Care Home: Larchwood Care Home

What the care home does well People enjoy a good quality of life at Larchwood. Relatives who completed surveys made positive comments about the service provided by the home. One person told us, "I am happy with the service that Larchwood provides" and another stated, "I wouldn`t want my [relative] to be in another home, the care and cleanliness together with the friendliness is 100 per cent". The home is well managed in the interests of the people who live there. The manager is competent and experienced and people living in the home are complimentary about the way she manages the service. People living in Larchwood benefit from good quality care that meets their needs. A relative who completed a survey told us, "We are most satisfied with the care our relative receives". There is a wide range of activities in place that are designed to meet people`s wishes and needs. Activities are organised by two activity co-ordinators who are enthusiastic about their role. People are supported by a competent, stable staff team. The relatives of people living in the home were complimentary about the way staff provide care. The home encourages and promotes the involvement of family and friends. Relatives told us they are made welcome and are consulted about their relatives` care. There are robust procedures in place for dealing with concerns and complaints and people using the service can be confident that any concerns they have will be taken seriously and dealt with appropriately. one person who completed a survey told us that what the home does well is, "Very responsive to enquiries or concerns". People living in Larchwood enjoy an environment that is comfortable, clean and well maintained. A member of staff who completed a survey told us that, "Larchwood has a very friendly feel to it making it a nice, pleasant environment for residents and relatives". What has improved since the last inspection? Since the last inspection the recording of medication has improved. Staffing levels have improved since the last inspection, including additional hours dedicated to providing activities. This ensures that there are good staffing levels so that people`s needs and wishes around care and lifestyle can be well met. There has been redecoration and refurbishment throughout the home as part of their ongoing maintenance programme. This includes redecoration and new flooring in some individual bedrooms as well as eye catching and innovative murals painted on the walls in Rowen. What the care home could do better: The service should continue to improve the environment with planned improvements such as replacing some carpets, new chairs in the lounge and the additions to the murals in Rowen. Key inspection report Care homes for older people Name: Address: Larchwood Care Home 108 Broad Road Braintree Essex CM7 9RX     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: Ray Finney     Date: 1 5 0 6 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 31 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 31 Information about the care home Name of care home: Address: Larchwood Care Home 108 Broad Road Braintree Essex CM7 9RX 01376347777 01376345556 larchwood@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Care Homes No 3 Limited care home 64 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 64 persons) Date of last inspection Brief description of the care home The owners of Larchwood are Southern Cross Healthcare and the registered manager is Sharon Thompson. Larchwood is a large purpose built two-storey care home for older people. The service user accommodation is arranged within three self-contained group living units, Acorn and Chestnut on the ground and first floor in one building, and Rowan, which is a larger unit on the ground floor in an adjoining building. Each unit consists of a group of bedrooms, communal lounge, dining room, bathrooms, toilets and kitchenette. All bedrooms are for single occupancy with en-suite facilities. All meals are prepared in a central kitchen. The home is set back from the main road in a residential area on the outskirts of Care Homes for Older People Page 4 of 31 Over 65 64 0 Brief description of the care home Braintree. There are ample car parking facilities and access to public transport is good. There is a passenger lift available for access to the first floor. The grounds adjacent to each unit are enclosed and there is a secure central courtyard area. Access to the building and all areas is good. Larchwood specialises in the care of older people with dementia and also frail elderly people. Fees charged by the home range from £453.11 to £891.00 per week. There are additional charges for toiletries and services such as chiropody and hairdressing. Information about the home can be obtained by contacting the manager. Care Homes for Older People Page 5 of 31 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: A range of evidence was looked at when compiling this report. Documentary evidence was examined, such as care plans, rotas, menus and personnel files. The manager completed an Annual Quality Assurance Assessment with information about the home and sent it to us at the Commission when requested. Throughout the report this document will be referred to as the AQAA. A visit to the home took place on 15th June 2009 and included a tour of the premises, discussions with a visiting healthcare professional and members of staff. Completed surveys were received from relatives of people living in the home and from members of staff. Observations of how members of staff interact and communicate with people living in the home have also been taken into account. On the day of the inspection we were given every assistance from the manager, the deputy manager and the staff team. Care Homes for Older People Page 6 of 31 The last inspection of this service was completed on 18th August 2007. