Care Home: Larchfield

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What the care home does well Holistic assessment tool is available as part of the service users plans this enables a more effective identification of peoples needs. There are policies and procedures for staff to follow. There is a statement of purpose, which states what the home offers and the staff who deliver the care. Specific preferences are outlined in the service user plan. All the people in the home spoken with could not praise the service highly enough. Comments were made such as "staff are really good" "they understand us". All care support workers are trained above mandatory level. All staff receives annual appraisals and regular supervision. The service takes into account the needs of the people living in the home and staff. People are encouraged to maintain community links through day centres, clubs and external activities. The manager and her team have a good overview of the service and good management system in place to make sure the home runs well and the people in the home receive a good standard of care. What has improved since the last inspection? There was only one requirement and one recommendation made at the last inspection. These have been addressed; all staff now receive regular supervision and individuals activities are recorded in their care plans. The introduction of new care plans and training for staff on assessment process has help to ensure people`s needs are met. What the care home could do better: Continue with planned programme of improvements, which will enhance the people living in the home environment. Continue to ensure people within the home have quality individual care packages. CARE HOMES FOR OLDER PEOPLE Larchfield Joseph Street Leeds West Yorkshire LS10 2AD Lead Inspector Hebrew Rawlins Key Unannounced Inspection 30th October 2007 8:45 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 Larchfield DS0000001473.V353962.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. Larchfield DS0000001473.V353962.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Larchfield Address Joseph Street Leeds West Yorkshire LS10 2AD 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) 0113 2772284 0113 2705280 www.anchor.org.uk Anchor Trust Mrs Caroline Rhodes Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability (5) of places Larchfield DS0000001473.V353962.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The PD places are only for the use of specified service users Date of last inspection 10th November 2006 Brief Description of the Service: Larchfield is owned by Anchor Trust, a registered charity and managed on their behalf by Mrs Caroline Rhodes. The care home provides care and accommodation for up to forty older people, five of who may have a physical disability. Larchfield is purpose built and opened in 1990. The care home is situated in a quiet cul-de-sac; to one side are eight properties, which provide housing for single persons who are supported by a visiting warden. These houses have no connection with the care home, apart from the fact that they are owned by the same organisation. A short walk from the home is the main road, which is well served by public transport. There are also local shops, which are within easy reach if service users do not wish to travel far. There is a perimeter fence around the building for added security. The care home is on two floors, there is a passenger lift. All bedrooms are single, with en-suite facilities. There are two dining areas on each floor, one communal lounge on the ground floor and a quiet sitting room on the first floor. The large kitchen is fitted with commercial equipment and is only used by staff. Small appliances are provided in people rooms for their own use and in the dining areas. All the people who users the service are subject to a risk assessment prior to them using any appliances. There is a staff room, which doubles up as a training room. There are two communal bathrooms on each floor; each is fitted with specialist equipment. There is also a shower available. All laundry is dealt with in house, consequently a large laundry area is provided. An emergency call system is fitted throughout the home, which can be used to summon assistance if required. Respite care is provided if there is a vacancy and the home can meet the needs of the person wishing to stay. The weekly fees range from £409.65 to £475.00. Additional charges are made for hairdressing, private chiropody and newspapers. Larchfield DS0000001473.V353962.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection (CSCI) inspects homes at a frequency determined by how the home has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. Information about the inspection process can be found on our website www.csci.org.uk This visit was unannounced and carried out by one inspector who was at the home from 8.45 until 16.00 on 30th October 2007. The purpose of the inspection was to make sure the home was operating and being managed for the benefit and well being of the people who use the service and in accordance with requirements. Before the inspection accumulated evidence about the home was reviewed. This included looking at any reported incidents, accidents and complaints. This information was used to plan the inspection visit. During the visit a number of documents were looked and all areas of the home used by the people living there were visited. A good proportion of time was spent talking with the people who live at the home as well as with the manager and staff. The manager had completed an Annual Quality Assurance Assessment (AQAA) before the visit to provide additional information about the home. Survey forms were sent out before the visit to the people who use the service, relatives, carers, general practitioners (GPs) and other healthcare professionals. Several were returned and information provided in this way will be reflected in the report. Feedback at the end of this inspection was given to the manager. Thanks are extended to everyone who contributed to the