Inspection on 18/12/07 for The Larches

This inspection was carried out on 18th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

The Larches 14/07/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Larches Canal Hill Tiverton Devon EX16 4JD Lead Inspector Dee McEvoy Unannounced Inspection 18th December 2007 & 14th January 2008 08:40 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.V352847.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.V352847.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 Anne Gray Care Limited ****Post Vacant**** 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.V352847.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. 13th July 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. Current information about the service is available to prospective residents. Up to date CSCI reports are kept at the home but are not freely available. The most recent report on display was dated 2004. The manager said that people could ask for the latest report. The Larches DS0000070349.V352847.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors visited the home for this unannounced inspection, which took place over 12 hours on the 18th December 2007 and further visit was made on 14th January 2008, we announced this visit to ensure that records were available to review. At the last key inspection there were several issues that needed improvement. These included poor quality outcomes with regards to health and personal care, the environment and management; and adequate outcomes with regards to choice, daily life and social activities, complaints and protection and staffing. A meeting with the owners was held with CSCI to discuss how they intended to make the necessary improvements. The owner outlined how they were going to address the requirements. The purpose of this key inspection was to review all the key National Minimum Standards, check progress in meeting the requirements and recommendations made at the previous inspection and to ensure that people living at The Larches are safe and properly cared for. Prior to the inspection, CSCI surveys were sent to people living at the home, their relatives, health and social care professionals, and staff members. We received completed surveys from 5 people living at the home, one relative, 2 health professionals and five staff members. Their experiences and comments have been used to help us make a judgment about how well the service is meeting people’s needs. There were 19 people living at the home during this inspection and we met or spoke with all of them. To help us understand the experiences of people living at this home, we looked closely at the care planned and delivered to four people. The home provides care for people with a dementia related illness and some people do not have the capacity to communicate fully or understand the inspection process. We spent considerable time observing the care and attention given to these people by staff. We also spoke with one relative and a visiting health professional. We spent time speaking with seven members of staff, including the manager and the company’s representative. A tour of the premises was made and we inspected a number of records including assessments and care plans and records relating to medication, staff recruitment and training, and health and safety. The outcome of the inspection was discussed with the manager and the company’s representative. What the service does well: The Larches DS0000070349.V352847.R01.S.doc Version 5.2 Page 6 Most people told us they had received enough information about the home before moving in. People can visit before they make a decision. The home’s Statement of Purpose gives people information about what to expect of the service. People living at the home have access to a variety of health care professionals to help meet their health care needs. There are no restrictions upon visiting at the home and relatives and friends are encouraged to visit as often as possible. Relatives told us they felt welcome at the home and staff gave them a friendly reception. Relatives also told us the home keeps them informed of any changes. People responding to CSCI surveys and those spoken with during our visits said they “always” enjoyed the food. People told us the food was good quality, one person said, “The food is good & plenty”. Complaints are generally handled well. People’s concerns are listened to and people told us that the home responds appropriately when concerns are raised. People are encouraged to ‘have their say’. The home has quality assurance arrangements which give them feed back from people living at the home, their relatives and outside professionals. Most people spoke highly of the staff, people told us staff were friendly and helpful. Relatives felt staff were caring. Over 50 of staff have obtained a nationally recognised qualification in care, which means that staff have training to a good standard in general care. What has improved since the last inspection? It is good to see that a number of the previous requirements have been met. The manager along with a suitably qualified person now undertakes assessments and the detail in initial assessments have improved. People’s nutritional needs are now being recorded in a more consistent way and people’s weights are regularly monitored to help ensure their well-being. The general environment continues to improve. Some rooms have been redecorated and new carpets have been laid. A new shower room has been fitted which has ensured that bathing facilities suit people’s needs and abilities. Steps were taken following the last inspection to reduce the risk of scalding from hot water on the top floor, however water temperatures need to be monitored (see what they could do better). The home has taken advice from the Health Protection Agency nurse regarding promoting good standards of infection control within the home. Several areas of staff training have been addressed to help improve practice and keep people safe. All staff have received adult protection training to help keep people safe although some staff need up-dating (see what they could do better). Several staff have received training such as manual handling, food The Larches DS0000070349.V352847.R01.S.doc Version 5.2 Page 7 hygiene and infection control but other staff still require this training to ensure consistently good standards (see what they could do better). The company’s representative visits the home regularly and completes a monthly quality report, which is sent to the Commission. This helps to monitor the progress the home is making to improve the overall service for people. What they could do better: 12 requirements have been made as a result of this inspection; there are seven outstanding requirements from the last inspection. There is continuing concern about the detail of information in plans of care. Assessments are not always being updated where changes have taken place and the detail in care plans and risk assessments does not describe how individual needs are to be met. Without good quality information that is reviewed and changed to take into account peoples changing needs, the quality and consistency of care could be compromised. Staff must ensure that people are assisted to maintain good standards of personal cleanliness and they should take timely action to ensure that people’s health care needs are meet appropriately. Attention is needed to ensure that the management of medication at the home is safe. There are some practices at the home that do not respect people’s dignity and privacy. We have recommended that staff work to promote and protect people’s privacy and dignity at all times. Improvements are needed to ensure that peoples’ social and leisure needs are met and recorded, especially those with limited capacity or specialist needs. People could be better enabled to take control over their daily lives and make decisions about where and how they spend their day. The routines at the home could be more flexible, particularly around meals times, giving people choice. The