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The service should continue to improve the environment with planned improvements Care Homes for Older People Page 8 of 31 such as replacing some carpets, new chairs in the lounge and the additions to the murals in Rowen. 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 9 of 31 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 10 of 31 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. Through the comprehensive admission process people choosing to live at Larchwood can be confident their needs will be met. Evidence: The manager stated in the AQAA, On the initial visit to the home the families and the prospective service user are welcomed into our family environment. A comprehensive show round is conducted by a senior member of staff covering all areas of the home and appropriate staff are made available to discuss any queries they may have. As previously reported, Larchwood continues to provide appropriate information for people wishing to use the service. A relative who completed a survey told us, I have limited experience of the service provider as my [relative] only joined them [recently]. Prior to admission, the care home manger, Sharon Thompson, was extremely helpful, informative and has, along with her team, done everything possible to make the transition into residential care Care Homes for Older People Page 11 of 31 Evidence: smooth and trouble free. The manager told us in the AQAA, The Home Manager or Deputy would arrange to carry out a thorough pre-admission assessment to ensure that the home can meet the needs of the service user. If funded by local authority a Com 5 assessment would be requested from the service placement team detailing additional information required for the assessment. In respect of a privately funded enquiry information would be sourced from family and other professionals. On the day of the inspection a sample of four care plans was examined, including that of the person most recently admitted to the home. There is a physical and social assessment that covers Maintaining a Safe Environment, Communicating, Breathing, Eating and Drinking, Hearing and Eyesight, Eliminating, Personal Cleansing and Dressing, Controlling Body Temperature, Mobilising, Expressing Sexuality, Sleeping, Dying. For people admitted under the local authority processes, there is also a local authority Com 5 assessment in place. The pre-admission assessment is a comprehensive process and includes a dementia assessment. Overall the assessment process is sufficiently robust to ensure that anyone moving to Larchwood can be confident that their needs will be assessed appropriately and the home will be able to meet those needs before being offered a place. Care Homes for Older People Page 12 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can expect their personal and healthcare needs to be identified and to be provided with the support to ensure these needs are met as they would wish. Evidence: The manager told us in the AQAA, We prepare and maintain a personalised care plan for each individual service user, which provides person centred care and enables staff to deliver the needs of the service user holistically. The care plans are evaluated on a monthly basis or sooner if the needs of the service user changes. Families, professional bodies and staff are involved in implementing any necessary changes to the care plan. From the records examined, it is evident that care plans are well organised with an index at the front setting out the range of care plans in place. The format of each care plan identifies the strength, need, problem or risk and then sets out the aim of care for the person. Planned care is then recorded in sufficient detail to ensure staff receive the necessary guidance to provide care consistently, in ways that meet the needs and Care Homes for Older People Page 13 of 31 Evidence: wishes of the individual. Each care plan has an evaluation of the planned care. Where necessary there is also a risk assessment to accompany the care plan. The risk assessment contains a description of the potential hazard, the level of risk, people affected, measures already in place and additional control measures to be implemented to further reduce the risk. In addition there are specific risk assessments including one using the Malnutrition Universal Screening Tool (MUST). We discussed falls at length with the manager, who was able to demonstrate that they are proactive in managing falls but are realistic that it is not possible to eliminate the risk of falls entirely. Where a problem develops people are referred for screening and advice from healthcare professionals is followed. Records examined contained falls risk assessments. A relative who completed a survey told us, Care provided to date has been of a high standard. Other relatives also were complimentary about the standard of care provided by Larchwood. One person stated, Carers have time and patience with my [relative] and others at all times and Since moving to Larchwood the care and support [they] receive has given [them] a new quality of life. [My relative] always presents as clean, well nourished and contented. Our family has nothing but praise for the Manager, Deputy Manager and all staff. Another relative told us, The staff at Larchwood obviously care very much for the residents. They treat them with kindness and understanding and said that what the service does well is, Treats all patients with love, care and attention at all times. The manager stated in the AQAA, Relevant professionals eg District Nurse, GP, are requested if necessary for input into the continuing care needs of the service user. If specialised