Inspection on 14/07/08 for The Larches

This inspection was carried out on 14th July 2008.

CSCI found this care home to be providing an Adequate service.

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

The Larches 18/12/07

The Larches 13/07/07

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE The Larches Canal Hill Tiverton Devon EX16 4JD Lead Inspector Vivien Stephens Unannounced Inspection 13:00 14th and 16th July 2008 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 The Larches DS0000070349.V368564.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. The Larches DS0000070349.V368564.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Larches Address Canal Hill Tiverton Devon EX16 4JD 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) 01884 257355 01884 253270 enquiries@ccstiverton.eclipse.co.uk ww.ccstiverton.co.uk/larches.htm Anne Gray Care Limited No registered manager at present Care Home 20 Category(ies) of Dementia (20), Old age, not falling within any registration, with number other category (20), Physical disability (20) of places The Larches DS0000070349.V368564.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia (Code DE) Physical disability (Code PD) The maximum number of service users who can be accommodated is 20. 18th December 2007 2. Date of last inspection Brief Description of the Service: The Larches is a residential home registered to provide care to 20 people. The categories of registration are for females of 60 years of age falling in no other category, and people over 65 years of age with or without dementia or a physical disability. The home is situated on the outskirts of Tiverton with views of the surrounding countryside. The home has 4 floors linked by a lift. There are two lounges with a dining area and conservatory attached to one. Eleven rooms have en-suite facilities and there are two double rooms. There is major building work taking place on the site of the home to build several self contained flats for older people. This work has decreased the garden space and the garden is not accessible to people living at the home at the moment. There is a new fee structure for the home. At the time of inspection the average cost of care ranged between £460.00 and £575.00 per week depending on individual needs. Additional costs, not covered in the fees, include chiropody, continence products, hairdressing, outings and personal items such as toiletries and newspapers. A copy of the latest CSCI report is normally on display in the entrance hallway. Further copies of the report can be requested through the manager. The Larches DS0000070349.V368564.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. At the time of this inspection there were 13 people accommodated at the home plus one person who was in hospital. At the last key inspection of this home on 18th December 2007 serious concerns were found. The home was rated 0 star – poor. Since that inspection a ‘random’ inspection took place on 9th and 11th April 2008 and an enforcement notice was issued as a result. The main purpose of this inspection was to ensure work has taken place and significant improvements have been made. We checked that the home is well on it’s way to meeting the deadlines agreed during a meeting between the owners and the Commission on 10th June 2008. The deadline agreed was 31st August 2008. Before this inspection took place we sent survey forms to the home to be distributed. We received 6 survey forms from people living in the home and two survey forms from staff. The information we received has helped us to form the judgements we reached in this report. This inspection took place over 1½ days. The first afternoon was spent talking to the manager (she is currently unregistered) about the progress the home has made since the last random inspection. A tour of the home took place. We talked to three people who live in the home. On the second day of this inspection we spent time in the morning looking at four care plan files and three recruitment files of staff employed since the last inspection. Later in the day we talked to care staff, relatives who were visiting the home that day, and we talked to the cook about the menus. We also looked at other records the home is required to maintain. What the service does well: What has improved since the last inspection? At the last key inspection serious problems were found in all aspects of the management and care services. Since then the Commission has been in The Larches DS0000070349.V368564.R01.S.doc Version 5.2 Page 6 regular communication with the home’s management, and a ‘random’ inspection has also been carried out. The home has produced an action plan to address all of the shortcomings identified in the last inspection. During this inspection we found the home had made significant improvements in all areas. The way the home provides information and opportunities for people to get to know the home before they decide to move in have improved. They are now more careful when assessing new people to ensure that they can meet the person’s needs before agreeing to admit the person. They will give people more opportunities to visit and get to know the home before they move in. Six months ago the home introduced a new care planning system. It has taken them several months to complete each section of the documentation and at the time of this inspection we found that all sections of the plans had been completed and the plans contained a clear overview of each person’s daily care needs. However, the home have found there are some limitations and problems with the new care planning system and have brought in a consultant to help them implement an improved system. This will be checked at the next ‘random’ inspection to ensure the home has met the agreed timescales. Procedures for administering medicines have improved in recent months and are now safer. All staff responsible for administering medicines have received training on this task and further training is planned for the near future. The level of activities provided in the home have improved. A member of staff has been given specific responsibility for