home has been asked to ensure that people spending time in communal areas are safe from harm from other residents of the home. The home should review staff presence in communal areas to maintain people’s safety. Some staff need an adult protection refresher course to ensure their practice and knowledge is up to date. As said, areas of the home have been redecorated and some furniture and fittings have been renewed. This improvement should continue. Some bedroom carpets are heavily stained and the home was not entirely odour free. People told us the lighting at the home was not sufficient to enable them to read properly, they have asked the management to look at providing alternatives. The home needs to continue to improve infection control practices by staff training and a comprehensive policy to guide staff about good standards. To promote good infection control practice, the home should consider obtaining individual slings for people requiring assistance to mobilise. Sufficient staff must be employed to meet the individual needs of people living at the home. It has been seen over an extended period of time that staff levels The Larches DS0000070349.V352847.R01.S.doc Version 5.2 Page 8 are not appropriate, particularly in the afternoon. The home must ensure that proper recruitment procedures are being followed in order to protect people. Staff must receive relevant training to enable them to meet the needs of people with a dementia type illness. Staff should also receive a structured induction training to help them understand how the home works and how to care for people respectfully and safely. Staff should receive regular one to one supervision in order to review their practice and learning needs. The manager should up-date her skills and knowledge appropriately and attend training outside of the home to ensure her practice and knowledge is developed and up to date. The home should ensure that people’s money is managed correctly, and that a good audit trail is in place to ensure accuracy. In order to maintain good health and safety practices staff require mandatory training in manual handling, fire safety and infection control. 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.V352847.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.V352847.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides people with information, which enables them to make a decision about whether the home will suit their needs. Some initial assessments are satisfactory but some do not contain sufficient information and have not been reviewed to reflect changing needs to enable staff to fully plan and deliver care. EVIDENCE: The home has a Statement of Purpose and service user’s guide, which are available to people living at the home and visitors. These documents are kept in the entrance hall. The most recent inspection report freely available to people in the hallway was dated 2004. The manager told us inspection reports were available on request. Having inspection reports freely available would enable people living at the home and their visitors to have access to up to date information about the service. The Larches DS0000070349.V352847.R01.S.doc Version 5.2 Page 11 Surveys from people living at the home show that most (four out of five) felt they had enough information about The Larches before they moved in. One relative told us that she had visited the home on behalf of their mother before she moved in, we were told, “Staff were polite and welcoming”. This relative had not seen the last inspection report but said they would like to. Information about the CSCI website was given so that the relative could read the last inspection report. Another relative responding to the CSCI survey felt they had enough information about the home. At the last inspection a requirement was made to ensure that a suitably qualified or suitably trained person assessed people’s needs, as the manager does not have a care or management qualification. The manager told us that the company’s representative or a senior carer (who do have nationally recognised qualifications in care) accompany her when completing assessments. Some information is also gathered before people decide to move in, including assessments carried out by health and social care professionals in some cases. We looked at the assessment for the two most recently admitted people. The home’s assessments contained basic information about people’s support needs and some preferences. It was noted that most areas of the assessments had been completed, which is an improvement since the last inspection. However, the manager told us that since the admission of one person, complex needs had come to light, which she said were not disclosed to her during her initial assessment. This has meant that the home has struggled to meet this person’s needs at times. The assessment had not been reviewed to reflect these emerging needs. Two staff told us they were not informed about new admissions to the home until the morning of their arrival. They said they were given very little information about people’s needs and often didn’t have time to read the plans of care. (Refer to standards 7 and 27). This could lead to people’s needs not being met consistently and safely. The Larches does not provide intermediate care. The Larches DS0000070349.V352847.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 poor. This judgement has been made using available evidence including a visit to this service. The home has made some progress to improve care planning but areas still lack detail about individual needs to ensure that consistent care is delivered in a way that people need and prefer. Some areas of the management of medication are not satisfactory and could put people at risk. Insufficient attention to personal care needs and a lack of understanding by some staff does not promote privacy and dignity. EVIDENCE: Three people responding to CSCI surveys told us they “usually” received the care and support they need, two others said they “always” get the support they require. People spoke with were generally happy with the care provided, one said, “On the whole I’m happy here”, another told us, “It’s alright here”. Several people were unable to tell us about the care they received. One relative responding to our survey felt that their relative “always” received the support they needed, another relative spoken with said they were “generally” happy with care but did raise concerns about the lack of activities and low staffing levels at times (refer to standards 12 and 27). The Larches DS0000070349.V352847.R01.S.doc Version 5.2 Page 13 We looked at the care planned for five people, three with complex and changing needs, which appear to challenging the home. Despite, care plans providing guidance in some areas of care, there were also significant gaps. For example, one person was recorded as regularly being aggressive towards staff and other people living at the home, staff also confirmed this, but there was no guidance as to how staff were to respond. No further information as to how staff could deal with aggression or ways of preventing aggression were recorded. Daily notes for this person recorded several incidents when they had been aggressive and had been physically violent towards both people living at the home and staff. This person also barred the door to their room and staff could not gain access. There were no specific instructions to staff of how to keep this person safe in the case of fire at the home, if they were barricaded in their room. Another care plan stated that a person was to be assessed daily as to whether they needed to be hoisted or, if they could stand, a different form of hoist, a stand aid could be used. We saw this person being assisted to stand with a stand aid. They were having difficulty standing and we were not aware of an assessment being undertaken before assisting this person to move. It was evident that the stand aid was not the appropriate piece of equipment to use at this time, as the person could not weight bear. Care plans had