Inspection on 31/10/06 for Larks Leas

This inspection was carried out on 31st October 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Larks Leas 12/11/07

Larks Leas 29/09/05

Larks Leas 20/04/05

Larks Leas 26/11/04

Larks Leas 03/08/04

Larks Leas 05/03/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Larks Leas Milldown Road Blandford Dorset DT11 7DE Lead Inspector Debra Jones Unannounced Inspection 31st October 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 Larks Leas DS0000055591.V318199.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. Larks Leas DS0000055591.V318199.R01.S.doc Version 5.2 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 admin@larksleas.co.uk 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.V318199.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 24 in 20 single and 2 double bedrooms. The rooms acceptable for double occupancy are 14, 18 or 19. 29th September 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. Current weekly charges range from £350 to £550. Larks Leas DS0000055591.V318199.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on 31st October 2006 and was the anticipated key inspection of the year. During the inspection records were looked at and the inspector walked around some of the building. The inspector also spoke with residents in the lounge and in a bedroom. The 4 requirements and 2 recommendations made at the last inspection were followed up to see the progress made towards meeting them. Mrs Andrea Falconer (Registered Manager) and her staff helped the inspector in her work on the day. Prior to the inspection the Commission asked the home to send out a number of comment cards to get people’s views of the home. Twenty-eight were returned. Nineteen were from residents, 2 were from relatives/ friends, 1 was from a health and social care professional, 1 from a care manager and 3 were from GP surgeries. Comment cards returned were generally positive about the staff and service provided at Larks Leas and all said that they were satisfied with the overall care provided there. ‘I’m happy in the home.’ (a resident) ‘Staff have a friendly disposition.’ (another resident) I’m happy at Larks Leas.’ (another resident) ‘I’m quite happy, well looked after and feel loved. Everyone is very kind to me.’ (another resident) ‘I feel quite pleased with my stay here the staff are lovely and helpful.’ (another resident) ‘It is very good, very homely atmosphere, the food is good and the staff are nice.’ (another resident) What the service does well: A good admissions procedure is in place that ensures that only people whose needs can be met are offered places at the home. Prospective residents and their representatives have the opportunity to visit the home to see if they like it before they move in. Assessments and care plans are of a good standard. They are kept up to date to make sure that staff know how to care for the residents living at the home. Larks Leas DS0000055591.V318199.R01.S.doc Version 5.2 Page 6 A range of community health professionals support the care staff in looking after the residents. There is a good system for medication administration at the home. Staff were observed throughout the inspection to be treating residents with courtesy, and kindness and residents confirm that their privacy and dignity are respected at all times. There is a programme of activities on offer at the home that residents can join in with if they choose to. Residents are free to spend their days doing as they wish. Visitors are always welcome at the home and residents are encouraged to maintain and develop relationships with people in the home and with their families and friends. Meals are varied and a choice is always available. The dining area is both pleasant and comfortable. The complaint and adult protection procedures reassure residents and their representatives that the well-being and comfort of residents is important to the home and that any concerns raised will be properly investigated and resolved. The home and grounds are very well maintained, comfortable and safe for the residents living there and anyone visiting. The home is kept clean and smells pleasant. Sufficient numbers of staff are on duty throughout the day and night to be able to meet the needs of the residents. Staff receive training in aspects of care work and other essential topics e.g. manual handling and first aid. The home is well managed and organised. The care and contentment of residents is clearly at the heart of the way the home is run. Systems are in place and records kept, that demonstrate the homes commitment to keeping residents safe. What has improved since the last inspection? Since the last inspection the home has purchased a fridge specifically to keep medicines in. The temperature is monitored daily to ensure that medicines are kept at the right temperature. Most of the staff at the home have now had training in adult protection to help ensure that residents are protected as well as they can be from abuse. Larks Leas DS0000055591.V318199.R01.S.doc Version 5.2 Page 7 The manager reported that photographs have been taken of all residents living at the home, as required by law. Staff training is now also up to date in respect of fire and residents can be assured that they are as safe as they could be if a fire were to break out. 