Care Home: Larchwood Grove

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What the care home does well People who live in the home are supported by an enthusiastic and committed staff team. There is a diverse staff team and residents’ emotional and physical needs are acknowledged within individual care plans and by staff who are delivering the care. There are a range of activities in which people can participate both within the home and the local community. What has improved since the last inspection? Since the last inspection the home has implemented more robust recruitment procedures in recruiting new staff. Staffing levels have been increased providing more support for service users. The home has a contract with a training provider to deliver all mandatory training to staff members and induction is linked to Skills for Care standards and assessed by a qualified NVQ assessor. What the care home could do better: Lines of accountability need to be made clear to staff members to ensure the smooth running of the service and in the best interests of service users.Larchwood GroveDS0000023972.V375830.R01.S.docVersion 5.2 Key inspection report CARE HOME ADULTS 18-65 Larchwood Grove 60 Parrock Road Gravesend Kent DA12 1QH Lead Inspector Paul Stibbons Key Unannounced Inspection 9th June 2009 12.15p Larchwood Grove DS0000023972.V375830.R01.S.doc Version 5.2 Page 1 This report is a review of the 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. 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 home adults 18-65 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. Larchwood Grove DS0000023972.V375830.R01.S.doc Version 5.2 Page 2 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 Larchwood Grove DS0000023972.V375830.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Larchwood Grove Address 60 Parrock Road Gravesend Kent DA12 1QH 01474 352722 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) Larchwood Court Ltd Post vacant Care Home 10 Category(ies) of Learning disability (0) registration, with number of places Larchwood Grove DS0000023972.V375830.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD). The maximum number of service users to be accommodated is 10. Date of last inspection 10th June 2008 Brief Description of the Service: Larchwood Grove is situated in a residential area in the town of Gravesend. The home has a large rear garden and accommodation is provided over 2 floors. The building has been extended and refurbished to provide modern accommodation and single bedrooms. There are 4 single wheelchair accessible bedrooms on the ground floor and 6 single bedrooms upstairs. The home is registered to provide accommodation and support to 8 people with a learning disability on a permanent basis. The home also offers 2 respite care beds. The home is staffed 24 hours a day with 1 waking night staff and 1 sleep over staff member. Public transport is available to access the town centre and there are a range of pubs, shops and cafes within walking distance. Larchwood Grove DS0000023972.V375830.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This key unannounced inspection took place over a period of 5 hours and the registered provider was present. The service had returned a completed AQAA (Annual Quality Assurance Assessment) to the commission prior to the site visit. A variety of records and documents were examined during the visit that included, 3 care plans, 3 personnel files, health and safety records, staffing rosters and menus. The inspector held discussions with the registered provider, deputy manager, 4 members of staff, 2 service users and 2 relatives. What the service does well: What has improved since the last inspection? What they could do better: Lines of accountability need to be made clear to staff members to ensure the smooth running of the service and in the best interests of service users. Larchwood Grove DS0000023972.V375830.R01.S.doc Version 5.2 Page 6 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. Larchwood Grove DS0000023972.V375830.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Larchwood Grove DS0000023972.V375830.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents have sufficient information on which to base an informed decision as to whether the home can meet their needs. A comprehensive assessment of needs is carried out prior to admission to ensure the home can meet prospective resident’s needs. EVIDENCE: There is a Statement of purpose and Service users guide in place and the provider confirmed that all people living in the home receive copies of these. The AQAA states that the aforementioned information can be provided in different formats if required, for example, widget form. There have been no new admissions to the service since the last inspection but the AQAA states a full assessment is undertaken prior to offering individuals accommodation in the home. Three care plans viewed confirm that assessments have been conducted by the home and care management. Larchwood Grove DS0000023972.V375830.R01.S.doc Version 5.2 Page 9 People who stay in the home on respite tend to return on a regular basis and the home has a pre-admission checklist to ensure any changes since their last visit are identified. Larchwood Grove DS0000023972.V375830.