not always been reviewed to reflect changing needs, for example one person’s daily notes showed that they were having disturbed nights, staff had written “A bit demanding”. Accident records showed that this person had fallen twice at night in November but the care plan and risk assessment had not been up-dated to guide staff about how to keep this person safe. This person had a catheter fitted in November but there were no instructions about how to care for the catheter only that they had become incontinent and a catheter had been fitted. Some information recorded when a person was admitted to the home had not been transferred to a plan of how they like to be cared for. For example “ could become frustrated if he doesn’t have a handkerchief in pocket everyday”. This could result in not all staff being aware of this information. Information provided in plans focused on people’s weaknesses rather than their strengths. For example, “difficult to bath due to increasing immobilityshould be bed bathed or strip washed.” There was nothing recorded in care plans to indicate that people living at the home had been consulted about the content, despite this commitment being made in the home’s philosophy of care. One relative told us she was unaware of the plan of care and that her mother’s needs were not discussed with her, and that her mother could not described her own needs due to dementia. The Larches DS0000070349.V352847.R01.S.doc Version 5.2 Page 14 Although risk assessments are were in place and covered issues such as falls, not all behavioural or situational risks had been considered. For example, two people were challenging the service and staff were finding it difficult to respond to some people’s behaviour, for example agitation or aggression. There was no clear guidance for staff to follow to ensure that when delivering care they took a consistent and safe approach. The daily notes and ‘behavioural chart’ of another person described behaviour, which put other people at risk; no risk assessment had been completed in respect of this. Basic manual handling plans are in place but lack detail about things, which might affect moving people safely, for example where they may be confused. One manual-handling plan had not been up-dated to reflect the changing needs of the person; the manual-handling plan for this person was dated February 2006. Since that time this person’s abilities and general condition have changed considerably. We saw that this person now required staff help to mobilise safely but accurate information was not contained in the plans of care. Staff surveys showed that four staff felt they were “usually” given up to date information about people’s needs; one wrote they were “sometimes” given up to date information. Three staff spoken with said that care plans did not contain sufficient information about people needs to help them provide the right care. One said, “Not good information, it’s not up to date”, another said, “There is little information, it’s really poor”. Two staff told us they did not have time to read care plans. Staff said the information given to them at handover was variable, one told us, “Handover doesn’t really cater for those staff that have been off for a few days”, another told us, “It depends on who is handing over, some staff give little information. It’s a waste of time then”. Care plans need further development, which includes consultation, regular reviews and updating and staff must be aware of their content. The manager said that care plans were being developed and could give examples of the thought they had put into collating information. Daily records were repetitive and gave little indication of life at the home other than task-orientated procedures. For example, ”Assisted to wash, dress, seems fine, quite bright this morning, BROUGHT up to the lounge”, [we had noted that this person had slept from 11am –1pm] another entry said, “ Stayed in bed as was a bit unwell and tired” and “ said he had a stomach ache, didn’t eat much”. There was no evidence of these entries being followed up. Some of the language used in daily notes was demeaning and judgemental showing that some staff had little understanding of people’s needs. This was discussed with the manager and company representative at the time of the inspection. One staff member told us they felt daily notes were “poor” and did not contain “real details” about the care given and the outcome. The Larches DS0000070349.V352847.R01.S.doc Version 5.2 Page 15 CSCI surveys from people living at the home showed that three people felt they “usually” received the medical support they needed, one person said they “always” receive the medical support they needed. We saw evidence that outside professionals, such as GP, nurse specialists, chiropodist and optician are involved in people’s care. Two health professionals responding to CSCI surveys said that the home “usually” seeks advice and acts on this advice, one wrote, “Can be variable depending on which staff are on duty”. Another wrote, “On occasion the care staff have not called health professionals where there have been health needs as early as should have been required. This has resulted in longer intervention for residents”. On the whole three health professionals felt that people’s needs were “usually” met but two said this could “vary depending on which staff were on duty”. When asked ‘what improvement’ the could make, one wrote “Clear identification of senior staff on each shift. Clear reporting of health care needs & advice given to staff. This would result in staff being aware of needs & thus end the comment “I have only just come on shift & don’t know!” The home has reviewed the nutritional assessment used and most looked at were completed. Since the last inspection one staff member has been given the responsibility of weighing people regularly and monitoring any weight loss. We looked at one person’s care plan and noted that food and drinks were to be “encouraged”. We also noted at coffee time his drink remained untouched and at lunchtime this person did not eat their lunch and staff took it away. There was no mention of this in the daily record when we checked later. Staff told us they verbally pass this information on but there is a risk that if this important information is not recorded this person may not get the nourishment they need. We looked at the nutritional assessment and weight chart for this person. The weight chart showed a loss of 11 pounds from July to November 2007, the nutritional assessment said on 14/11/07, “refer to dietician”. There was no further mention of this in the care plan or daily notes. The manager told us the home was to speak with the GP and request a referral to the dietician, but at the time of the inspection this had not been done. We noted that some finer details of personal care could be improved, for example several people had dirty hands and fingernails. We looked at how the home manages medication. We found that the Controlled Drug book was well documented, accurate and up to date. Staff told us and we observed that 2 members of staff carry out the morning medication round. One carer checks the medication administration records (MAR) and dispenses the medication into a pot and signs the MAR as being given. The second carer then takes the medication to the person. This is not good practice, and poses a risk to people living at the home. Some teatime medicines are “potted up” (dispensed into pots) and put on teatime trays, which poses a risk to people. One staff member was particularly unhappy with this practice and told us pots with pills were left on the tea trolley and accessible to people living at the home. The Larches DS0000070349.V352847.R01.S.doc Version 5.2 Page 16 Prescribed creams are not being recorded when applied. Some creams were being used when out of date, which reduces its efficacy, other creams with a limited ‘shelf-life’ once open did not have dates of opening to ensure they were used within the manufactures guidelines. Hand written prescriptions had not been signed