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. Larks Leas DS0000055591.V318199.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 Larks Leas DS0000055591.V318199.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): 3&5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admissions procedure enables prospective residents to make informed decisions about moving to the home and ensures that only residents whose needs can be met by the home are offered places there. EVIDENCE: Two files were sampled that contained thorough pre-admission assessments; these are always carried out by the manager. One assessment had taken place in the prospective residents’ home and the other in hospital. Both residents spoke to the inspector about their experience of moving to the home. One had come for a short stay and decided to move in on a longer term. Both had been helped by family members who had visited the home and made all the arrangements for them. They were very pleased with the choice their families had made and felt very settled at Larks Leas. Larks Leas DS0000055591.V318199.R01.S.doc Version 5.2 Page 10 The manager said that the home has recently revised their service user guide and statement of purpose and had made sure that only up to date versions were around the home for residents and their visitors to look at. Inspection reports are also readily available. The inspector was assured that the policies and procedures manual had been updated with the latest versions of the statement of purpose / service user guide and complaints procedure to ensure that staff have the most up to date information at their fingertips. The manager said that all residents were issued with a contract. In some cases where it was considered more appropriate this was given to their families. Eleven of the 19 residents who returned comment cards said that had been issued with a contract. Others commented: ‘My son does all that.’ ‘My son probably has.’ ‘I have never received a contract whilst here.’ ‘My family have received documents on my behalf.’ Fifteen said and that they had enough information before they moved into the home so they could decide if it was the right place for them. ‘My doctor suggested / recommended it.’ ‘But when I first arrived it did not seem right. It is now much better.’ ‘My family viewed the home before I came to live here and would not have considered it suitable it they were not satisfied when they visited.’ Larks Leas DS0000055591.V318199.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 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a clear, consistent care planning system in place, which provides staff with the information they need to meet the needs of residents. The health needs of residents are well met with evidence of good support from a range of community health professionals. The medication at this home is generally well managed promoting the good health and well being of residents. Residents are treated with respect and their privacy and dignity are promoted at all times. EVIDENCE: Files sampled contained very thorough care plans, which were well laid out and clearly specified the needs of the residents. These are in place from the day the resident moves into the home. Care plans cover the same general areas for all residents but are tailored to the individual e.g. where there are specific Larks Leas DS0000055591.V318199.R01.S.doc Version 5.2 Page 12 conditions, individual needs these are covered such as diabetes. Plans are copied to the resident and or their relative. It was suggested that care plans for residents with diabetes include when important check up appointments are due e.g. optician, so that the home could remind the resident / relative if they appeared to be overdue. Care plans are backed up by a variety of assessments. Each file contains an overview risk assessment and manual handling assessment as well as specific risk assessments where appropriate e.g. falls, ‘going out’ and pressure area care. The action to be taken as a result of these assessments is made clear in the care plan. The home has recently introduced ‘day sheets’ which they feel bridge the gap between the lengthy care plan and actual daily practice. These sheets act as reminders to staff about specific care they give to give or areas that need monitoring and help to ensure that ‘nothing gets missed’ (the manager). They even cover social reminders e.g. ‘am. Needs to be ready to go to church.’ Information noted on these sheets is added to the daily notes which in turn inform the care plans. Care plans are reviewed every month and audited regularly by the manager. When asked ‘do you get the care and support you need?’ Seven of the 19 residents who returned comment cards prior to the visit replied ‘always’, with 9 saying ‘usually’ and 2 saying ‘sometimes.’ ‘looked after well during my 4 years stay here. Food excellent, room cleaned regularly. Fresh drinking water given twice, once at night and then daytime again.’ One resident talked with the inspector about her anxiety about bathing and of how she had been reassured and supported by staff at the home who were letting her take her time and not forcing her to do anything she did not feel comfortable with. When asked ‘do the staff listen and act on what you say.’ Seventeen residents said ‘yes.’ Comments included ‘Very happy with the staff’ ‘Mostly.’ ‘Staff very considerate in all aspects. When needed they come to all situations without hesitation.’ Both relatives/ friends who responded by comment card said that they were informed of important matters in respect of their relatives and where appropriate were consulted about their care. Care records also showed the interventions of community professionals. Where advice is given or action to be taken these are communicated to staff via handovers, care plans and the newly introduced day sheets to ensure that they are followed. Larks Leas DS0000055591.V318199.R01.S.doc Version 5.2 Page 13 As well as GPs and District Nurses residents have access to community services such as chiropodists, dentists and opticians. Specialist services and advice are also accessed e.g. advice and training re mental health issues from Community Psychiatric Nurses. The manager said that the home was very well supported by local GPs and nurses. Where residents are in need of aids to help them around the home, or in and out of bed, residents have been assessed and aids made available to them e.g. hoists, pressure cushions, bath seats, wheel chairs, slide sheets, zimmer frames etc. the manager described the Occupational Therapy service as ‘Valuable’ and ‘brilliant.’ Twelve residents who returned comment cards said that they ‘always’ received the medical support they needed and seven said that they did ‘usually.’ ‘I have my pain tablets 4 hourly, when needed a bean bag, having a cold I am pleased they supply hot lemon and honey drink.’ ‘I have not so far needed this, but have been visited by my GP (only been at home 2 weeks) The three GP surgeries and the health professional that returned comment cards to the Commission said that the home communicated clearly, worked in partnership with them and that staff demonstrated a clear understanding of the care needs of residents. They also said that the home took appropriate decisions when they could no longer manage the care needs of residents. ‘The home find it difficult to cope with patients with mental health needs. However they make appropriate use of our services’. (a Community Psychiatric Nurse) Medication at Larks Leas is only administered by staff who are well trained and confident in carrying out this task. Medication administration records (MARs) sampled were up to date and properly completed. Any allergies known are clearly recorded, and where there are none known this is noted. The quantities of medicines received were noted on the MARs. Where staff had made handwritten changes to the MARs e.g. where medicines were introduced later in the month these were countersigned by a second person, who had checked the entry for accuracy, and dated as per good practice. Most medicines at the home are delivered in monitored dosage packs and so it is easy to match medicines taken with the records and to know how many tablets should be on the premises at any time. Some medicines are in ordinary packets and are prescribed to be taken ‘when required’. For these medicines it was not immediately clear how many tablets should be in the home. Introducing a simple system to make this audit possible were discussed e.g. writing on the packets the date they are brought into use or putting a ‘carry forward balance’ on the MAR sheet. Medication was tidily stored in appropriate places e.g. medication cupboards, trolleys and in the fridge. Useful information about medicines was available Larks Leas DS0000055591.V318199.R01.S.doc Version 5.2 Page 14 along with a 2003 British National Formulary, an essential reference providing up-to-date guidance on prescribing, dispensing and administering medicines. Since the last inspection visit the area that medicines are kept in has been refurbished and a dedicated fridge for storing medicines that need to be kept at a lower temperature has been purchased and is in use. The temperature of the fridge is monitored to ensure that the medicines in it are stored at the right temperature. Staff are involved in administering insulin to some diabetic residents. The manager said that some staff had been trained by a district nurse to do this but there was not a written confirmation from a district nurse as to which staff this task had been delegated to / had been deemed competent. The GPs and health professional who returned comment cards said that in their opinion medication was appropriately managed in the home. Residents confirmed that they felt treated with respect and that their privacy was respected. ‘I have my own room that is private’. (a resident) ‘Treated with respect? Oh yes’. (another resident) ‘They call me by my first name. I like the informality’. (another resident) The home have introduced a residents charter which outlines what residents should expect from staff and the home generally. A strong emphasis is placed in this document on treating people well and respecting their confidentiality. All those who returned comment cards to the Commission confirmed that they were able to see residents in private when they visited. Larks Leas DS0000055591.V318199.