CARE HOMES FOR OLDER PEOPLE
Larwood Fullbrook Lane South Ockendon Essex RM15 5JY Lead Inspector
Sarah Hannington Unannounced Inspection 6th July 2007 11:00 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 Larwood DS0000018114.V341210.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. Larwood DS0000018114.V341210.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Larwood Address Fullbrook Lane South Ockendon Essex RM15 5JY 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) 01708 857354 01708 857354 larwood@rchl.tiscali.co.uk www.rchl.org.uk Redbridge Community Housing Limited [RCHL] Mrs Freda Lee Care Home 8 Category(ies) of Learning disability (4), Physical disability (4) registration, with number of places Larwood DS0000018114.V341210.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Care to be provided to four (4) adults with learning disabilities Care to be provided to four (4) adults with a physical disability The Home to be used as a Care Home only. Date of last inspection Brief Description of the Service: Larwood is a two-storey purpose built care home in South Ockendon. It has a large secluded garden and has off road parking. It provides accommodation for eight younger adults with severe or profound learning disabilities and also caters for those with additional mobility or physical differences. All residents’ rooms have washing facilities and are spacious enough to accommodate mobility equipment and personal items. Fees are one flat rate of £1,022. 70 per week. Larwood DS0000018114.V341210.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This site visit was unannounced and focused on all the key standards, requirements and recommendations from the last inspection. The visit took two and a half hours to complete. The deputy manager and senior carer assisted through out the inspection. One new resident and three staff were spoken with as part of this process. Prior to inspection CSCI had sent out an Annual Quality Assurance Assessment, this documentation was returned before the site visit took place and was completed to a good standard, being informative and an aid to the site visit inspection. What the service does well: What has improved since the last inspection?
The improvements and changes to documentation in terms of evidencing good practice, consultation with residents, admissions of new residents, and structures of support for staff, guidance and the way in which all of this is organised is impressive. There have been many good changes and evidences that issues rose at the last inspection. Overall resident’s views, wishes and goals are better recorded and in most documentation sampled include the signature of the resident that consultation has gone ahead. General documentation gave clear information what had been achieved and what is further planned. Lots of use of photographs and pictorial documents are in use. Staff have been newly recruited. Residents have joined an advocacy group. There are compliment letters from families. New programmes and assessments for individuals are being carried out by an Occupational Therapist. (OT). New good have been purchased such as a cooker, microwave and music centre. The residents now have an aquarium. The support systems of communication amongst the team have greatly improved. Overall the manager and staff of the home have worked hard to address issues raised. All requirements and recommendation from the last inspection are either fully or partially achieved. Staff spoken with showed that they were aware of individual residents issues, had good training, support and were keen to improve upon their practice to the quality of life for the residents. Larwood DS0000018114.V341210.R01.S.doc Version 5.2 Page 6 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. Larwood DS0000018114.V341210.R01.S.doc Version 5.2 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 Larwood DS0000018114.V341210.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Larwood has evidenced that there is good consultation documentation, policy and procedures in place regarding new potential residents and their families prior to admission. EVIDENCE: Documentation regarding the latest admission of a service user was inspected. All assessments including the homes assessment is thorough and covered all aspects of an individual’s life that you would expect to see. Other documentation evidenced that visits had been in place for both residents and family prior to any admission. Larwood DS0000018114.V341210.R01.S.doc Version 5.2 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. 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. Good Care Planning guidance for staff and consultation for residents was evident. EVIDENCE: A good standard of support plans is in place for all residents. Professionals, families and resident are involved in the admission process as much as possible. A key worker/coordinator is identified as soon as possible to support this transition period. Resident’s files evidenced that health needs are fully met and that a wide range of health professionals are in use both from the private and public sectors. An OT has recently be assessed all equipment as well as assessing individual ability to enhance their lifestyle. Recorded within folders is how individuals wish to be treated, in one file a residents has been offered a key to their private room, this is declined and is
Larwood DS0000018114.V341210.R01.S.doc Version 5.2 Page 10 recorded from their requests ‘ I don’t want my own key, but please knock on my door before entering.’ Daily records and summaries have been improved upon and prompt staff to carry out checks on vital information needed and to be recorded consistently and regularly. A good policy, procedures, guidance and systems are in place for all medications. No resident self-administers. All medication is accounted for correctly and administered to a good standard. Larwood DS0000018114.V341210.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a good standard of exploring new possibilities and ideas for residents to retain skills, use community facilities and provide day pursuits. The food provided is balanced, nutritious and menus reflect service user choice. EVIDENCE: Overall resident’s views, wishes and goals are better recorded in most documentation sampled includes the signature of the resident that consultation has gone ahead. Larwood has recently put a weekly activities programme in place for each resident. Finding new activities is an on going process at Larwood. Discussion with staff and looking through documentation evidenced that the home is keen to pursue activities, community access and educational needs as much as possible. Resident’s views are recorded and staff are creative in how they try to cater for these needs. A new summerhouse has been built within the garden, which allows residents to carry out activities in another environment. Residents have part of the garden in which to plant and grow vegetables.