by two as is recommended for good practice. Not all medicines had been signed in when received at the home, making it difficult to audit medicication. During the observation period of two hours, we saw that some guidance in the care plans had been followed. People were heard being called by their preferred name, as confirmed by them and recorded in their care plans. However people’s privacy and dignity was not always promoted. For example, the care plan for one person recently admitted described the assistance they needed at night, particularly with regards to their continence needs. We visited this person at about 09.00. They were having breakfast on the side of their bed. The person had been incontinent of urine and was very wet. The bed was also very wet, and it was obvious it had been wet for some time. Staff had not changed this person or the bed before serving breakfast. This does not promote dignity, as no one would choose to eat breakfast in this state. This person told us they needed help at night to reach the toilet safely. They had pressed the call bell during the night for assistance but “no-one had come”. We tested the call bell to find that it was not working and this person had no way to alert staff to their needs (refer to standard 22). People were asked indiscreetly about whether they needed the toilet, and some were told they were being “taken” to the toilet. One person had been given lunch when staff realised that they had not been “toileted” and was taken in the middle of lunch. On another occasion staff spoke about a person over their head, and spoke about doing ‘the feeds’, which reduces people to objects rather than someone with feelings. Health professionals felt that staff “usually” respected people’s privacy and dignity, one wrote, “Sometimes (staff) need prompting to be aware of privacy and dignity issues. I have had serious problems in the past”. The Larches DS0000070349.V352847.R01.S.doc Version 5.2 Page 17 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 adequate. This judgement has been made using available evidence including a visit to this service. Whilst there are some activities, and good contact with family and friends, social and leisure needs are not well organised and do not provide regular stimulation for people to ensure that their individual needs are met. People could be better enabled to exercise a full range of choices or take control over their daily lives. People enjoy the food, which mostly meets their dietary needs and preferences. EVIDENCE: Three people responding with surveys told us there were “usually” activities they could join in with. Two people spoken with told us they had the occasional game of bingo; one said they had made biscuits. Both said no outings had been arranged. One person said they would enjoy getting out and another said a trip out had been planned for the summer but was cancelled due to bad weather. One relative told us, “I think the activities are limited. Mum needs a little “job” to keep her busy and active”. Another wrote, “It would be nice if there were more staff so that more 1-1 interaction could take place. With so many residents needing a high level of care there is not enough time for adequate individual attention. It is difficult to find activities that residents can The Larches DS0000070349.V352847.R01.S.doc Version 5.2 Page 18 do, but they enjoy having visiting musicians etc. More of these would be good”. Staff told us that very little meaningful or individual activities were provided. The home allocates two hours a day for activities Monday to Friday. Staff told us that due to recent staff shortages activities had not been organised. One told us, “Maybe 2 or 3 times a week there’s a game of bingo or singing”, another said “Activities happen when there are enough staff”, a third told us they felt there should be daily activities “but lucky if weekly at the moment”. Three staff told us there was little opportunity to spend one to one time with people, one said, “There are no one to one activities”; another said they had spent one to one time with one person once in past two months. One staff member told us, “People are pretty neglected with regards to stimulation here, and some are sat up for 10 hours doing nothing”. Another staff member wrote in their survey under ‘what could be improved’, “Offer better quality of living. Seems quite basic”. We looked at records relating to activities. The manager is introducing a system for recording peoples’ individual interests and past hobbies. All people have a Social Care Enquiry form but only five had been completed. Information recorded would include peoples preference in relation to hobbies, radio programmes enjoyed, type of music liked, TV enjoyed, what they would like to do and any other information including religious beliefs. Information recorded for one person stated that they “ likes painting and drawing” and were “ an excellent painter” but there was no evidence that the person had been encouraged or supported to take part in this activity. Some staff interactions with people living at the home showed a lack of awareness, and a need for training, focused supervision and positive role models. For example, during the time spent in the lounge one member of staff was involved with 11 people in an “I spy” game. Little was done to involve people and one or two more able people dominated the game. When the carer stopped the game “ for a couple of minutes” she did not return and people were left with no staff interactions for 20 minutes. During this time 3 people fell asleep. One carer spoke to a person who immediately perked up and began an animated discussion. Another person was sitting beside a small Xmas tree, which they caused to fall as they reached out to pick up a magazine on the same table. A member of staff righted the tree but did not help the person reach a magazine. The person gave up and went back to sitting with their eyes closed. A record is kept of activities that people have taken part in. We looked at three records. Activities recorded included, making biscuits, walking in the garden and four chats since Sept 07 for one person. Another person had not been involved in any activities since October 07, whilst another had had been The Larches DS0000070349.V352847.R01.S.doc Version 5.2 Page 19 engaged in 16 activities in a month for example “sat in conservatory x 2 and sat in sun lounge x 1 and dog came to home x 1” recorded. One person who responded to our questionnaire sent before the inspection said that they preferred to stay in their room. No activities had been recorded for this person. We visited them and they were thrilled to be able to chat and said that they are often lonely. Some people had little one to one time with staff and were not involved in any activity. One person spent the majority of the morning sleeping, another at times sat with their head in their hands. There was little in the room for people to occupy themselves or to stimulate them. Staff were task orientated and spoke to people in the lounge quickly, and did not engage with them. The manager came into the lounge at one point and told a person that they had post; she then read a card to the person. It was obvious how delighted the person was at receiving the card. One person sat all morning with no involvement with staff or other people. We were told later that this person came to the home for ‘day care’ to give his carer at home a rest. During the afternoon two or three people enjoyed making Christmas table decorations and some people also enjoyed a Christmas service given by a local church. A number of Christmas activities had been organised including a visit from local school children singing carols, a coral society visit and a Christmas party. Two relatives told us they could visit freely and that the home kept them up to date with events affecting their relative. One relative wrote, “It is like a large family. Staff always treat residents & their visitors with dignity and respect”. Another told us, “I get a lovely reception from staff, they