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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ lives are enriched by the choices they are able to exercise in their daily lives, the social opportunities afforded by their visitors and the activities and entertainment available in the home. The meals in this home are very good offering both choice and variety and are served in a pleasant environment. EVIDENCE: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ lives are enriched by the choices they are able to exercise in their daily lives, the social opportunities afforded by their visitors and the activities and entertainment available in the home. The meals in this home are very good offering both choice and variety and are served in a pleasant environment. Larks Leas DS0000055591.V318199.R01.S.doc Version 5.2 Page 16 An activities co-ordinator is employed on a part time basis at the home (4 hours a week). Some regular activities take place, such as bingo, shopping trips. Mobile shops selling clothes and cosmetics have visited recently. The library also comes to the home bringing books and audio tapes. Clergy visit to meet spiritual needs. Whilst opportunities are available to join in with the organised activities at the home residents say they feel that there is no obligation to do so. Photographs on the walls were of the summer fete. Residents had taken an active part in planning and organising this event. Some residents had their own stalls e.g. bric a brac and cakes. Money raised was given to the NSPCC. The Christmas party is currently being planned. Residents spoken to said that they were happy in the home but at times were a bit bored and would like to have more to do. ‘We play cards and dominoes when the staff are available’. (a resident) ‘I go out when it suits me. I am a free agent’. (another resident) Of the 19 residents who returned comment cards 2 said that they it was ‘always’ the case that there are activities arranged by the home that they can take part in; 4 said that this was true ‘usually’ and 9 said ‘sometimes’. Comments included: ‘I don’t know if there are any’. ‘Don’t like to take part. Find some activities difficult’. ‘I have been here only 2 weeks but gather there are appropriate arranged activities’. ‘If others join in’. Residents talked of their families and how often they visited. They said that visitors were welcome to come at any time. The manager talked of how residents could invite friends / family for meals at the home, with some notice to the cook. The visitors’ book confirmed the number and range of visitors to the home. The relatives/ friends who returned comment cards to the Commission all said that they felt welcome at Larks Leas at any time. Residents spoken to said they were in control of their lives, within the limitations of a group environment. They talked of how they chose where they spent their days, what they did, what possessions they had around them, who they saw and what they ate. ‘We are not confined’ (a resident) All residents spoke highly of the food ‘we get a choice for lunch of two different things as well as a choice in the evening’. (a resident) Residents are offered meal choices the day before but can always change their mind on the day. If they go out, or have appointments at meal times a meal can be saved for them. Larks Leas DS0000055591.V318199.R01.S.doc Version 5.2 Page 17 The lunchtime meal on the day of inspection was either lamb steaks or pasties. This was served with brussel sprouts, cauliflower and green beans and mashed potato. Vegetables are served in separate dishes, one for each resident ‘like a restaurant’. (the manager) This allows residents to be in absolute control of what they have and how much. Dessert was a choice of sweet pancakes with cherry filling or fruit and ice cream. There are home made cakes in the afternoon for tea. A bowl of fresh fruit is available in the lounge area. Appropriate food records are kept. Residents said they could have meals where it suited them. The home has a pleasant dining room, overlooking the garden that residents can eat in if they wish. A kitchenette is available for residents to make tea or coffee whenever they want. This is also a useful facility for visitors. There is a monthly residents meeting and food is often on the agenda. Residents are encouraged to say what they like and if they want any changes made to menus. The cook said that she would soon know if residents wanted something different. She also confirmed that the quality of ingredients she was given to cook with were good. ‘I enjoy my job, I really love cooking.’ (the cook) Nineteen comment cards were received by the Commission from residents. Eight of the 19 said that they ‘always’ liked the meals at the home and 11 said that they liked them ‘usually’. ‘Very good meals’. ‘I would like to have a bit more fresh greenery as a bit short of teeth to chew!’ ‘Did not like the white bait – too greasy. Salads nice in the summer time. Something on toast for supper and sandwiches are good.’ Larks Leas DS0000055591.V318199.R01.S.doc Version 5.2 Page 18 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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A system is in place to deal with complaints that are made by residents and their representatives. The home’s adult protection policy and ongoing staff training demonstrates the homes commitment to understanding abuse and of protecting residents. EVIDENCE: The home has a complaints policy / procedure that is included in the information given to residents and a copy is on display in the entrance hall. The manager reported that no complaints have been received by the home since the last inspection. The Commission have not received any either. Residents have regular monthly meetings and are able to raise anything they wish to. Residents spoken to said that they were confident that if they had any concerns they would raise them with the manager or staff and that they would be listened to. ‘I’ve no complaints’. (a resident) Another said ‘there is a good lady in charge I would talk to her’. Larks Leas DS0000055591.V318199.R01.S.doc Version 5.2 Page 19 The comment cards sent to residents asked the question ‘Do you know who to speak to when you are not happy?’ Nineteen residents sent back cards. Eleven answered ‘always’ to this question, four ‘usually,’ and 2 ‘sometimes.’ Comments included: ‘I am happy to discuss such matters with one of the senior carers, whom I know.’ ‘Always someone to talk to.’ ‘I talk to my key worker, head of care and daughter.’ In respect of knowing how to make a complaint eight said yes ‘always’, 5 said ‘usually’ and one said ‘sometimes.’ One person said that they would talk ‘to Mrs Falconer at the residents meeting once a month.’ Two residents said that they did not know how to make a complaint and one commented ‘I would discuss this with my family.’ Both relatives / friends who returned comment cards said that they were aware of the complaints procedure. Neither had made a complaint. An adult protection policy and information about abuse is available to staff in the home and there was evidence to show that most staff had been trained in adult protection. Those new staff who have not had formal training are due to have it in the next 6-8 weeks. As part of the recruitment procedure new staff are checked against the protection of vulnerable adults list, held by the Department of Health. (See text under standard 29.) Larks Leas DS0000055591.V318199.R01.S.doc Version 5.2 Page 20 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 & 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Larks Leas is an excellent facility managing to create an environment that is homely, comfortable and at the same time safe for the residents living there and for anyone visiting. Bedrooms are well decorated, well furnished and personalised to suit the residents. Adequate communal facilities are available to meet the number and needs of the current residents and the home is kept clean and smelling pleasant altogether enhancing the daily life of residents. EVIDENCE: The home has a warm and homely atmosphere. It is well decorated throughout. Residents can enjoy walks around the garden and plenty of seating is provided. Work to the garden has now been completed following consultation with Larks Leas DS0000055591.V318199.R01.S.doc Version 5.2 Page 21 residents. The garden has been ramped making it fully accessible from the lounge. This has made it easier for those who found walking on the grass difficult to enjoy the garden. Some residents have immediate access to the garden from their ground floor rooms. ‘I can walk out of my French doors to the lawn. I like to watch the squirrels running about.’ (a resident) Another resident talked of how she felt about the home ‘I like it. It’s very comfortable. The outlook is nice. I have a lovely room that looks out on the garden.’ Flower beds have been raised so residents can get involved in the gardening. When the garden was complete there was a competition amongst residents to name it and a plaque put in place commemorating this. The garden is known as ‘Leas retreat.’ The home encourages staff and residents to bring maintenance issues to their attention. These are written in the maintenance book and entries are dated when the work has been done. The lounge and dining area are comfortably furnished. In the newer part of the home there is a quiet area where residents can entertain their visitors if they wish. There are a number of communal bathing areas in the home. ‘I like the big bath with the special seat; it is very comfortable. I enjoy having my back washed.’ (a resident) All but one room have en suite facility. Some residents who use wheelchairs have larger en suites making them far easier to use and contribute to them managing more independently and retaining privacy and dignity. Aids and adaptations are available throughout the home e.g. grab rails, raised toilet seats. Residents with particular needs have their own personal equipment to assist with their independence. One resident showed the inspector the grab rails that had been specially fitted for her in her bedroom and en suite, placed there to promote both her safety and to increase her confidence. Another resident talked of her walking aid saying ‘I can’t do without it.’ Adjustable beds are in place for those who need them. Although the home is registered as having 3 bedrooms large enough to share and which can be used at any time, bedrooms are currently only used as singles. Residents are able to personalise their rooms with furniture and general belongings as they wish and in agreement with the home. There are two passenger lifts in the home, enabling easy access to both floors and for residents who use wheelchairs to have bedrooms on the upper level. There are emergency alarm bells throughout the home. Where residents are identified as being at high risk of falling they are equipped with pendants they can wear at all times which allow them to summon help wherever they were. Larks Leas DS0000055591.V318199.R01.S.doc Version 5.2 Page 22 On the day of the visit the home was clean and there were no unpleasant odours. The laundry was clean and tidy. It is equipped with suitable washing machines. All laundry is done at the home. There are hand washing facilities in this room but on the day of the visit there was no soap or paper towels in the room. The manager undertook to rectify this. Residents praised the cleaning and laundry services at the home, taking pleasure in not having to do anything for themselves ‘it’s not part of the contract that I have to do that for myself!’ (a resident) Seventeen of the 19 residents that returned comment cards said that the home is ‘always’ fresh and clean. Two said this was the case ‘usually.’ One commented ‘yes, staff clean regularly once a week.’ The home is advised to obtain a copy of the new Department of Health guidance ‘Infection control guidance for care homes’ June 2006. Larks Leas DS0000055591.V318199.R01.S.doc Version 5.2 Page 23 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 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Sufficient, well-trained care staff are employed and deployed to ensure that the needs of residents can be met. Recruitment procedures are in place to protect residents from the risk of unsuitable staff working at the home but not all checks that should be carried out prior to anyone starting to work at the home and not all information required by law is on file. The home does not meet the recommended standard for at least 50 of care staff to hold a National Vocational Qualification in care at level 2. EVIDENCE: Duty rosters are kept that showing who is on duty and what jobs they do. A number of staff were only referred to by their first names on the roster. Three care staff are on duty between 7am and 2pm. During the busiest period between 9 am and midday another member of care staff is on duty. Three care staff are on duty between 3pm and 10pm. Two members of care staff are on duty overnight. The manager is additional to these numbers, as are the domestic and kitchen staff. Care staff also carry out laundry duties. The manager said that staffing levels are kept under review and reflect the changing needs of the residents. Larks Leas DS0000055591.V318199.R01.S.doc Version 5.2 Page 24 Residents were asked are the staff available when you need them? Five residents who responded said ‘always’ with 12 saying this was the case ‘usually’ and 1 said ‘sometimes.’ One of the relatives / friends who returned comment cards to the Commission said that in their opinion there were always sufficient numbers of staff on duty whilst the other said ‘on odd occasions it has been noticed that there are not enough staff on duty.’ The GPs, health care professional and care manager all said that there was always a senior member of staff for them to confer with when they needed to. Three of the sixteen members of care staff at Larks Leas have achieved a National Vocational Qualification at level 2 in care. (The target set by the Department of Health is for 50 of care staff to have this qualification.) Staff development continues to be seen as a priority at the home. A system is in place to monitor ongoing staff training and to identify when refreshers are needed. Recent training has included manual handling, health and safety, first aid, food hygiene and the ongoing reading of policies and procedures. Induction records were seen. The home is using the newly developed staff induction / foundation programme by Skills for Care (the industry standard) as the basis of their induction programme. Some staff files were sampled to see how the home manages recruitment. Prospective staff complete application forms and all are interviewed. If successful they are sent a letter of appointment and when they start working they are issued with a contract. Since the last inspection the home has introduced a recruitment checklist to ensure that all information required by law is in place prior to employment and always available for inspection. However despite this there were still gaps in the staff files sampled for new members of staff. The home is still not getting prospective staff to give them their full employment histories and staff have been starting work before the home has confirmed that they are not on the Protection of Vulnerable Adults list (held by the Department of Health). The manager was aware that staff were starting before this important check but said that while they were waiting for the result of the enquiry to the list they were very closely supervised. The file of a worker from an accession state country was reviewed and did not contain confirmation from the Home Office of their registration or exemption from the Worker Registration Scheme. At previous inspections the home have been recommended to update their recruitment policy so that it is clear what checks must be carried out prior to employment and what documents need to be on file, this has still not been addressed. The procedure on file was last reviewed in 2005 and is out of date in it’s content in places. Larks Leas DS0000055591.V318199.R01.S.doc Version 5.2 Page 25 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 & 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 organised and the daily management and running of the home centres round the care and contentment of residents. Good management practice, systems in place, and