Larwood DS0000018114.V341210.R01.S.doc Version 5.2 Page 12 Advocacy has now been introduced. One-to-one meetings go ahead with residents to share information and listen to views. Residents have regular contact with friends and family. The latest resident to be admitted had recorded within their plan, to stay in contact with a close friend. Upon discussion with the deputy manager this has already been planned for. Other residents have joined groups that keep them in contact with friends who use to attend day services with them, but that centre has since closed. Each resident has a day in using and building upon life skills within their home and are encouraged to participate as much as possible. Each resident has a ‘Life book’, which is based on person centred planning and is an on going piece of work. Within he book it covers areas such as, communication, decisionmaking, things I like doing and weekly schedule amongst other topics. This piece of work is well written from the resident’s point of view and includes pictorial and photographs to aid individual understanding of what has been written. The food is nutritious and reflects client choice. Lunchtime was observed and staff were seen to be supporting residents appropriately with sensitivity, unhurried and in a relaxed atmosphere. Larwood DS0000018114.V341210.R01.S.doc Version 5.2 Page 13 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. Good recording, policy and procedures, training is in place regarding complaints and protection. EVIDENCE: There have been no complaints made to the home since the last inspection and there have been no reports made to CSCI. A number of compliments received by families were in place. The home has made sure that all relatives and residents know their rights to complain. The statement of purpose service user guide and each resident has a friendly format version kept in their rooms. Additionally all residents have a small folder called ‘welcome to Larwood’. This piece of work is to a good standard and very informative. Included within this pack are subjects such as what can be classed as abuse, this pack uses photographs, pictures and symbols to support residents understanding. All staff have had the ‘protection of vulnerable adults’ (POVA) training. Staff spoken with were clear and confident about reporting, recognising different forms of abuse. Larwood DS0000018114.V341210.R01.S.doc Version 5.2 Page 14 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The cleanliness, standard of decoration, individual rooms and communal rooms are personalised are all of a good standard. EVIDENCE: On the day of inspection the home was observed to be clean, tidy and odour free. Overall the home environment present no health and safety issues, the environment was homely comfortable and practical for the use of residents at Larwood. The garden has been developed by providing a summerhouse for residents to carry out activities and provides a pleasant area for residents to use. Resident’s rooms were clean and personalised. Larwood DS0000018114.V341210.R01.S.doc Version 5.2 Page 15 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 good. This judgement has been made using available evidence including a visit to this service. There are good standards in place for recruitment. The numbers of staff and the mixture of knowledge, experience and training are good. EVIDENCE: On the day of inspection there were sufficient numbers on duty, which included deputy and senior cover. The manager is in the process of interviewing and has employed one new senior and one support worker. Two care workers are needed to complete the team. The need to rely less on agency staff has improved. There is a good recruitment and selection policy in place and contained all necessary checks required. All staff had enhanced CRB checks and are Pova checked before being offered a contract of employment. Staff receive regular supervision and new appraisal systems are in the process of being developed. Key workers have one-to-one consultation meeting with their key clients on regular basis. Then senior staff that are now responsible for monitoring and supervising a delegated number of key workers and their key clients, hold oneto-one meetings to share information and give guidance. Any relevant issues arising from these meetings get fed back into the management or staff meetings, which ever is appropriate. This way of working is good practice. Larwood DS0000018114.V341210.R01.S.doc Version 5.2 Page 16 Staff commented that they felt the manager, deputy and seniors were approachable and that training, supervision, staff meetings had enhanced their knowledge, skills and understanding of the current client group Training and documentation sampled showed that there are a stable, experienced and knowledgeable well-trained staff team in place and that the health safety and welfare of residents are protected. Staff are currently being offered the NVQ training. Larwood DS0000018114.V341210.R01.S.doc Version 5.2 Page 17 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 management of the home has demonstrated that organisation of documentation, evidencing, consultation; resident’s quality of life and staff support is to a good standard. . EVIDENCE: There has been much development in how documentation in general has been re-organised. Documentation is clearer, easy to find and is better recorded. Admission of new residents is thorough and well evidenced. New support structures put into place such as the key worker monitoring of duties and seniors carrying out checks, supervisions and support, this has been well thought out and makes the team work more consistently and effectively.
Larwood DS0000018114.V341210.R01.S.doc Version 5.2 Page 18 It is apparent that these changes are raising awareness amongst the whole staffing group and this was evidenced through discussion with individual staff. Documentation and discussion with staff evidence that the resident’s views, wishes and aspiration are moulding how the service is being developed. In general evidence supports that consultation with residents is in place and is part of the day-to-day process of Larwood. Checks and reviews made on residents documentation is regular and to a good standard. The health, safety and welfare of both the residents and staff are protected by these procedures that are in place. Quality assurance from the ‘home’ surveys to be stored so that they are easily accessible to all interested parties and that staff are aware of where this documentation is held so they can be produced if need be. For results of the ‘home’ surveys sent to service users, family, professionals and staff are collated and results sent to CSCI. For an action plan resulting from Quality assurance to be put into place for the home to address areas of improvements to be made. However overall Larwood has consistently been able to evidence that the quality of service it provides is to a good standard. Larwood DS0000018114.V341210.R01.S.doc Version 5.2 Page 19 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 3 3 3 3 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 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 Larwood DS0000018114.V341210.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Larwood DS0000018114.V341210.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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