tell me what’s going on and I can have a cuppa”. We saw little evidence of people being offered choice during this visit. On one occasion, when assisting a person to the lounge, staff were deciding where he should sit. This person was frail, got to the middle of the room and could walk no further. A carer got a chair for them and sat them down. They were left there and brought a cup of coffee. This was taken away again. Another carer got a table, put it beside him and left him. Later another carer took the cup, but the contents had not been drunk. This person was not given any assistance to drink or offered another drink, as the original one was cold. Another person was restless and wandering around. Several times this person was returned to a chair and told to “sit there” in a polite way. The care plan for this person highlighted the risk of falls but did not explore how staff could reduce restless by enabling the person to mobilise safely. This person became increasingly restless and distressed at times but staff had little time to spend with her to reassure her or find out why she was restless. The Larches DS0000070349.V352847.R01.S.doc Version 5.2 Page 20 During our observation time we saw some good interactions, which improved people’s state of being, we also saw a number poor contacts between staff and people living at the home. Our observations showed that the majority of staff interaction was ‘neutral’ meaning it neither undermined or enhanced people’s state of being. These interactions were part of everyday care and were often short. Four of the five people returning CSCI surveys told us they “always” enjoyed the food, comments included “The food is good & plenty”. Another person told us the food was good “quality” but that the menu was repetitive and that there were too many sausages. The menus show that sausages are served every week and two roast dinners are also served each week. There are no alternatives on the menu but people can request something different. However, generally, people were not told what the meal was. Some did ask and staff had to check before telling them. This could limit what people may have as an alternative to the main dish. The manager and cook are developing new menus with people’s preferences and needs in mind. Mealtimes did not appear to be flexible – staff told us that the main meal was always served at the same time regardless of what was happening. Staff also described difficulties should they request breakfast at a different time for some people, although we did see one person having a late breakfast. The manager and the company representative told us they would like mealtimes to be more flexible and are working to change routines and staff attitudes. Staff told one person that it would soon be dinnertime when it was not served until forty-five minutes later. This unreliable information could lead to confusion and frustration on the part of the person. The Larches DS0000070349.V352847.R01.S.doc Version 5.2 Page 21 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 adequate. This judgement has been made using available evidence including a visit to this service. People can be confident that their complaints will be listened to and staff understand the principles of adult protection, which helps to protect people from abuse. However additional supervision, guidance and care planning will protect people further. EVIDENCE: Most people returning CSCI surveys knew how to make a complaint should they need to. Relatives were also aware of the complaints procedure and told us that concerns were responded to. Two health professionals told us that the home responded appropriately when concerns were raised but one wrote, “On occasion there have been difficulty in meeting with senior staff to discuss needs”. We looked at the complaints record; the home had received two complaints since the last inspection, which they have acted upon. Due to their condition some people do not have an understanding of personal boundaries and space. Some people were seen to encroach on other’s space and daily notes and a behavioural chart showed that one person was behaving “inappropriately” with another person in communal areas. There was no consistent information to guide staff about whether this was a consenting behaviour or how to reduce any risk to people. There was no evidence that the home had consulted with other professionals about how to deal with this situation. Staff spoken with were aware of the situation and described some actions taken to deal with it. However, there is a lack of staff The Larches DS0000070349.V352847.R01.S.doc Version 5.2 Page 22 supervision/presence in the lounge for various periods through the day, which could leave people at risk. Staff spoken with had received in-house adult protection training to help them recognised abuse and poor practice, and ensure any concerns were reported. Staff said they would report any concerns and one had details of outside professionals to contact should they have any concerns. One staff member told us they had this training “years ago”. Training records show that some staff had not received up-dated training since 2004 and 2006 to make sure their practice was up to dated. The Larches DS0000070349.V352847.R01.S.doc Version 5.2 Page 23 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, 21, 22, 25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements have been made to the fabric of the home, which ensures that people enjoy a pleasant and homely environment. However, consistent improvement relating to safety has not been maintained. EVIDENCE: The communal area, sitting room and dining area, are bright having been redecorated last year. New flooring was also laid in this area. Work must now be continued to complete the refurbishment of the home. For example it was noted at the last inspection that dining room tables and chairs were in a poor state. The company’s representative told us these pieces of furniture had been ordered and were due to arrive in January. We looked around the home visiting several peoples’ rooms. The furniture in some bedrooms is showing signs of wear or damage, for example wardrobes and chests of drawers. Some bedroom carpets are in need of replacement. We The Larches DS0000070349.V352847.R01.S.doc Version 5.2 Page 24 visited one room that was malodorous and the bed was very wet, and the carpet was stained with faeces. Communal space remains is limited, and all chairs in the lounge were in use. Three people spent the day in wheelchairs. The manager told us this was their choice but there were no other chairs available in the sitting room should they choose to sit in a more comfortable chair. The lounge is cramped and the chairs in the corners are only accessible by those who are very mobile. The conservatory is used to stored wheelchairs and tables and remains cramped and uninviting. There was little room to move people in wheelchairs in the dining room. The garden is not accessible at present due to the major building work at the back of the home. The company’s representative told us that once the building work was completed the garden would be accessible again. She was not sure how the “new” garden was to be developed but this would be a good opportunity to ensure that the garden was a pleasant and safe space for people to enjoy. The home was awarded a substantial sum by Devon County Council to improve the bathing facilities at the home. We are please to report that a new shower room has been fitted on the lower ground floor to enable people who cannot access the bath to have a shower. Staff told us this had improved the personal care delivered to people, although the manager said that not everyone likes to shower but people are getting used to the idea. There were still a limited number of slings to use with equipment such as the hoist or stand aid and this means that people share slings. This is not ideal and may compromise infection control. One person who had been living a the home for a few days told us that staff had not come to help him when he had