inspection and for the hospitality during the visit. What the service does well: Holistic assessment tool is available as part of the service users plans this enables a more effective identification of peoples needs. There are policies and procedures for staff to follow. There is a statement of purpose, which states what the home offers and the staff who deliver the care. Specific preferences Larchfield DS0000001473.V353962.R01.S.doc Version 5.2 Page 6 are outlined in the service user plan. All the people in the home spoken with could not praise the service highly enough. Comments were made such as “staff are really good” “they understand us”. All care support workers are trained above mandatory level. All staff receives annual appraisals and regular supervision. The service takes into account the needs of the people living in the home and staff. People are encouraged to maintain community links through day centres, clubs and external activities. The manager and her team have a good overview of the service and good management system in place to make sure the home runs well and the people in the home receive a good standard of care. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Larchfield DS0000001473.V353962.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Larchfield DS0000001473.V353962.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. People who use the service experience good quality outcomes in this area. Contract arrangements are clear and people have enough information about the service to make an informed choice about its ability to meet their needs. The pre-admission assessment makes sure the home can meet the person’s needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The organisation has produced a statement of purpose and service user guide, which are available to both current and prospective people. The people who use the service confirmed that they are provided with information about the service at the beginning of their care. People spoken with said they were given the opportunity to visit and assess the facilities and suitability of Larchfield. Larchfield DS0000001473.V353962.R01.S.doc Version 5.2 Page 9 Six care plans were looked at in detail and in all six there was a signed contract showing the terms and conditions of residency. In respect of the people case tracked there was evidence of comprehensive pre-admission assessments. It provides details of peoples condition, health and other professional’s involvement with the individual. Larchfield DS0000001473.V353962.R01.S.doc Version 5.2 Page 10 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 and 11. People who use the service experience good quality outcomes in this area. Peoples care needs are met in a way that respects their privacy and dignity. People’s health care needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has almost completed its new care documentation on people living in the home. The manager said this would be done by the end of December. Before a service is provided a detailed support and care needs assessment is carried out which involves the person using the service and other healthcare professionals. Care plans address personal, health and social care needs. Care plans include information on spiritual and cultural needs. There are risk assessments in place for falls, nutrition, and the risk of developing pressure sores. There was evidence of people’s wishes in respect of end of life care are recorded. Larchfield DS0000001473.V353962.R01.S.doc Version 5.2 Page 11 There was evidence in records that people have access to GPs (General Practitioner), chiropodody, dental and optical services. Survey forms returned from GPs state that the home manages peoples’ health care needs well and always seek to give clients privacy. The medication system was examined. Storage facilities are secure and the accompanying record sheets have been accurately completed. From discussions with people living at the home and from the returned completed survey forms it is clear that they feel that their dignity and privacy are respected. People living in the home looked well cared for. Staff said they give a good service, one said, “Everyone works hard with sometime difficult people but they know we care”. During conversations with a visitor he said “there are no concerns about this home everyone does their best and the people living here are happy”. Larchfield DS0000001473.V353962.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use the service experience good quality outcomes in this area. The home has a relaxed and informal atmosphere that promotes flexibility and visitors are made to feel welcome. People are encouraged to take part in social and leisure activities. A good and varied diet is provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People can choose whether to spend their time in one of the communal areas or in their bedrooms. Daily routines are fairly flexible and adapted to fit in with peoples’ preferences. People are offered a range of activities in the home and opportunities to go out either with staff, on their own, or with family/friends. Some people living in the home routinely go out to day centres. Activities that people have taken part in are now recorded in their files. There are no restrictions on visiting and during the inspection visitors were seen coming and going. Some people go out with family or friends. Larchfield DS0000001473.V353962.R01.S.doc Version 5.2 Page 13 Observing care practices in the home there is genuine warmth in the way staff deal with people. People are confident and comfortable in the home. There was a relaxed relationship between people living in the home and staff with lots of banter, when staff joked with people in the home they responded appropriately. Staff were patient and answered the same questions over and over again with one person without showing any signs of irritation. People said the food was good and clearly thought very highly of the staff, one person said “its lovely here”. The chief has a good knowledge of people’s likes and dislikes and takes these into account when preparing the food. The food is simple and wholesome, it is well presented, and staff were seen to help and encourage people where necessary. Throughout the day people were offered lots of drinks and given a choice of hot or cold drinks. Larchfield DS0000001473.V353962.