debra Jones Unannounced Inspection 29th September 2005 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 Larks Leas DS0000055591.V255173.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Larks Leas DS0000055591.V255173.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Larks Leas Address Milldown Road Blandford Dorset DT11 7DE 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) 01258 452777 www.larksleas.co.uk Castle Farm Care Limited Mrs Andrea Jain Falconer Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Larks Leas DS0000055591.V255173.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 24 in 20 single and 2 double bedrooms. The rooms acceptable for double occupancy are 6, 7 or 12. 20th April 2005 Date of last inspection Brief Description of the Service: Larks Leas currently cares for 22 older people (capacity 24) in a detached property on a main road approximately half a mile from the centre of Blandford where there are shops, a post office and churches. Larks Leas is close to a GP surgery. The home is on two floors and there are two passenger lifts. There are a variety of aids and adaptations around the building to allow residents to move about more independently. All 22 rooms are used as single rooms although the home is registered to accommodate a maximum of 24 people in twenty single and two double rooms. Some bedrooms have direct access to the rear terrace and patio areas. All but one room have en suite toilet facilities. There is an additional communal bathroom and toilet facilities on the ground and first floors. Larks Leas DS0000055591.V255173.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over 2 hours and was the second of the two anticipated inspections this year. The core standards that had not been inspected at the last inspection were looked at and the two requirements and three recommendations made at the last inspection were followed up to see if the home had made any progress towards meeting them. The Inspector looked around some of the building and at a number of records. The Deputy Manager assisted the Inspector in the absence of the Manager. Three of the residents were spoken to at some length to get a sense of what it is like to live at the home. What the service does well: What has improved since the last inspection?
Larks Leas DS0000055591.V255173.R01.S.doc Version 5.0 Page 6 The home has updated their complaints procedure. The person who represents the company that owns the home is now making a record of their regular visits to the home. The home have continued their own programme of improvements doing things like making the driveway more accessible for people with disabilities, installing more ramps and handrails around the home and covering all radiators while still making it possible for residents to control the temperature of those in their rooms. The dining area has also been refurbished and is very attractive and comfortable. The home is now keeping copies of Protection of Vulnerable Adult list checks that are made prior to staff being employed at the home. 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. Larks Leas DS0000055591.V255173.R01.S.doc Version 5.0 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 Larks Leas DS0000055591.V255173.R01.S.doc Version 5.0 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. (6 does not apply to this home. Standard 3 was met at the last inspection.) The home provides prospective residents with details of the services the home provides enabling them to make an informed decision about going to live at the home. This information is also useful for anyone living at the home. EVIDENCE: The home revised the service user guide and statement of purpose in April 2005. These are well-written and informative documents. Copies of the statement of purpose and service users guide are available around the home to residents and their visitors, along with inspection reports. The ones seen were older versions and could do with being replaced with the newer updated documents. The policies and procedures manual also needs to be updated with the latest versions of the statement of purpose / service users guide and complaints procedure to ensure that staff also have the most up to date information at their fingertips. Larks Leas DS0000055591.V255173.R01.S.doc Version 5.0 Page 9 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): 9. (Standards 7,8 and 10 were met at the last inspection). The medication at this home is well managed, promoting the good health and well being of residents. EVIDENCE: Medication at Lark Leas is only administered by staff who are well trained and confident in carrying out this task. Medication records sampled matched up with the medication held on the premises. Where it is recommended that 2 staff sign to confirm balances of certain medicines this was seen to be happening. Medication was tidily stored in appropriate places e.g. medication cupboards, trolleys and in the fridge. A system for returning medicines was in place and clearly in regular use. Plans are in place to refurbish the area that medicines are kept in. This would include the purchase of a dedicated fridge for medicines that might need to be kept at a lower temperature. This is a welcome move. The home does not have a thermometer that records the maximum and minimum temperature of the fridge used to store medication.