called during the night. We checked the call bell and found that it was not working. We checked call bells in other rooms and found that another 2 did not work. We were told that the maintenance person was responsible for checking batteries in call bells. The maintenance person was unaware of this. We were told that care staff would replace batteries and that these were kept in the office. However, a screwdriver would be needed to undertake this and was not available. At the last key inspection we were joined by an Environmental Health Officer (EHO), who served an improvement notice to ensure that the home maintains a safe environment for people by regulating the hot water on the top floor of the home. Following that inspection the company’s representative informed the Commission that thermostatic values had been fitted to control the water temperature. We tested the water during our visit – the water in the top floor bathroom was recorded on the home’s thermometer as being 54oC – posing a serious risk of scalding. An immediate requirement was issued to ensure that The Larches DS0000070349.V352847.R01.S.doc Version 5.2 Page 25 steps were taken to adjust the water temperature. The manager told us that they had notice the temperature was too hot a few days before and had left a message with a local plumber to fix it. This had not been followed up. The manager made the bathroom secure to ensure people could not get in. We received confirmation from the company’s representative on 24/12/07 that work had been completed to adjust the water temperature, which she said was now 45oC. On our second visit to the home on 14/1/08 the water temperature in the top bathroom was 45oC. This would be considered ‘too hot for skin contact’. The EHO has been informed and Environmental Health Services will take any further action. It was noted that records kept of bath temperatures showed that some people were being bathed in water of 32oC and 34oC, which is rather chilly. Staff said that some people prefer a cooler bath but they couldn’t confirm whom exactly and there was no information in care plans to show that this was personal choice. Two people commented on the poor light at the home. We observed that lighting in some parts of the house was very dim. People told us it was difficult to read sometimes and that they would like better lighting or sidelights. This was also noted in the company representative’s monthly quality report but no action had been taken to address this. The home are to be commended for using low energy light bulbs but should consider how they can improve lighting as requested. The home was not entirely free from unpleasant odours. Two bedrooms were particularly noticeable. Three people returning CSCI surveys said the home was “always” fresh and clean, another said it was “usually” like this. One health professional wrote, “There is always the smell of urine at The Larches. Some of the rooms – particularly in the basement are dingy and smell damp”. We noted that one bedroom carpet was heavily soiled with faeces. At the last key inspection the home was required to ensure that alternative arrangements were found for cleaning commodes as the practice employed was poor and increased the risk of infection. Since the last inspection, the home has consulted with The Health Protection Agency (HPA). A nurse specialist from The HPA visited the home and gave comprehensive advice about the changes that need to be made to ensure infection control practices at the home were acceptable. Although all recommendations had not been fully implemented during our visit, subsequent information from the company’s representative has confirmed that a sluice room is to be fitted on the top floor. According to training records a number of staff still require infection control training (refer to standard 38). Two staff told us that the training they received had mainly consisted of watching a DVD, which they said was not very informative. The policy and procedure for infection control at the home is very brief and does not give staff information about how to deal with waste, The Larches DS0000070349.V352847.R01.S.doc Version 5.2 Page 26 spillages or the appropriate protection to use. Two staff said they hadn’t seen any infection control policy. There was alcohol gel and liquid soap and paper towels in most communal bathrooms and most toilets. One visiting professional told us “There is not always soap and towels for me to use”. The Larches DS0000070349.V352847.R01.S.doc Version 5.2 Page 27 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. The numbers and skill mix of staff on duty are not always meeting the diverse needs of people living at this home. One area of recruitment needs to be more robust in order to ensure people are fully protected. EVIDENCE: People responding to CSCI surveys told us that staff were “usually” available when needed. One person wrote, “They (staff) are very good & will come as soon as they are free to do so”, another wrote, “The staff are always busy but help you when possible”. Relatives told us they would like to see more staff on duty so that people could have one to one time. One wrote, “There is not enough time for adequate individual attention”. Another told us they were “worried” about staffing levels and said, “There never is enough staff”. Health professionals also raised concerns about staffing levels; one told us it was sometimes difficult to find staff when assistance was needed. One raised specific concerns about the staffing arrangements at night. Three staff responding with surveys told us there was “sometimes” enough staff on duty to meet people’s needs, two others said there was “never” enough staff on duty. We spoke with four care staff during our visit and they all said there was not enough staff on duty to meet people’s individual needs. For example, one told us “I try to go at the resident’s pace but we are rushed”, The Larches DS0000070349.V352847.R01.S.doc Version 5.2 Page 28 another said, “There are poor levels of staff and a lot to get done in the time. It can take time to assist people ….” Staff told us that people could be “wet” as they weren’t assisted to the toilet in time. Another staff member told us that some people could not be supervised properly and some had a tendency to “wander”. One person at the home had fallen down the stairs twice. There have been no changes to the number or deployment of staff on duty since the last inspection. The staff rota shows there are usually four care on from 08.00 until 14.00, then three staff from 14.00 until 19.00, this reduces to two staff between 19.00 and 20.00. Afternoon staff are still expected to undertake domestic tasks such as laundry, filling jugs in bedrooms and preparing afternoon tea and supper. One carer told us they didn’t like having to prepare tea and supper and felt it was a waste of her NVQ and skills. The company’s representative told us they were trying to recruit a kitchen assistant for the afternoon to relieve staff of this duty but this has not be achieved. There were 19 people living at the home during our visit and several had complex needs, which challenged staff. Other people had varying dependency levels some requiring a high level of support, for example needing two staff for safe manual handling. A number of other people stay in their room, one visiting professional was concerned about the level of attention these people get and wrote, “The layout of the home does cause concern as residents who are unwell may be in their rooms for long periods of time and it is unclear the level/timing of monitoring”. There was no evidence that staff have time to enable people to enjoy leisure time or make choices about how they spend their time. Staff spoken with, one health professional and one relative raised concern about the night staffing arrangements. These have not changed since the last inspection. The home has one waking and one sleeping carer on at night. Staff that had worked nights told us they had not been called during the assist changing people who may be wet. We