records kept, confirm the health and safety of all in the home. EVIDENCE: Mrs Falconer is the manager of Larks Leas. She has a nursing background and keeps her registration ‘live’ on the National Midwifery Council register. Mrs Falconer also has a range of qualifications that enable to carry out her management role, including a BSC in clinical leadership. Larks Leas DS0000055591.V318199.R01.S.doc Version 5.2 Page 26 The home sent out and made available comment cards for the Commission as requested prior to this inspection. Those that came back were generally very positive about home. Regular monthly meetings take place between home management and residents. The residents choose the agenda items and attendance at meetings is high. Fourteen residents attended the last meeting. Minutes are taken of the meetings and made available to all residents in large print. These meetings give residents the opportunity to air their views about the home and have an input into how the home is run. Meetings also serve to keep residents up to date with any changes to the home and the staff. There is also a suggestion box in the hallway outside the lounge. A quality assurance policy and system is in place. Residents and relatives were asked for their views on the home in July 2006 by questionnaire. The response was very good and the manager has compiled a ‘reader friendly’ report based on the analysis of the results of the survey and a copy has been placed in the entrance hall. The home does not routinely seek the views of other stakeholders e.g. visiting health professionals etc. Nor do they produce an annual development plan, of which the results of their survey would form part and they are strongly advised to do so. The inspector alerted the manager to the recent changes to the Care Home Regulations in respect of ‘quality of care.’ The home does not hold or manage 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 owns the home, makes regular visits to Larks Leas and written reports are made of these visits as required by law. Records required by regulation in respect of each resident are being kept. The manager confirmed that a photograph has been taken of all residents. The registration certificate was clearly displayed as was the home’s insurance certificate. After the inspection, whilst the report was in draft, the home submitted a ‘pre inspection questionnaire’ to the Commission. This showed that the home was up to date with their maintenance checks ensuring safety in the home. Fire records were inspected. An external company carries out quarterly checks of the fire equipment gives the home a certificate stating the outcome of the check. Internal checks are being carried out and records demonstrated these are carried out as often as they should be e.g. weekly and monthly. Records Larks Leas DS0000055591.V318199.R01.S.doc Version 5.2 Page 27 seen demonstrate that staff have fire training at regular and appropriate intervals. Accident records were looked at. Records are excellently completed in that they are clear about how staff writing up accident reports knew about accidents. The manager carries out an accident analysis every 3 months, where identified measures are put in place to minimise the risk of future accidents e.g. equipping a resident with a pendant alarm, encouraging another to wear her hip protectors. Larks Leas DS0000055591.V318199.R01.S.doc Version 5.2 Page 28 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 X X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Larks Leas DS0000055591.V318199.R01.S.doc Version 5.2 Page 29 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 OP29 Regulation 19 • Requirement All documentation as specified in the regulations must be kept on file and be available for inspection in respect of all staff employed at the home i.e. full employment histories. (previous timescale for action 01/12/05) Where workers are from accession states the home must have proof that they have registered or are exempt from the Workers Registration Scheme. All new staff must be checked against the POVA list and the result obtained of that check prior to them starting working at the home. Timescale for action 01/01/07 • • 13 • Larks Leas DS0000055591.V318199.R01.S.doc Version 5.2 Page 30 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 introduce a simple system that enables them to know how much medication, not delivered in the monitored dosage system, should be at the home at any time. It is recommended that the home obtain proof that the staff administering insulin have been deemed competent to carry out this task by those who are delegating this task i.e. the District Nursing service. • 2. 3. 4. OP27 OP28 OP29 Duty rosters should contain the full names of staff. 50 of care staff should have a qualification in care at NVQ level 2. The recruitment procedure should be updated to reflect the pre employment checks that the home has to undertake. The procedure also needs to be in line with the latest Home Office Guidance in respect of the employment of foreign nationals, including the registration on the workers registration scheme. Larks Leas DS0000055591.V318199.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 Larks Leas DS0000055591.V318199.R01.S.doc Version 5.2 Page 32 - 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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