Care Home: Larchfield

What the care home does well All people that wish to use service benefit from a pre-admission assessment and the care plans are then generated from this initial assessment. The pre-admission assessment is kept in the persons individual care plan folder. Care plans and risk assessments contained enough information about the people using the service that allowed staff to care for them appropriately. The staff spoken to on the day were knowledgeable about the care needs of the people using the service.They were observed to be interacting and speaking appropriately to the people in a calm manner. Regular training takes place and this includes the NVQ (National Vocational Qualification) which all staff have access to. People using the service were observed during the inspection and good interaction between them and the staff was observed. Visitors to the home that was spoken to were complementary about the care that their relative received. One relative told us `I visit very regularly and the staff make me feel very welcome`. Another told us `my husband is very well cared for the staff really care about the residents here`. What has improved since the last inspection? No requirements were made following the key inspection in May 2007. What the care home could do better: No requirements were made following this inspection. Key inspection report Care homes for older people Name: Address: Larchfield Larchfield Road Maidenhead Berkshire SL6 2SJ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Lesley Garrett     Date: 1 8 0 5 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 24 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Larchfield Larchfield Road Maidenhead Berkshire SL6 2SJ 01628639428 01628635936 larchfieldcare@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): European Care (West) Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 75 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 75 The registered person may provide the following category/ies of service only: Care home with nursing - N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia DE Date of last inspection Brief description of the care home The European Care Group owns Larchfield. The group runs services for younger people and older people in many areas of the UK and Europe. Larchfield opened in December 2006 and is situated in a quiet residential area within half a mile of Maidenhead town centre. It is a nursing home that caters for the needs of people aged 65 years or over, who, because of physical or mental incapacity, require help with daily living. Larchfield can meet the needs of 74 residents. The home is purpose built over three floors and has the necessary adaptations, aids and equipment to meet the needs Care Homes for Older People Page 4 of 24 Over 65 0 75 Brief description of the care home of its user group. Each person is provided with a single room with en-suite facilities and has the use of all communal facilities. Care Homes for Older People Page 5 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection of the care home was an unannounced Key Inspection. Mrs Lesley Garrett, Regulation Inspector carried out the inspection. The deputy manager represented the service and we were also assisted by the registered manager in the afternoon. We arrived at the service at 10:40 and were in the home for four and a half hours. It was a thorough look at how well the home is doing. It took into account information provided by the home and any information that CQC has received about the service. The manager for the service supplied CQC with an AQAA (Annual Quality Assurance Assessment) and this document was used to assist with the inspection. We also spent time talking to and observing some of the people using the service, staff members and visitors. We looked at how well the service was meeting the key national minimum standards Care Homes for Older People Page 6 of 24 and complying with the regulations and have in this report made judgements about the standard of the service. Documents sampled during the inspection included the homes care plans, daily records and risk assessments, staff files, training records, and the homes safeguarding and complaints policies and procedures. From the evidence seen by us, and the comments received, we consider that the home would be able to provide a service to meet the needs of individuals who have diverse religious, racial or cultural needs. Care Homes for Older People Page 7 of 24 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 24 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who wish to use the service benefit from a pre-admission assessment from a suitably trained person from the home to ensure that the home can meet their needs. Evidence: We sampled the service user guide and statement of purpose for the home and found these to contain detailed information about the home. These documents are reviewed regularly to ensure they contain the most recent information. The deputy manager told us that the manager, the deputy or another nurse always carry out a pre-admission assessment prior to anyone being admitted to the home. Four care plan folders were sampled and the assessments were all in place. The assessments used by the home were detailed and allowed care plans to be generated from this document. The home does not offer intermediate care. Care Homes for Older People Page 10 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care of people using the service are maintained with staff knowledgeable about their needs. Care plans were very detailed with enough information available to allow staff to care appropriately for the people using the service. Evidence: Four care plans were sampled and all contained detailed information about each person using the service and they had been written in a person centred way. The way personal care was to be delivered was described and it was apparent that consultation had taken place with each person using the service or their representative. The deputy said that all care plans are reviewed