were told that people were “very wet” in the morning. We found this on two occasions during this visit. A district nurse told us that in her opinion one waking staff member could not adequately meet people’s needs and said she had concerns about people’s skin. In the past she has seen people with excoriated skin, which she felt was caused by incontinence. The manager and the company’s representative said there was usually enough staff on duty in their opinion. The home has been experiencing problems with recruitment and retention of staff. The company’s representative told us that the owner had agreed to increase staffing levels in the afternoon but they had been unable to recruit. One staff member told us they felt “pressured” to cover other shifts and that they had worked 50 hours one week. The owners are using an agency to recruit overseas staff; so far one overseas person has joined the staff team. At the last inspection it was suggested that the The Larches DS0000070349.V352847.R01.S.doc Version 5.2 Page 29 management of the home undertake internal review of staffing levels. The Commission has not been informed of the outcome of any review. We looked at the recruitment files for three new staff. Two continued completed application forms, and the necessary references and Criminal Records Bureau checks (CRB & POVA) obtained before they started working at the home. This helps to protect people from unsuitable staff. The recruitment file for one overseas staff recruited by an agency did not have references addressed to the home but addressed “to whom it may concern”. It was noted that these references also related to periods of time between 1973 and 1978. The company’s representative said they were to request more up-to date references. A CRB and POVA check had been obtained and information from this person’s country of origin showed they did not have a criminal record. Information from the last key inspection showed that over 50 of care staff have achieved a nationally recognised care qualification (NVQ 2 or above) to ensure that staff are competent to meet peoples’ general care needs. Other training is less well addressed. Discussions with staff and observation of staff showed a varying degree of understanding about how to support people with dementia in a person centred way. Several people at the home described staff as “friendly, polite and helpful”. One relative told us that staff had the skills and experience to meet people’s needs but another said that staff “sometimes” had the right skills and felt that people with dementia “really need trained staff”. Health professionals said that staff “usually” or “sometimes” have the right skills. Their comments included, “Staff changes mean that on occasion staff do not have necessary skills to meet the health needs of residents”, and “Very variable according to which staff are on duty. There have been problems with some carers for whom English is not a first language. Some of them need a lot of instruction from me, some are quite rough with the clients e.g. wanting them to mobilise more quickly than they are able”. It is good to see that since the last inspection six staff have attended in-house dementia training provided by the company’s representative. Staff had mixed opinions about how useful this training was, one said, “We need more in-depth training about dementia” and another said “We need more training as some people are not getting their needs meet”. We were told that this was because not all staff understood dementia or how to communicate with people. There is evidence that training is taking place but it is not always possible to demonstrate that the knowledge gained is being put into practice. We spoke with the company’s representative about the dementia training she delivered. The home has purchased a dementia training pack, which includes a DVD and questionnaires and discussion points. The company’s representative told us she had not had dementia training for “donkey’s years” and has no teaching experience or qualifications in this area. Staff practice, skills and knowledge would be improved with skilled training in dementia. The Larches DS0000070349.V352847.R01.S.doc Version 5.2 Page 30 Staff surveys showed that induction training “mostly” covered things they needed to know to do the job when they first started work. We looked at the induction records for three staff. One was signed as being completed within two days, another was completed over a period of four months and the records for a third were completely blank. This does not provide a consistent approach to ensure staff are able to fulfil their role and meet the changing needs of people loving at the home. The Larches DS0000070349.V352847.R01.S.doc Version 5.2 Page 31 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, 36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager has an open and friendly style but she is unable to fully discharge her duties to ensure peoples’ needs are met safely and consistently. People’s views are sought and they are encouraged to be involved in the running of the home. Better record keeping is needed to protect people’s finances. Inadequate training for staff could place people at risk. EVIDENCE: The manager has been in post since September 2006 and her application to register as the manager for the home was recently received by the Commission. The manager does not have previous experience of managing a registered care home and currently may not have the qualifications expected. Although the management team have said they are keen to support the manager and develop her skills, she has still not started a nationally The Larches DS0000070349.V352847.R01.S.doc Version 5.2 Page 32 recognised qualification in care or management. Following the inspection the manager informed us she would be starting the Registered Manager’s Award (RMA) in late January 2008. This is will followed by an NVQ 4 in care. She has obtained a NVQ 2 in customer service and attended some study days, but these have mainly been in-house. For example Adult protection (4 hours), manual handling trainer’s course, falls awareness (half day), medication training, dementia care (2 hours) and food safety (a DVD). The home has undertaken a Quality assurance audit in August 2007. 23 questionnaires were sent to people living at the home and their relatives, social services and doctors. Fourteen were returned. People were asked to rate aspects of the home, staff and the service provided by the home on a scale of excellent, very good, good, poor and very poor. If a person expresses concern they are given the opportunity to discuss them with a member of the management team. Since the last inspection the Commission has been receiving regular quality report from the company representative, the information within these reports ahs improved over recent months. Although improvements have been achieved since the last key inspection, the home has been unable to meet several requirements within agreed timescales. Records are kept of the personal allowances that the manager keeps for those people who wish it. Receipts of money paid out are not always kept. For example no receipts when the chiropodist or hairdresser has attended to people. Staff surveys show that staff have not received regular supervision. Staff spoken with told us they did not receive regular supervision; one said, “There’s no time”. Supervision would provide an opportunity to discuss aspects of care practice, and training and development needs. 