equipment is required this can be obtained through the GP or Community Nurse. Care plans contain relevant healthcare information. Records examined confirm that people have consultations with a range of healthcare professionals and routine health checks are carried out. These include Optician, Dentist, Chiropodist, doctors and District Nursing Services. We had a lengthy discussion with a visiting Community Nurse who acts as a liaison between care homes and local NHS health care facilities. The healthcare professional provided some positive comments about the standard of care, in particular in relation to the management team. A relative who completed a survey told us, Medical problems are treated quickly and Care Homes for Older People Page 14 of 31 Evidence: thoroughly. The manager told us in the AQAA, All senior staff have up to date training in medication to enable them to administer medication safely and in line with company policy and procedure. A monthly medication audit is carried out by the Home Manager this will identify any concerns or issues regarding the administration of medication. Procedures around medication were examined, including storage and recording. The deputy manager was able to explain the process in detail and showed an excellent understanding of their responsibilities around safeguarding people by following robust procedures. There are medication rooms in both sides of the premises. Storage is in secure locked cupboards and trolleys that are securely fixed to the wall. There is also a separate Controlled Drugs cabinet designed for medication that requires a greater level of secure storage and a lockable fridge for medication that needs to be stored in controlled temperatures. Creams and topical preparations are stored separately from oral medicines and are marked with the date of opening. Medicines Administration Record (MAR) sheets were examined and found to be in order and appropriately signed. Individual records have a photograph of the person at the front to help minimise risks of administering to the wrong person. The controlled drugs record book was examined and found to be completed appropriately. The home carries out a monthly internal audit that covers Systems and Recording. Areas looked at include administering medicines, medication stocks, recording methods, storage, temperature controlled medicines, controlled drugs, disposal of medications, information and training. During the course of the inspection we observed good practices being followed by staff to ensure peoples privacy and dignity were maintained, including knocking on doors before entering a private room. Staff spoken with were able to demonstrate a good awareness of appropriate practices around maintaining peoples dignity when carrying out personal care. Observations of interactions between staff and people living in the home were respectful and appropriate. Care Homes for Older People Page 15 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service are being offered the opportunity to engage in meaningful and enjoyable activities, which meet their preferences and interests. Evidence: The manager stated in the AQAA, Activity hours have been increased and additional activities have been implemented and We have two dedicated activity co-ordinators who have a vast knowledge of activities designed to benefit our client group. Activities are carried out in groups and on a one-to-one basis. Activities programmes are displayed on all floors informing the service users and relatives of forthcoming activities. Since the last inspection there has been an increase in the hours allocated to activities co-ordinators from 30 hours to 40. We had discussions with the two activities coordinators, both of whom were enthusiastic and demonstrated a commitment to their role. There is a structured activities planner in place, which has planned group activities as well as individual pastimes. The manager told us in the AQAA, We encourage family members of the service users to complete a Life Story Booklet. This enables staff to have a greater understanding of Care Homes for Older People Page 16 of 31 Evidence: the service users life prior to living at Larchwood. We can then where possible integrate a personalised activity to individual service users i.e. hobbies, pets, trades etc and We now have a monthly pub group, a professional art and craft session with external provider and visits to the local garden centre. External entertainers visit the home frequently providing additional services i.e. singing, dancing, art and craft and pat-a-dog. Records examined confirm that activities provided include bingo, quiz, board games, music and singalong, table top games, skittles, bean bag target game, art and craft, floor games, balloon fun, reminiscing, discussion cards , one-to-one activities, hairdressing and nail care. Since the last inspection they have put an in-house hairdressing salon in place that is well equipped and decorated to a good standard. The manager explained that this gives people a better hairdressing experience. She told us in the AQAA, We have a purpose built hair salon within the home, where a qualified hairdresser visits twice weekly. This enables our service users to enjoy a visit to the salon and maintain their self image. A relative who completed a survey was complimentary about the activities and the way they are organised. They told us, The entertainment they organise is excellent. They have different things to do every day from bingo, painting, quizzes, music etc. The entertainment manager is excellent. She always has a smile on her face and this radiates through to the residents. Another relative said, Birthday and other occasions are made special. The activities co-ordinators explained that they are currently preparing for the