Larks Leas DS0000055591.V255173.R01.S.doc Version 5.0 Page 10 Residents spoken to said that they felt they had the right level of support in respect of their medication needs and they were confident in getting their medication when they were supposed to have it. Larks Leas DS0000055591.V255173.R01.S.doc Version 5.0 Page 11 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. (Standards 13, 14 and 15 were all met at the last inspection). Stimulating social activities are available in the home and residents are able to make choices as to whether they take part in them or spend their days in pursuit of individual interests. EVIDENCE: An activities co-ordinator is employed on a part time basis at the home. Residents spoke highly of her and the work she does in making their lives more enjoyable through the things she arranges. Some regular activities take place, such as bingo and puzzles, coffee mornings and local outings. Entertainers visit the home; most recently a singer came to perform for residents. The library visits bringing books and audio tapes. Clergy visit to meet spiritual needs. Residents confirmed that they are able to make choices about how they spend their time and could not think of anything more that the home could do to make their lives more stimulating. Whilst opportunities are available to join in with the organised activities at the home residents feel there is no obligation to do so. Residents and staff talked of the open day that had been taken place a few weeks previously to celebrate the completion of the extension of the home arranged by the company that own the home. Amongst other things residents had enjoyed meeting the mayor and drinking champagne.
Larks Leas DS0000055591.V255173.R01.S.doc Version 5.0 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. The home’s adult protection policy demonstrates the homes commitment to understanding abuse and of protecting residents. Ensuring that all staff have an understanding of adult protection matters will make residents even safer in the home. EVIDENCE: Residents spoken to said that they felt safe living at the home ‘where could you possibly feel safer?’ An adult protection policy and information about abuse is available to staff in the home. There was evidence to show that some staff had been trained in adult protection and more staff are due to go on external training courses in the next few months. This will still leave a number of staff who will have not had training, although they do have access to the home’s policies that relate to this area. Some in house training / discussion needs to take place covering the recognition and prevention of abuse, to ensure that all staff have an understanding of this topic. As part of the recruitment procedure new staff are checked against the protection of vulnerable adults list, held by the Department of Health, before they start work. The complaints procedure has been updated and now says that residents may complain to the Commission at any time, should they wish to. As per Standard 1 above - the most up to date complaints procedure needs to replace previous versions still available in the home.
Larks Leas DS0000055591.V255173.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All these standards were met at the last inspection. EVIDENCE: Whilst these standards were not inspected on this occasion it is noted that the home has continued to make improvements to the environment. The dining area has been completely refurbished – new carpets, curtains, furniture and furnishings. Following the assessment of the home by an Occupational Therapist a programme of work was devised by the home which has now been completed. Recent works completed include – having a disabled toilet in the garden suite, making the driveway accessible for people with disabilities, installing handrails and ramps and covering all radiators and fitting them with temperature regulators where needed. Larks Leas DS0000055591.V255173.R01.S.doc Version 5.0 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 29 and 30. (Standard 27 was met at the last inspection). Robust recruitment procedures are in place to protect residents from the risk of unsuitable staff working at the home although some documentation was not on file / had not been received. The home acknowledges the importance of staff training and ensures that staff are well trained and competent to do their jobs, in order that residents are in safe hands at all times. EVIDENCE: Well-ordered files are kept that demonstrate the recruitment process in action. 3 files of the latest recruits were sampled. One file showed that the home was now keeping confirmations of POVA 1st checks (allowing employers to start workers whilst waiting for full Criminal Records Bureau (CRB) disclosures to arrive, along with all the other documentation that is to be kept. The other two files seen did not contain all the necessary information and whilst the difficulties in these particular instances were appreciated this must be addressed. The written recruitment procedure does not reflect the extent of the checks being undertaken by the home and could do with being updated. A system is in place to monitor ongoing staff training and to identify when refreshers are needed. Recent training included manual handling, health and safety, first aid, food hygiene and ongoing reading of policies and procedures.