providing activities every afternoon. Some people enjoy going out for walks or car trips, while other people were seen taking part in card games. Friends and families are encouraged to visit and participate in the home. The menus have been changed and now incorporate a range of meals that have been suggested by people living in the home. Alternatives are offered at each mealtime. Records have been maintained to show the amounts that people have eaten in order to ensure people are receiving a balanced and health diet. Improvements have been made to the way people can raise concerns or complaints. People told us they felt confident that any concerns or complaints they have will be listened to and acted on appropriately. The home keeps records of all concerns, complaints and compliments. The level of training for staff on the protection of vulnerable adults has improved. Since the last key inspection the decoration and furnishings in the home have been improved. Most areas were found to be bright, clean, comfortable and homely. During this inspection there were no unpleasant odours found in any part of the home. The Larches DS0000070349.V368564.R01.S.doc Version 5.2 Page 7 Building works being carried out in the grounds of the home have affected some rooms with the removal of some windows. In most instances this has not made a significant difference to the rooms as there are other windows. Staffing levels have improved and at this inspection we found staffing levels were sufficient to meet people’s needs. At the time of this inspection the number of people accommodated had reduced while staffing levels had remained the same. In addition the level of needs of each person in the home was lower, with no people seriously ill or close to death. As a result the home was calmer, and we saw staff spending time sitting and talking to people and appearing cheerful and relaxed. The standard of recruitment checks has improved. The records we saw showed that careful checks have been carried out to ensure new staff are suitable. The level of training and supervision has improved. We saw records of the training staff have received, and also dates of future training planned. Management systems in the home have improved. People have been consulted in various ways including surveys and residents and relatives’ meetings. The way the home handles cash on behalf of people has improved – we saw good recording systems and copies of receipts for all items purchased on behalf of people. Balances are checked regularly to ensure they are accurate. The home has improved their health and safety systems. Staff training has improved, and the home have consulted with various professionals to ensure their policies and procedures are up-to-date and follow current good practice recommendations. What they could do better: We will carry out another ‘random’ inspection to ensure the home meets the agreed timescales for satisfactory completion of the assessment and care planning systems . We will also check to ensure that the home has made further improvements to the administration of medicines. The home must ensure that all staff are fully aware of the home’s medication policy, and to ensure that the staff have received thorough training and their competency checked to ensure medicines are handled safely. The home must continue to improve the way creams and lotions are administered and the way they monitor people’s skin condition. The home should continue to improve the level and range of activities. They should ensure that records show the consultation with each person to find out the things they used to do in the past, and what they would like to do in the future. A plan of regular activities should be drawn up to provide a range of activities that will suit everyone in the home, including those who are less able, or those who may choose to spend more time in their own rooms. The Larches DS0000070349.V368564.R01.S.doc Version 5.2 Page 8 One bedroom that has been affected by the recent building works should be improved to ensure there is good natural lighting, and to ensure the room is bright, comfortable, and has a pleasant outlook. 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. The Larches DS0000070349.V368564.R01.S.doc Version 5.2 Page 9 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 The Larches DS0000070349.V368564.R01.S.doc Version 5.2 Page 10 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, 3, 6 Quality in this outcome area is good. Good procedures are in place so that people have all the information they need before they make a decision to move in. The home will assess people carefully and will only agree to admit a new person if they are certain the person’s needs can be met fully. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who enquire about the possibility of moving into The Larches are given written information about the home and the services provided. There is a service user guide that provides information about all aspects of the home as set out in the Care Homes regulations. This included photographs of the home that will give people an idea of what the home looks like. Information is also available on their internet website. A copy of the most recent inspection report can normally be seen in the entrance hallway. The Larches DS0000070349.V368564.R01.S.doc Version 5.2 Page 11 No new people have been admitted since the last ‘random’ inspection and therefore we were unable to check to ensure the home has improved the way they assess new people before they move into the home. The providers have recently employed a consultant to provide training and advice to the home on good assessment procedures. We saw an example of proposed new assessment documentation the home plan to use. The forms were thorough and covered a wide area of needs. We talked to the manager about the way they plan to assess new people in the future. While we were talking to her she received a phone call from a person enquiring about a vacancy. We were reassured that the home is now far more careful when considering the suitability of prospective new people. They will always visit a person either in their own home or in hospital to carry out their own assessment, and they also gather information from as many other sources as possible, including health and social care professionals. They also intend to encourage people to visit the home at least once before any decision to move in is made. The home does not provide intermediate care. The Larches DS0000070349.V368564.