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9,10 People using the 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 benefit from having an individual plan of care that reflects their assessed and changing needs. People living in the home are consulted and supported in taking risks as part of an independent lifestyle. EVIDENCE: Three care plans were viewed that had assessments of individual needs and general guidance for support workers to meet these needs. The care plans would benefit from detailing resident’s personal goals and aspirations and action plans of how they will be achieved. The provider informed the inspector that the deputy manager is in the process of reviewing individual care plans Larchwood Grove DS0000023972.V375830.R01.S.doc Version 5.2 Page 11 with the aim of providing all service users with a plan of care in a format understandable to each individual. Each care plan includes a comprehensive risk assessment, which is reviewed regularly. The management of risk is positive in addressing safety issues while aiming for improved outcomes for people, for example, two service users are now attending the local gym on a weekly basis. The home ensures that residents are consulted regularly to gather information about their satisfaction with the home, the last recorded resident’s meeting was seen to be on the 5th June 2009. Confidential information is stored securely and residents were not discussed in front of others. Larchwood Grove DS0000023972.V375830.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 11,12,13,14,15,16,17 People using the 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 have a range of opportunities that will meet their social, leisure and educational needs and their own personal development. People living in the home are supported in maintaining appropriate relationships with friends and family. People living in the home enjoy a healthy and varied diet that is of their choosing. EVIDENCE: Residents are involved in daytime activities of their own choice and according to their individual interests, diverse needs and capabilities. There is an activity Larchwood Grove DS0000023972.V375830.R01.S.doc Version 5.2 Page 13 board in the main lounge that highlights the current weeks activities. On the day of the visit three residents were out bowling and others were involved in art work within the home. Interaction observed between staff and residents was respectful and friendly and residents spoken with said they were happy at the home. The home has a computer that residents can use and the AQAA states that the home will work on developing the residents IT skills so they can access the computer more readily Two visitors spoken with confirmed that their relative went out a lot during the week and was well cared for by the home. There is a four-week menu in place and people are supported to make their choices on a weekly basis. Residents assist with meal preparation where they have the capacity. Resident’s spoken with said how they enjoyed the meals in the home. Larchwood Grove DS0000023972.V375830.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 People using the 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 receive personal support in the manner they prefer and require and their physical and emotional needs are met. People living in the home are protected by the homes policies and procedures for dealing with medication. EVIDENCE: Care plans viewed evidenced that residents have access to healthcare and remedial services. Staff make sure that those who are fit and well enough are encouraged to be independent, have regular appointments and visit local health care services. The home has provided specialised equipment, for example, over-head tracking hoist, to assist less mobile residents in accessing bathing facilities. Larchwood Grove DS0000023972.V375830.R01.S.doc Version 5.2 Page 15 Care plans viewed were reflective of individual needs and give clear guidance with regards to personal preferences and how people want to be supported. The home has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. Medication records are fully completed, contain required entries, and are signed by appropriately trained staff. Larchwood Grove DS0000023972.V375830.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 People using the 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 that their views will be listened to and acted on and they are protected from abuse and neglect. EVIDENCE: The service has a complaints procedure that is clearly written and easy to understand. It is also available in widget format to help anyone living at, or involved with, the service to complain or make suggestions for improvement. The complaints procedure is supplied to everyone living at the home and is displayed in the hallway of the service. Residents and others involved with the home understand how to make a complaint and are clear about what will happen if a complaint is made. The home keeps a full record of complaints and this includes details of the investigation and any actions taken. Unless there are exceptional circumstances the service always responds within the agreed timescale. The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. Staff members spoken with know when incidents need external input and who to refer the incident to. Larchwood Grove DS0000023972.V375830.