every month or more often if it is required. Every six months a review takes place with the relative or representative and the key worker. Risk assessments were detailed with clear instructions for staff. The deputy manager told us that the documentation was in the process of being changed. Staff spoken to on the day were knowledgeable about the care needs of the people using the service. Care Homes for Older People Page 11 of 24 Evidence: Aids and equipment are provided to encourage maximum independence for people using the service and these are reviewed and replaced to accommodate peoples changing needs. The deputy told us that the home has the support of one GP practise. The doctor visits every week and during this time will review four people using the service from each unit. During this review the medications are also reviewed to ensure that the people are on the appropriate medication and doses. The GP will also visit the home in between the weekly visits if needed. Other healthcare professionals that visit the home are optician, chiropodist, community psychiatric nurse, psychiatrist and physiotherapist. The deputy said that the home also has the services of the speech and language therapist and dietitian if they are required. Medication policies and procedures are in place. The medicines are ordered every month and are delivered to the home. All the nurses who handle the medicines receive training and the records observed supported this. The deputy told us that she audits the medication administration records every week to check for gaps in the recordings and errors. The deputy told us that there are no medication issues at present. During a tour of the building it was observed that staff were speaking appropriately to the people using the service by their preferred name which had been documented in their care plan. All people were dressed in clothes appropriate for the weather with hair well groomed and nails clean. Some of the bedroom doors were locked when the people using the service had left the bedroom and staff told us this was to prevent people wandering into the wrong bedrooms and allowing people the privacy of their own room. One person told us that the staff lock her bedroom door sometimes but she asks the staff and they soon open it for her. Care Homes for Older People Page 12 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to take part in social, religious and recreational activities. The standard and quality of the meals are high resulting in nutritional needs being met. Evidence: We spoke with the homes activity organiser who told us that she is responsible for the activities that take place in the home. There is a vacancy for another person to help her and interviews are taking place. We observed in the care plans that all people using the service have life care plans in place. The activity organiser told us that these are completed in the first instance by the nurses and she then adds to them with further information. The activity organiser is a trained SONAS practitioner. this is a therapeutic programme which is specifically designed for people with dementia. Staff are motivated to be involved with the provision of activities as the home has introduced a keeping busy trophy. Staff are awarded points for engaging in all types of activities with the people who use the service in each unit.The AQAA told us that activity training has also been developed for all staff to ensure they are aware of how to involve people who use the service in activities. Care Homes for Older People Page 13 of 24 Evidence: Entertainers visit the home every month and this has become a popular occasion enjoyed by relatives also. On the day of inspection the activity organiser was preparing the large lounge for the entertainment organised for that day. Staff were busy on each unit informing the people who use the service and encouraging them to go to the lounge after their lunch. The home maintains links with the local community by having visits from local schools, Pat A Dog Therapy and representatives from different local churches. The home also holds regular church services and has a keyboard so that hymns that are sung may be accompanied. The manager told us that visitors are welcome in the home at any time and the home promotes open visiting. On the day of inspection it was observed that visitors were in and out of the building all day. One visitor told us that they visit most days and that they can also join in the activities and are always made welcome by the staff. The manager told us that the home has a head chef, an assistant chef and two cooks. The menus for the people who use the service are discussed with the chef, the manager and the head of care. Fresh fruit and vegetables are always available and juice kept in each dining room on each unit.The AQAA told us that the chef bakes a birthday cake for each person using the service and families are invited to the home to join in the birthday celebration. The home had an environmental health visit in February 2008 and the manager said that any recommendations made have been addressed. Care Homes for Older People Page 14 of 24 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be confident that their complaints are listend to and that they are protected from abuse from a staff team that have received training in safeguarding adults. Evidence: The home has a complaints procedure that is clearly written and easy to understand. It is avaiable to all people using the service and their representatives.The home keeps a full record of complaints they have received and this includes details of the investigation. The manager told us that she has received two complaints during the last twelve months and both have been satisfactorily resolved. The AQAA advised us that the manager completes an audit of all concerns that have been raised so that the home can address any trends through the quality assurance process. CQC have not been made aware of any complaints concerning the home. The staff at the home have access to an internal safeguaring policy