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. Care planning systems are currently being improved. When completed they will ensure that people’s health and social care needs will be fully met. Procedures for administering medicines have improved in recent months and are now safer, although there are still some areas that need to be addressed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: After the last ‘random’ inspection enforcement notices were issued to the home in relation to the home’s care planning system. The original timescales for compliance have been extended to 31st August 2008 following a meeting between the providers and the Commission. It was agreed that at this inspection we will check to ensure the home is actively working towards The Larches DS0000070349.V368564.R01.S.doc Version 5.2 Page 13 compliance. We will carry out another ‘random’ inspection to ensure the home has complied with this requirement and timescale. In the last year the home has introduced a commercially printed care planning system that is used in many homes across the country. At this inspection we looked at four care plan files. We found that the manager and staff have worked hard in the last few weeks to ensure that every section of these documents have been completed fully. They have also introduced their own ‘top sheet’ that gives staff a quick and easy overview of the person’s care needs. The documents gave staff clear and up-to-date instructions on how each person should be assisted with their daily care needs. They gave information on the preferred times for people to get up/go to bed and how people wanted personal care tasks to be carried out. We saw the daily records completed by care staff to show the care they have given to each person, including personal hygiene, specific health needs, diet and nutrition, and social care needs. We talked to the manager about the specific health needs of the people we case tracked. Jean was able to turn to the records completed by care workers to quickly find the answers to our questions. We found that the records were being used consistently and they gave good information about the care provided. The home has employed a consultant who has given them training on assessment and care planning. They plan to change their care planning system once again as they have found that the current care planning forms have some limitations and problems. They showed us the forms they plan to introduce. At this inspection we found there were no people seriously ill or close to death. One person was in hospital. We looked at the way the home assesses the risk of health problems. Since the last inspection the home has consulted with local health professionals to ensure that those people who have been diagnosed, or who may be at risk of diabetes have regular checks to ensure they are receiving the correct treatment and medications. We saw risk assessments that have been completed on skin care and the risk of pressure sores. The home has liaised with local district nurses to ensure that people who may be at risk of pressure sores are assessed and treatment and equipment provided in order to reduce/eliminate the risk. The home has a file containing all the completed risk assessments for each person living in the home. We talked to the manager about how the information in this file has been transferred to each person’s care plan file. We saw that in some cases the information had been transferred, but in one case the instructions to care staff could have been improved in order to give clear The Larches DS0000070349.V368564.R01.S.doc Version 5.2 Page 14 directions on the action they must take to reduce the assessed risk. The manager said that this would be addressed with the new care planning system about to be introduced. We received 6 completed survey forms before this inspection and during our visit we talked to four people and also to some relatives who were visiting the home that day. Most people indicated that they were happy with the way the care staff meet their needs. In answer to the question ‘Do you receive the care and support you need?’, two people said ‘always’ , two people said ‘usually’, one person said ‘sometimes’, and one person said “Not compared to talking to people who live in care homes in other parts of the country”. The people we talked to during this inspection said they were satisfied with the care they received. We looked at the way the home stores and administers medicines. The home uses a monitored dosage system supplied by a local pharmacy. Medicines required on a daily basis are stored in a lockable medicine trolley. Other medicines are locked in a cabinet in the office. Controlled drugs are stored in a secure cabinet. Medicines that require refrigeration are currently stored in a locked box in the kitchen refrigerator. The manager told us that a new office/medication room/care plan room is nearing completion and this will give them additional space where they will be able to have a secure refrigerator just for medication. Stocks of medicines were found to be neatly stored. We watched as a care worker gave people their medicines. She took good care to check the records to make sure each person was given the correct medicines. We asked what action she would take if she found a gap in the records. She said she would leave a note in the handover book to make sure that this was followed up. We were concerned that this may mean that a medication error is not addressed as soon as possible - we asked if she knew what the home’s medicines administration policy said about this. She said she had only recently started to administer medicines and, while she had seen the policy she was not fully aware of the full details in the policy. She told us she has received 2 