summer BBQ, which is well supported by relatives and visitors. The manager said, An annual Summer BBQ takes place at Larchwood for service users, families, friends and staff. This is always a successful event. It is evident from records examined and staff spoken with that the service values the input from relatives and friends. Relatives who completed surveys made positive comments about how the home keeps them informed. One person told us, Larchwood care staff always contact the family should there be any concerns regarding my [relative] and another stated, Larchwood do their best at keeping me informed of my [relatives] wellbeing. If [they are] unwell or had a fall they contact me immediately. Its reassuring to know that I am kept in the picture if anything occurs. Another relative stated, I am always made welcome by members of staff, given refreshments when I am with my [relative] and can have meals with [them] if I wish. Visitors are welcome at any time day or night. Care Homes for Older People Page 17 of 31 Evidence: Observations during the day that people were being consulted about what they wanted to do, what they preferred to eat and where they wanted to spend their day. The deputy manager spoke with knowledge and commitment about the importance of supporting people to have control over their lives. It is evident that staff treat people as individuals. Throughout the course of the day we observed good interactions that were appropriately friendly, patient, polite and caring. The manager stated in the AQAA, From listening to relatives and service users the Nutmeg system has now been implemented which enables the chef to deliver a well balanced and nutritional diet for our client group, offering a wide choice of foods at each meal time. We discussed menus and food planning with the manager who explained about the computerised system called Nutmeg that is used for planning menus. The manager explained that this does not mean that menus are fixed but when planning the menus they discuss peoples likes and wishes with them. They can then feed this information into the system which calculates the nutritional value of the chosen meals. Food stocks and storage were examined and we noted that there was a good range of both fresh and store cupboard foods, including plenty of fresh fruit and vegetables. The lunchtime meal was observed to be enjoyed, including one person who chose to eat in the lounge rather than the dining room. Staff spoken with were able to demonstrate a good knowledge of peoples tastes, likes and dislikes around food. A relative who completed a survey told us, My [relative] is very fussy with [their] food and they try to accommodate [them] with alternative choices and another stated, meals are varied with plenty of choice. A member of staff said, they have a variety of food on their menus for breakfast, dinner and tea with tea and biscuits being served in between. Care Homes for Older People Page 18 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be confident that their concerns about how they are treated are listened to and acted upon as stated in the complaints and safeguarding procedures. Evidence: The manager stated in the AQAA, The home has a complaints procedure displayed in reception and We encourage service users and families to voice their opinions and concerns to prevent a complaint being made. We deal with all concerns, issues, complaints promptly as per company policy and endeavour to resolve quickly and efficiently keeping all parties involved informed. The service has an appropriate complaints procedure in place that is clearly written in a format appropriate for the people who live there. We discussed the complaints procedure at length with the manager, who explained that Southern Cross have a very structured process for dealing with complaints. Records examined confirmed that complaints are appropriately recorded and the process is followed. A relative who completed a survey told us, My [relative] is looked after 100 so I have no complaints and another stated, As yet I have never had the need to complain. On the day of the inspection we discussed the homes processes around safeguarding Care Homes for Older People Page 19 of 31 Evidence: with the manager. There have been two referrals made through the local authority safeguarding procedures which we had been made aware of. In both cases we were informed promptly through the Regulation 37 process. The manager was able to give a thorough and robust account of her knowledge of the local authoritys safeguarding processes and it was evident that these processes are followed promptly should any issue arise. Staff spoken with were also able to demonstrate an awareness of their responsibilities around recognising and reporting abuse or poor practice. A recent safeguarding referral confirms that staff acted promptly when the occasion arose. The staff training planner confirms that all staff have up to date safeguarding training (previously referred to as Protection of Vulnerable Adults or POVA). It is evident that the processes in place around complaints and safeguarding are followed and any issues are dealt with appropriately. Care Homes for Older People Page 20 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can enjoy living in an environment that suits their lifestyle and which is homely, well maintained and clean. Evidence: The manager stated in the AQAA, Our secure environment is specially designed for the client group that live here. Our buildings cater for the specialist equipment required by our service users. Large corridors and doorways enable the safe use of hoists and wheelchairs. Handrails to assist with mobility. All bedrooms are single and have en-suite facilities. A full tour of the premises was carried out. Despite being a large