and procedure and to that of the local authority. The manager said that the local authoritys procedure is the one that staff follow. The home has had two safeguarding alerts during the last year and one has been resolved and one is on going. Staff receive training in safeguarding adults procedures and records confirmed this. Staff spoken to on the day had knowledge of these procedures. Care Homes for Older People Page 15 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home enables people who use the service to live in a safe, well maintained and comfortable environment. Evidence: During the tour of the building it was observed that people using the service benefit from a well maintained and decorated environment. All bedrooms are single and have en-suite facilities. It was observed that the bedrooms had been personalised and the AQAA states that the home encourages people to bring in their personal belongings. Each bedroom door has been personalised with either a picture or figure to help the people using the service to identify their room. All bedroom doors can be locked and staff hold keys for the rooms also. There are plenty of communal facilities which include lounge and dining room for each unit. There is also a larger lounge on the first floor where large group activities can be held. The bedrooms benefit from adjustable beds, bed-rails, (if required), and equipment which aids manual handling for example hoists. The home benefits from domestic staff who work every day to ensure the home is clean and free from offensive odours. The team is lead by the housekeeping manager who completes rotas for the staff which ensures the home has staff seven days a week to maintain the standards of cleanliness. Soap dispensers and paper towels were Care Homes for Older People Page 16 of 24 Evidence: available in the communal areas which assist with infection control within the home. Records showed that staff have also received infection control, food hygiene and COSHH training. Care Homes for Older People Page 17 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff numbers at the home on the day of inspection were sufficient to meet the assessed needs of the people using the service. NVQ training for the care staff continues to ensure a good skill mix of staff on duty. Evidence: The home benefits from an experienced staff team and when sampling the staff rota it was observed that staffing levels are consistent. The matron also told us that staff levels can be increased if the dependency levels of the people using the service increases. The manager and the deputy manager are always supernumerary and the deputy is responsible for writing the rotas. We were told that the home rarely uses agency staff as they have a team of bank staff and permanent staff will often cover empty shifts. It was also stated that when the rotas are being written the skill mix of the staff is also taken into consideration. The manager said that well over 50 of the care staff have NVQ certificate, some at level three. The training at the home is on going and the records confirmed that this training takes place.Staff also receive an induction programme which is linked to a national organisations induction programme. . Four staff employment folders staff were sampled and were found to have all the Care Homes for Older People Page 18 of 24 Evidence: necessary paper work to enable the home to safely employ those people. This ensures that the people who use the service are protected by the homes recruitment procedures. Records showed that mandatory training takes place which includes fire awareness, safeguarding adults, food hygiene and manual handling. Staff spoken to on the day told us that they had received lots of training and feel well supported. Other training is also provided to support the staff in carrying out their duties and this includes Dementia training and person centred care planning. Care Homes for Older People Page 19 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management arrangements at the home ensures the staff team is adequately supported and there are clear lines of managerial accountability. Quality assurance systems are in place which improve the quality of care offered to the people who use the service. Evidence: The registered manager of the home had been appointed prior to the home opening. She is in day to day charge of the home supported by a deputy manager. The manager and deputy take it in turns to be on call for the weekends. The registered manager is a nurse and has achieved her registered managers award. In discussion with the manager and deputy manager it was evident they were knowledgeable about the care needs of the people using the service and the training needs of the staff to meet these identified needs. There are clear lines of accountability within the home, each member of staff spoken to on the day of inspection aware of their role and responsibilities. Care Homes for Older People Page 20 of 24 Evidence: The manager told us that surveys are sent to the people who use the service and their relatives/representatives to seek their views on the quality of the service and care provided.The last surveys were completed in February this year.The results are sent to head office and the results are then fed back to the home and an action plan drawn up to address any identified problems. Regulation 26 visits take place at the home every month. These visits are unannounced and the report is very detailed and copies left at the home and available for inspection. No personal money is held by the home. All invoices are passed to the relatives or representatives for them to settle the bill themselves. All necessary health and safety certificates are in place and we also observed a range of policies and procedures relating to health and safety. The AQAA did not identify any health and safety issues. Care Homes for Older People Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 24 of 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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