training sessions by the pharmacy on the safe administration of medicines. She had also been monitored by experienced staff on several occasions before being allowed to administer medications on her own. We talked to the manager about how they check the competency of staff before they are given full responsibility for administering medicines. We were told that all staff with this responsibility are about to undertake a thorough training course in the very near future. This course will include a test at the end to ensure the staff have understood what they have been told. The manager also acknowledged that staff may not be fully familiar with the home’s medication administration policy and agreed to ensure all staff see this policy and familiarise themselves with it. The Larches DS0000070349.V368564.R01.S.doc Version 5.2 Page 15 We talked to the manager about the practice of signing the administration sheet before each medicine is given out. She said that has always been the practice in the home and thought that this was the way the pharmacy had instructed them to complete the administration sheets. We pointed to the printed instructions provided by the pharmacy at the front of the medicine administration records that shows that the records must be completed after each medicine is administered. While these things indicated that there may still be some areas of medication administration that could be improved we were satisfied that this may be addressed in the forthcoming training for care staff. We looked at the way creams and lotions are administered in the home. We saw some gaps in the administration charts. The manger told us she had already seen these gaps and had followed them up. The administration records gave staff instructions on how, where and when each cream should be administered. We suggested the records also include instructions on how the staff should monitor the skin condition and what they should do if the condition worsens or improves. The Larches DS0000070349.V368564.R01.S.doc Version 5.2 Page 16 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. People’s quality of daily life has improved in recent months and they are offered a range of activities to suit most interests. Friends and families are encouraged to visit and participate in the home. People are offered a good choice of menu that provides a balanced and health diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the level of regular organised activities has improved. One member of staff is employed every afternoon to provide a range of activities. We heard that some of the recent activities provided have included bingo, games and cooking. On the day of this inspection we saw people playing cards, and also a member of staff escorted a person for a walk in the local area. One person was doing some knitting. We also heard that people have been offered outings and car trips. The Larches DS0000070349.V368564.R01.S.doc Version 5.2 Page 17 The home did not have a regular plan of activities. We suggested that the care plans should be used to find out the things that people used to enjoy doing, and to use this to draw up a weekly or monthly plan of the activities that will be offered. In this way people would know in advance what activities they want to take part in. Some people told us they were disappointed that building works in the grounds of the home have prevented them from sitting outside this summer. However, for some people the building work has provided a source of interest - some people have enjoyed sitting at the lounge window and watching the works going on. Some people told us that they are hoping the new building will result in new people to meet and more people they can talk to when they eventually get outside to sit in the gardens. People who completed a survey form before this inspection told us there are ‘usually’ activities they can take part in. The home holds regular Residents’ Meetings, and also Relatives Meetings – the dates/times of future meetings were displayed on the notice board. These are minuted and we could see that the home has encouraged people The relatives we met during this inspection told us they were satisfied with the way the home has kept in touch with them. They said they are always made to feel welcome when they visit. Since the last inspection a new cook has been employed. People told us the meals are always good. We saw new menus that have been drawn up. These are on a 4 weekly rotational basis. Daily menus have been printed up and were on display on the dining tables on the day of this inspection. We heard that people have been consulted over the menus – their suggestions for favourite foods have been incorporated. Every day there is always at least 2 choices for the main meal. We heard that the menus have been tried and they have realised there are a few alterations that are needed. The menus are discussed in the residents’ meetings. Fresh fruit is offered every day. Records kept in the kitchen show the amount of food each person had eaten every day. In this way the staff have been able to monitor people’s diet to ensure they receive adequate nutrition. All equipment in the kitchen was in good order. The Larches DS0000070349.V368564.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. People can be confident that any concerns or complaints they have will be listened to and acted on appropriately. People are protected from abuse by well-trained staff and good recruitment procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last random inspection no complaints have been received by either the Commission or the home. We checked the homes’ complaints, concerns and compliments records and found they have received some letters of thanks from grateful families, but no complaints. The complaints procedure is set out in the Service User Guide. The people who completed a survey form told us they knew how to make a complaint, and they knew who to speak to if they are not happy about something. We were shown records of training staff have received. These showed that all staff have received training on the protection of vulnerable adults and have also watched the ‘no secrets’ video. The staff who completed survey forms before this inspection, and one member of staff we spoke to during this inspection confirmed that they knew what to do if someone raised a concern about the home. The Larches DS0000070349.V368564.R01.S.doc Version 5.2 Page 19 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, 24, 25, 26 Quality in this outcome area is good. People live in a bright, clean and comfortable environment, although one bedroom could be improved to provide better natural light and outlook. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Building works were being carried out in the grounds of the home at the time of this inspection. This has resulted in people being unable to use the rear gardens during the summer months. The works have cause some minor disruption and changes inside the home. One room that was previously a bedroom no longer has a window and the room is about to be altered to create an office where medicines will be stored and where care plans can be stored/updated. Two bedrooms on the first and second floors have had a The Larches DS0000070349.V368564.R01.S.doc Version 5.2 Page 20 window blocked in, but these rooms have other windows that still give a reasonable outlook. One bedroom on the lower ground floor has lost a window and now only has light from the door. This room is now very dark and has a poor outlook onto a brick wall. We asked the home to consider what can be done to improve the quality of this accommodation. The lounge/dining room has been attractively decorated and furnished. The conservatory gives additional sitting space and is sometimes used by people during the day but most people prefer sitting in the main lounge. There is also a quiet lounge on the lower ground floor, although this room is rarely used. Some people were sat in their wheelchairs during our visit. We asked them if they were happy sitting in their wheelchairs rather than a lounge chair. They confirmed that they were comfortable in their wheelchair. At the time of this inspection there were only 13 people in the home and we saw that there were enough chairs for those people who wanted to sit in the main lounge. However, if more people move in who want to sit in the main lounge there may be insufficient chairs and people may find they either have to sit in the conservatory, the quiet lounge, or remain in their bedroom. We found the bedrooms were comfortable and attractively decorated. People have been able to personalise their rooms with pictures and personal effects to make the rooms feel homely. All of the radiators have been covered to ensure people do not suffer burns if they accidentally fall against a radiator. All areas of the home were found to be clean and free from unpleasant odours. Two domestic staff are employed each day. Since the last inspection the home has looked closely at their infection control policy. The home has received advice and information from the Health Protection Agency. At the time of this inspection they were in the process of drawing up a new infection control policy. Most staff have receive training on infection control. At the last inspection the home was experiencing problems with hot water temperature. The water from some hot water taps was too hot and people were at risk of scalding. Since then the home has adjusted the temperature controls to ensure the water is now at a safe temperature. The water temperatures are tested regularly by the home’s maintenance person – records of the checks were available for inspection. The Larches DS0000070349.V368564.R01.S.doc Version 5.2 Page 21 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 good. Staffing levels are sufficient to meet people’s needs. Careful checks have been carried out to ensure new staff are suitable and people are protected from harm or poor care. Staff have received a good range of training and supervision in order to give people the support they need. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On arrival at the home we found the following staff on duty – 1 manager, 1 senior carer, 3 care assistants, 1 cook, 2 domestics and a handyman. In the afternoons the care staffing levels are reduced to 2. The cook is employed for cooking duties until 2pm and then in the afternoons she is employed to provide activities. At night there is 1 waking and 1 sleeping-in night staff. We found that these staffing levels were sufficient to meet the needs of the 13 people in the home at the time of this inspection. The Larches DS0000070349.V368564.R01.S.doc Version 5.2 Page 22 We checked the records of 4 staff employed since the last key inspection. We found that the home had taken up at least two satisfactory references and a Protection of Vulnerable Adults (POVA 1st) check before confirming new staff in employments. Criminal Records Bureau (CRB) checks had been applied for and staff were employed subject to this check being satisfactory. Staff recruited from overseas had the correct documentation in place. The home is currently seeking additional English language courses for these staff to address any communication problems they may have. All new staff have undertaken a thorough induction at the start of their employment. Induction records were seen during this inspection. These were signed by a manager and the care worker to confirm each section had been completed satisfactorily. We were given a record of the training each member of staff has received. We could see that all staff except those very recently employed have received training on moving and handling, protection of vulnerable adults, food hygiene, and fire training. Approximately half of the staff have received training on first aid. Other training has included medicine training and medicine management, falls awareness, health and safety, infection control, dementia, care of the dying and diabetes. A number of courses are offered to staff later this year on a range of dementia-related topics. 