12 staff have received infection control training since the last inspection but records show that a number of staff still require this training to ensure that good standards are maintained. Staff who had completed the in-house infection control training told us they watched a DVD, which was not particular useful. One said she had completed a questionnaire but not seen the DVD. The Health Protection Agency will offer training for staff in care homes and the home would be advised to take up this valuable training. Staff spoken with said they had received manual handling, two told us how much they had enjoyed this training and how much they had learnt. They said the session was practical and fun. Records show that 10 staff have received manual handling training since the last inspection. Records show that four staff have not attended up dates since 2006 and one person had not attended training since 2005. During this visit we noted that some staff were not confident using some pieces of equipment and in one case inappropriate equipment was used to assist one person to when transferring. The Larches DS0000070349.V352847.R01.S.doc Version 5.2 Page 33 Four staff have attended food hygiene training since the last inspection to maintain good practice in this area. Records show that most staff have attended this training (with the exception of two) and we were told only staff who have completed this training work in the kitchen preparing food. Fire records show that fire safety checks are carried out such as fire alarm testing and testing of emergency lights. Equipment is serviced. Staff spoken with said they had received fire safety training although training records show that at least three had not received fire training and others were in need of an up-date. We have referred this to Devon Fire and Rescue. Several fire door guards have been fitted to bedroom doors to enable people to have their door open if they choose. Accident records were up to date and accurate, and generally well recorded. The Larches DS0000070349.V352847.R01.S.doc Version 5.2 Page 34 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 1 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X 3 2 X X 1 2 STAFFING Standard No Score 27 1 28 3 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 2 2 X 1 The Larches DS0000070349.V352847.R01.S.doc Version 5.2 Page 35 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 OP3 Regulation 14 (2) (a) (b) Requirement You must ensure that the assessment of people’s needs is kept under review and revised when necessary to reflect any changing circumstances. You must ensure that plans of care contain sufficient information about individual’s needs and how these needs are to be met Care plans must be reviewed regularly to accurately reflect people’s changing needs. Where possible, you must consult with people or their representatives when planning and delivering care. (Previous timescale of 30/08/05, 24/02/06, 28/09/06, 30/05/07 & 06/08/07 not met) You must ensure that unnecessary risks to the health and safety of people are identified and so far as possible eliminated. Risk assessments must identify behavioural, situational and environmental risks and describe the measures in place to reduce harm. (Previous timescale of 06/08/07 not met) DS0000070349.V352847.R01.S.doc Timescale for action 28/03/08 2. OP7 15 (1) 28/03/08 3. OP7 13 (4)(1) 28/03/08 The Larches Version 5.2 Page 36 4. OP8 12 (1) (a) 5. OP9 13(2) 6. OP12 16 (2) (m) 7. OP25 13 (4)(a) 8. OP27 18 (1) (a) You must ensure that you promote and make proper provision for the health and welfare of people living at the home. Timely action must be taken to ensure that people’s health care needs are meet appropriately. You must ensure the safe management of medicines in the home by - Ensuing that dispensing and administration practice is safe. - You must ensure that out of date creams are not used and that medicines with a limited efficacy once opened are dated. - Handwritten MAR entries must be signed by two competent people to ensure accuracy. - There must be a record kept of all medicines received by the home. You must consult 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. Particular consideration must be given to people less able and those spending considerable time in their bedrooms. You must ensure that water temperatures are safe in order to reduce the risk of harm to people. (Previous timescale of 21/12/04, 8/2/05, 30/08/05, 30/06/07, 26/10/06 & 14/09/07 not met) An immediate requirement was issued. This issue has now been passed to Environmental Health. You must ensure that sufficient staff are on duty at all times to meet the needs of the residents DS0000070349.V352847.R01.S.doc 28/03/08 28/03/08 25/04/08 18/12/07 28/03/08 The Larches Version 5.2 Page 37 9. OP29 19 (1) (a)(b) 10. OP30 18 (1) 11. OP38 13 (5) 12 OP38 16 (2) (j) and ensure their safety. (Previous timescale of 30/08/05, 10/03/06, 19/09/06, 30/06/07 & 10/09/07 not met) You must ensure that you operate a robust recruitment procedures in order to protect people. You must ensure that two references are obtained in respect of each new employee. You must ensure that all staff are adequately trained to look after people living at the home, with particular regard to those people with dementia. (Previous timescale of 08/10/07 not met) You must ensure that suitable arrangements are in place for a safe system for moving and handling people. This includes staff training. (Previous timescale of 10/09/07 not met) You must ensure that safe working practices in relation to infection control are up-held. Staff must have training to help them maintain safe practice. (Previous timescale of 10/09/07 not met) 28/03/08 25/04/08 28/03/08 28/03/08 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. 2. Refer to Standard OP1 OP7 Good Practice Recommendations It is recommended that a copy of the latest inspection report is freely available to people so that they have information about the home. It is recommended that the daily notes kept by staff be accurate and respectful. DS0000070349.V352847.R01.S.doc Version 5.2 Page 38 The Larches (Recommendation carried over from the last inspection) 3. OP8 In order to promote people’s dignity and wellbeing, it is recommended that people’s personal care is maintained to a good standard, this includes ensuring fingernails and hands are clean. It is recommended that people’s privacy and dignity is promoted by staff at all times. It is recommended that that staff ensure choice and autonomy is promoted for less able people. (Recommendation carried over from the last inspection) 4. 5. 6. OP10 OP14 OP18 7. 8. OP19 OP22 It is recommended that staff received up-dated adult protection training to ensure good practice is maintained and people are protected. It is recommended that the home review the level of staff supervision in communal areas to ensure that all people are safe. It is recommended that the refurbishment of the home continue to ensure that people live in a pleasant and homely environment. It is recommended that individual slings be obtained for people requiring assistance to mobilise. (Recommendation carried over from the last inspection) 9. 10. OP25 OP26 11. OP30 It is recommended that all people have access to a working call in order to alert staff to their needs. It is recommended that the lighting in the home be adjusted to suit the needs and preferences of the people living there. It is recommended that the home is kept odour free and clean, including carpets. It is recommended that a comprehensive infection control policy be in place to guide staff with good practice and maintain good standards. It is recommended that all members of staff should receive a structured induction period to ensure they are competent to do their jobs. (Recommendation carried over from the last inspection) 12. 13. 14. OP31 OP35 OP36 The manager should be experienced and qualified to ensure she is fit to manage the home. The owners should ensure she is able to discharge her responsibilities fully. It is recommended that receipts are kept for all money transactions to ensure records are accurate, and can be audited and that people’s finances are protected. It is recommended that all staff receive regular one to one supervision to review aspects of their practice and help to identify any training and development needs. (Recommendation carried over from the last inspection) The Larches DS0000070349.V352847.R01.S.doc Version 5.2 Page 39 Commission for Social Care Inspection 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. 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