home, Larchwood has a homely atmosphere and is bright, airy and comfortable throughout, with good quality furnishings. Peoples individual rooms are decorated to a good standard with ample evidence of personal belongings. The manager told us that some of the improvements made for people living in the home include specialist beds. She stated in the AQAA, We have purchased profiling beds to replace some of the divan beds for residents with increased needs. The chairs in one of the communal lounges are quite old and the manager explained that they are due to be replaced. We also noted that some of the carpets, although clean, would benefit from being replaced. The manager was passionate about about Care Homes for Older People Page 21 of 31 Evidence: maintaining a high standard in the environment, which reflects the commitment to providing good care and valuing the people who live in the home. The manager told us about further improvements planned to the environment for the benefit of the people living in Larchwood. She told us, A Summer House is to be purchased for Acorn garden as the residents have expressed a wish to sit in the garden during all weather conditions. Outside lighting to be put in place to enable the residents to benefit from using the garden during the evenings. The manager told us in the AQAA, Maintenance checks are carried out daily by the maintenance man and The home is currently undergoing a decoration programme of the communal areas, a refurbishment programme is also taking place. We have a dedicated team of domestics that ensure a high standard of cleanliness and hygiene throughout the home. Cleanliness throughout the home was seen to be good and the furniture, fixtures and fittings were all well maintained. Credit must be given to the homes maintenance man and the housekeeping team for maintaining a high standard. The manager told us in the AQAA, Following a successful grant application we have been able to benefit from two local artists who have painted murals on the corridor walls in Rowan House. The murals consist of familiar surroundings for the residents from living in the community and encourages a settled surrounding. A further grant has been awarded, this will be used for additional art work for Rowan House. Shops, post boxes, street lamps will complete the street scene. We saw that the murals on the walls in the corridors make the environment very pleasant. Levels of hygiene throughout all areas of Larchwood were observed to be good. The laundry was clean, tidy and well organised. Similarly the kitchen was clean and well maintained. There were no offensive odours evident in the home. The staff training tracker confirms that staff have received training around infection control and we observed staff following good practices such as wearing gloves and aprons and washing hands appropriately. There were no offensive odours throughout the home. The manager stated in the AQAA, Some bedroom carpets have been replaced with Texalino non-slip flooring to eliminate malodours. A relative who completed a survey told us, I feel that there could be more cleaning staff. This comment is no reflection on the current cleaning staff who do an excellent job in difficult circumstances. Unfortunately people suffering from dementia do create Care Homes for Older People Page 22 of 31 Evidence: an awful lot of work which in my view almost warrants a 24 hour cleaning service. When the cleaning staff have finished for the day the onus to clean up falls on the carers who already have a substantial workload. I must add though, they do it without complaint. However, another relative stated, Larchwood is a bright, clean and friendly environment. I feel that I was fortunate to find it when looking for a care home for my [relative]. Care Homes for Older People Page 23 of 31 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. People living in the home can be confident they are cared for by a competent staff team who can meet their needs. Evidence: The manager stated in the AQAA, We provide a skill mix of staff on each shift. We have bank staff employed to cover shifts on an as and when needed basis to eliminate the use of agency staff and providing continuity of care. On the day of the inspection we discussed staffing levels with the manager. She explained that since the last inspection they have increased staffing levels with an additional two members of staff on duty during the day. Observations during the course of the inspection confirmed that there were appropriate staffing levels to meet peoples needs. Peoples needs were being responded to promptly and they were not waiting unduly for support. The manager explained that they are committed to supporting staff to achieve national Vocational Qualifications (NVQ). The manager demonstrated a good awareness that ensuring staff are well qualified raises morale and also raises the standard of care provided. The manager told us in the AQAA there is, Ongoing NVQ training for all staff. NVQ 2 Care Homes for Older People Page 24 of 31 Evidence: training for care staff and NVQ 3 training for senior staff is taking place. NVQ 2 in Business and Administration being completed by administrators. Housekeeper has obtained NVQ and chef has NVQ in catering. The AQAA dataset tells us the out of a team of 34 permanent care workers, 19 have already achieved a National Vocational Qualification (NVQ) at level 2 or above. One relative who completed a survey said that what the home does well is, It provides the care that my [relative] needs in a friendly and efficient manner. The staff are always kind and considerate to [their] needs. There is generally a low turnover of staff which I find encouraging. [My relatives] wellbeing is constantly monitored. Other relatives who completed surveys also made positive