4 staff were in the process of obtaining a nationally recognised qualification known as NVQ. 8 staff have already achieved this qualification. The 2 staff who completed survey forms before this inspection confirmed that they have been offered a good range of training and updates. The Larches DS0000070349.V368564.R01.S.doc Version 5.2 Page 23 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. The home is well managed. People can be confident that their views will be listened to and acted upon. People’s finances are protected by good recording and checking systems. People are protected from harm by well trained staff and good systems of health and safety protection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of this inspection the manager was awaiting the outcome of her application for registration. She has been in post since September 2006. In the last six months she has undertaken a range of training and is in the The Larches DS0000070349.V368564.R01.S.doc Version 5.2 Page 24 process of obtaining a nationally recognised qualification for managers of a care service. There is also a Director of Care who oversees both the care home and the domiciliary care service that operates from an office in the grounds of the home. A Deputy Director of Care has just been appointed. The home has undertaken a quality audit earlier this year. The results of this audit were displayed on the notice board in the entrance hallway. We were also given a copy of the results during this inspection. 7 people completed questionnaires out of 22 that were sent out. The results showed all respondents said the care they receive from the care staff was either good or excellent. They also said meals were either good or excellent. The home also consults with people through residents and relatives meetings that are held several times a year. The dates of these are displayed on the notice board in the hallway. The relatives we spoke to during the inspection said they would like to be able to attend these meetings but live some distance away so can’t always attend. They said they appreciated being given a copy of the minutes after the meeting and in this way felt they were still kept informed and involved. We looked at the records of cash held on behalf of those people who are either unable or do not want to look after their own cash for day-to-day expenses. There is a separate wallet and record of transactions for each person. Good records have been maintained, with receipts retained and balances regularly checked. We carried out a spot check of three balances and found they were correct. We talked to the manager and staff about the level of supervision in the home. Good handover sessions are held between each shift changeover. These are recorded. Since the last key inspection the level of supervision has improved. The manager said that a combination of lower resident numbers, increased staff training, new staff recently recruited, and other positive changes in the home has improved the atmosphere significantly. She said the atmosphere is now calmer and happier, and staff were working together well. Records of staff training showed that staff have received recent training on a range of health and safety topics including moving and handling, infection control, fire safety, first aid, food hygiene, and health and safety. Policies and procedures are in place. The policy on infection control was in the process of being updated. The home has notified the Commission of deaths and serious incidents. Accident reports have been completed satisfactorily. We checked the fire log book and found that all maintenance and safety checks have been carried out regularly in accordance with required standards. The Larches DS0000070349.V368564.R01.S.doc Version 5.2 Page 25 The Larches DS0000070349.V368564.R01.S.doc Version 5.2 Page 26 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 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x 3 2 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 The Larches DS0000070349.V368564.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 15 (1) (2) (b) Requirement You must ensure that all service users have a care plan that is compiled by the home. The care plan must be up to date and reviewed when required. The plan must provide staff with up to date, detailed information on service users’ needs and wishes. The plan must provide clear instructions to staff on what they need to do to care for service users safely and consistently. (Previous timescale of 30/08/05, 24/02/06, 28/09/06, 30/05/07 06/08/07 & 28/03/08 not met) 2. OP9 13(2) You must ensure the safe management of medicines in the home by - Ensuing that administration practice is safe and records of medication administered are accurate and follow the guidelines set down by the pharmacy. - You must ensure records show when creams have been DS0000070349.V368564.R01.S.doc Timescale for action 31/08/08 31/08/08 The Larches Version 5.2 Page 28 administered. - You must ensure that staff competency with regards to the management of people’s medication is checked and any further training requirements are identified and provided. Staff must be aware of the homes’ policy on the safe administration of medicines. (Some previous timescales have been met but this requirement will be checked again at the next random inspection) 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 OP12 Good Practice Recommendations You should continue to improve the level of consultation with people about their social interests and make arrangements to enable them to engage in a range of activities inside and outside of the home. You should draw up a programme of future activities so that people know when an activity they want to participate in will be held. Particular consideration should be given to people less able and those spending considerable time in their bedrooms. The lighting and outlook in one bedroom that has been affected by the new building works should be improved to ensure the room is bright, has good natural lighting and a pleasant outlook. 2 OP25 The Larches DS0000070349.V368564.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 The Larches DS0000070349.V368564.R01.S.doc Version 5.2 Page 30 - 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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