Larks Leas DS0000055591.V255173.R01.S.doc Version 5.0 Page 15 The programme of study for staff doing national vocational qualifications in care continues. There are some gaps in essential staff training that have affected the scoring of these standards as referred to in other parts of this report, namely adult protection and fire training. Larks Leas DS0000055591.V255173.R01.S.doc Version 5.0 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,35,37and 38. (Standards 31 and 32 were met at the last inspection). The home is well organised and the care and contentment of residents is at the heart of the daily management and running of the home. Staff fire training records do not demonstrate that residents would be as safe as they could be in the event of a fire breaking out. EVIDENCE: Regular meetings take place with residents. These are well structured, have an agenda and minutes of the meetings are taken and made available to all residents. Residents are able to air their views about the home and have an input into how the home is run. They are also kept up to date with any changes to the home and the staff. A quality assurance policy and system is in place. The Deputy Manager was not aware of the annual quality assurance survey, to find out what people
Larks Leas DS0000055591.V255173.R01.S.doc Version 5.0 Page 17 think about the home, having taken place this year (it was last done in June 2004). When it is done a report will have to be written based on the analysis of the results of the survey. This report can then be circulated to any interested parties. The home does not hold any money belonging to residents. All records kept in the home were made available to the inspector as requested and are appropriately stored. The responsible individual, for the company who own the home, makes regular visits to the home and written reports are now made of these visits as required by law. Records required by regulation in respect of each resident are being kept. Following the last inspection it is clear that the home followed the requirement made and took photographs of all residents. However there were not photographs on file for the residents who had moved into the home in the last few months. Fire records were inspected. An external company carries out quarterly checks of the fire equipment and certificates are held. Internal checks are being carried out and records demonstrated these regular weekly and monthly checks. The records seen demonstrated that staff had had fire training but showed that the majority of staff – both night and day staff – were overdue for refresher training. A fire evacuation took place earlier this month and a record was made of it. It is suggested that in future the record be more detailed in that it include the names of all staff taking part. It is also suggested that consideration be given to involving night staff in fire evacuations / drills and perhaps conducting some in the evening / at night. One resident talked of the recent fire evacuation that took place and others of how they regularly hear the testing of the fire equipment. Data product sheets are also kept that give advice about hazardous substances used in the home e.g. cleaning products. Accident records were looked at. Some accident records were excellently completed in that they were clear about how staff writing up accident reports knew about accidents e.g. if they came across someone who had fallen, if a resident told them of an accident or saw someone else having an accident or if they are alerted to an accident by a resident ringing their emergency call bell. Ideally if all records were written in this way the analysis of such records would provide the home with important information as to the effectiveness of the emergency systems in operation and of any further measures that could be put in place to minimise risks to residents.
Larks Leas DS0000055591.V255173.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 2 x x x x x x x x STAFFING Standard No Score 27 x 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 3 x 3 x 3 2 Larks Leas DS0000055591.V255173.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP8 Regulation 23 Requirement Timescale for action 01/11/05 2 OP18 13 3 OP29 19 4 OP37 17 Staff fire training must take place at the required intervals – 6 monthly for day staff and 3 monthly for night staff and records be kept. The registered person shall make 01/04/06 arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. All documentation as specified in 01/12/05 the regulations must be kept on file and be available for inspection in respect of all staff employed at the home. The home must have 01/12/05 photographs of all residents. Larks Leas DS0000055591.V255173.R01.S.doc Version 5.0 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations It is recommended that the home obtains a thermometer that records the maximum and minimum temperature of the fridge used to store medication and that the home record the temperatures daily. The recruitment procedure should be updated to reflect the rigorous pre employment checks that the home undertakes. The procedure also needs to be in line with the latest Home Office Guidance in respect of the employment of foreign nationals. 2 OP29 Larks Leas DS0000055591.V255173.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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