comments about the staff team, including, The care team are always patient, caring and treat clients with respect, The staff are excellent and friendly and create a warm, happy environment for residents and their families, The staff appear well trained. My [relative] can sometimes be quite stubborn and they cope well with [them] and All staff appear professional. I am aware of internal and external training. Im happy with the care. The manager stated in the AQAA, Personnel files are kept in line with company policy. A sample of three personnel files was examined. Each file had a checklist on the front and contained a photograph of the member of staff, an application form with no unexplained gaps in employment history, relevant references and proofs of identity. The staff files were well organised and contained all the documentation required by regulation. There was evidence that new staff undergo an appropriate induction. The company has robust recruitment procedures and all staff have relevant checks including Criminal Record Bureau (CRB) disclosures before commencing employment. The manager told us in the AQAA, We have a comprehensive training tracker in place which identifies relevant training needs for all staff and The home has an in-house trainer who delivers training in Moving and Handling, Dementia, Nutrition, Pressure Care and Infection Control. Evidence examined on the day of the inspection confirmed there is a robust staff training and development programme in place, including an appropriate and thorough induction for new staff. There is evidence in the homes training planner and personnel records examined that people receive training around Fire Safety, Fire Drills, Food Hygiene, Moving and Handling, Control of Substances Hazardous to Health (COSHH), Health and Safety, Abuse and Safeguarding (previously referred to as Protection of Vulnerable Adults or POVA), Infection Control and Nutrition. Senior staff also have Care Homes for Older People Page 25 of 31 Evidence: training around the Safe Handling of Medication. Staff spoken with knew about their responsibilities and were positive about the training provided. A member of staff who completed a survey was complimentary about the training. They stated, I think the training and courses made available to staff are very good and do help staff to understand the type of clients they are looking after and their needs. Care Homes for Older People Page 26 of 31 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. The home is well managed in the best interests of people living there. Evidence: The manager stated in the AQAA, The manager has been employed at Larchwood since 1999, employed as full time manager in September 2004. Manager has undertaken RMA and is currently working towards NVQ level 4. Through extensive discussions on the day of the inspection the manager demonstrated a good awareness of her responsibilities. She explained that she has been with the organisation for a number of years originally working as a carer and has been in post as manager for five years. During the course of the day we observed good management practices. It is evident that the manager continues to develop her skills and knowledge and keeps up to date with the latest developments in care and management, including the Mental Capacity Act and Deprivation of Liberty Safeguards (DOLS). The manager uses Southern Cross tools to check procedures in the home. She told us, Monthly internal and external audits are carried out for medication, Care Homes for Older People Page 27 of 31 Evidence: catering, care plans etc. A relative who completed a survey told us, Sharon, the manager, is very good at her job. She runs a tight ship and is aware of everything going on. The manager told us in the AQAA, we listen to the views of the service users very carefully. A weekly managers surgery is held to enable relatives and significant others to discuss any concerns or issues. Due to the cognitive impairment of our residents we feel it is not possible to have satisfactory resident meetings, therefore regular meetings are arranged where the views of the relatives are listened to and addressed. Relative meetings are carried out 3 monthly, these are planned at the beginning of the year. Minutes are available in reception. The home has an established and robust Quality Assurance programme in place. They use surveys to seek the views of people using the service and the information is collated into a report. The manager demonstrated a good awareness of the importance of listening to people and planning developments for the service taking these views into account. Peoples finances are handled by relatives or other representatives. Small amounts of personal spending monies are held by the home and there is a robust process for recording expenditure. Admin staff do a good job in ensuring these records are well maintained. Documentation relating to Health and Safety was examined. This included the sluice room equipment maintenance certificate, the landlords gas certificate, lift maintenance records and a Gold Food Hygiene certificate awarded by Braintree District Council in September 2008. There was a Braintree District Council Environmental Health visit in October 2008 during which advice was given and no formal notices were made. A visit by Essex County Fire and Rescue Service in February 2008 showed a satisfactory standard of fire safety was evident. The Health and Safety records were well organised and those examined were all found to be in order. Care Homes for Older People Page 28 of 31 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 29 of 31 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 30 of 31 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. 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