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use the service experience good quality outcomes in this area. People and their representatives can be confident that their concerns will be listened to and dealt with. The home has the necessary systems in place to make sure that people are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a comprehensive complaints procedure in place, which is made available to people. The home records all complaints they receive. No complaints have been made either to the home or the Commission For Social Care Inspection. People spoken with and from the survey returned said that they were aware of how to raise any concerns. They said they would approach the manager and they were confident that she would put things right. Comprehensive policies and procedures on the protection of vulnerable adults were seen including the local multi-agency agreement. In discussion with staff they all appeared confident in the action to be taken should abuse be suspected or alleged. Larchfield DS0000001473.V353962.R01.S.doc Version 5.2 Page 15 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, 20, 23, 24, 25 and 26. People who use the service experience good quality outcomes in this area. People live in a homely environment that is clean, comfortable, and generally well maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was clean, welcoming and provides an homely environment. Infection control procedures are in place. Hand washing is promoted at all time and training takes place at induction BTEC Alcohol gel and hibi scrub is available and used. Cleaning programmes is in place for all areas. The programme of refurbishment is ongoing. The ground floor bathroom has been refurbished, rooms are decorated and carpets replaced as they become empty. Larchfield DS0000001473.V353962.R01.S.doc Version 5.2 Page 16 The home has received a grant to allow people living in the home to purchase soft furnishing etc for their own rooms as well as a large flat screen wall mounted television. There are plans to buy new furniture for the dinning rooms, new curtains and new furniture for the lounge. All within the next 12 months. Larchfield DS0000001473.V353962.R01.S.doc Version 5.2 Page 17 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, 29 and30. People who use the service experience good quality outcomes in this area. There appear to be enough staff to meet people in the home needs. They are protected by the homes recruitment procedures. Overall staff are well trained for their roles. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a robust recruitment procedure in place, which is supported by the organisation recruitment team. They were clear evidence of job profiles and formal interview process. Planned training programme incorporates mandatory training. Over 50 of the staff have achieved a National Vocational Qualification (NVQ) in care at level 2. Management training is also available for seniors. Duty rotas indicated that there is sufficient care staff on duty to meet the needs of the people living in the home. People living in the home returned survey stated there is usually enough staff to meet their needs. Staff have regular supervision and all the necessary checks are carried out before staff start work at the home. Larchfield DS0000001473.V353962.R01.S.doc Version 5.2 Page 18 There was information on terms and conditions of employment in staff files. The home continues to let us know about things that have happened and to date they have shown that they have managed issues well. In surveys returned from staff they said that management are supportive of them and any complaints are taken seriously. Larchfield DS0000001473.V353962.R01.S.doc Version 5.2 Page 19 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, 32, 34, 36, 37 and 38. People who use the service experience good quality outcomes in this area. The home is well organised and the manager provides effective leadership. Health and safety of people is promoted and protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A qualified, competent and experienced manager manages the service. It is clear that she has a good knowledge of the people who use the service and their needs. Comments from people who use the service included, “We are very happy and satisfied with the home” and “It is a good caring home”. Larchfield DS0000001473.V353962.R01.S.doc Version 5.2 Page 20 Accident records in individual files and accident monitoring system in place. Training records show that staff have received training in health and safety. Financial records were seen, where people cannot look after their finances themselves, good records were in place. Every year the organisation sends a satisfaction survey out to people who use the service. The information is gathered and analysed, looking at where improvements to the service can be made. It was clear from discussion with the manager that she has good management systems in place to support her. She has good knowledge on recruitment and training and is well aware of policy and procedure within the organisation. The returned annual quality assurance assessment showed that servicing of equipment takes place as required and a selection of service certificates were seen, along with the records of fire alarm tests which show a different actuation point is tested each time. Larchfield DS0000001473.V353962.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X 3 3 3 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X 3 X 3 3 3 Larchfield DS0000001473.V353962.R01.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Larchfield DS0000001473.V353962.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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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