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a homely, safe and comfortable environment with sufficient personal and communal space to meet their needs. EVIDENCE: The home provides a physical environment that is appropriate to the specific needs of the people who live there. The well-maintained environment provides specialist aids and equipment to meet their needs. The home is a very pleasant, safe place to live and the bedrooms and communal rooms meet the NMS or are larger. Most bedrooms have en-suite facilities. Larchwood Grove DS0000023972.V375830.R01.S.doc Version 5.2 Page 18 Residents are encouraged to personalise their bedrooms and all the home’s fixtures and fittings meet the needs of individuals and can be changed if their needs change. The shared areas provide a choice of communal space with two large lounges and a dining room which gives opportunities to meet relatives and friends in private. There is a rear garden laid to lawn with seating enabling residents to enjoy the outdoors as weather permits. The home has adequate laundry facilities, is well lit, clean and tidy and smells fresh. The management has a good infection control policy. Larchwood Grove DS0000023972.V375830.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36 People using the 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 are supported by caring staff that respect their choices and preferences and are in sufficient numbers to meet their needs. EVIDENCE: The home has recruited a new staff team in the last 12 months due to several of the former employees being removed by immigration officials. The home has robust recruitment practices in place and records viewed confirm three satisfactory references are taken up and CRB and POVA checks are carried out. One individual identified as requiring additional carers at the last inspection is no longer with the service. Staffing levels have been increased to four staff on duty during the day and two at night to support six current residents. Previous duty rosters viewed indicated that generally these levels were adhered to. Larchwood Grove DS0000023972.V375830.R01.S.doc Version 5.2 Page 20 The home has a contract with a training provider to provide all mandatory training requirements to the staff team. The provider states that training is due for completion in August 2009. Four staff have achieved an NVQ award in care and four are enrolled on the award. The home employs an NVQ assessor who conducts induction training for new employees. Records viewed indicate bi-monthly supervision for staff and this was confirmed by staff spoken with. Members of staff spoken with were enthusiastic and committed to good quality care and this was observed throughout the visit. Two members of staff raised employment issues outside of the commissions remit and these were given in feedback to the provider at the end of the visit. Larchwood Grove DS0000023972.V375830.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,41,42,43 People using the 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 have their health, safety and welfare safeguarded but would benefit from the lines of accountability within the home, and with any external management, being clearly understood by staff and service users. EVIDENCE: The home currently has no registered manager for the service. A deputy manager is in charge of day to day management of the service and is supported by the registered provider. The deputy manager is enrolled for the Larchwood Grove DS0000023972.V375830.R01.S.doc Version 5.2 Page 22 leadership and management award and the commission is awaiting an application for registration. The AQAA contains clear, relevant information that is supported by a range of evidence. The AQAA lets us know about changes they have made and where they still need to make improvements. It shows clearly how they are going to do this. The data section of the AQAA is accurately and fully completed. The deputy manager states that initially the complete change of the staff team was difficult for residents but as the new staff received training any issues have been resolved. Observations and discussions with staff and residents appear to support this. Staff members were enthusiastic and committed to good care and residents spoken with were relaxed and happy. Evidence was seen of staff team meetings taking place monthly and resident meetings weekly, which facilitates people in expressing their views. Records are kept in the home that evidences health and safety checks on a regular basis and the servicing of equipment. There is evidence of monitoring of the service by the providers representative, however, some of the contents of the report are disputed by the deputy manager and some staff members. The deputy manager also raised other employment issues with the inspector and these were discussed with the provider following the inspection. The provider states a meeting is arranged to address these issues and the commission would welcome a resolution that does not have a negative impact on quality outcomes for residents. Larchwood Grove DS0000023972.V375830.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 3 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 3 3 3 2 Version 5.2 Page 24 Larchwood Grove DS0000023972.V375830.R01.S.doc No Are there any outstanding requirements from the last inspection? 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 Larchwood Grove DS0000023972.V375830.R01.S.doc Version 5.2 Page 25 Care Quality Commission South East Citygate Gallowgate Newcastle uponTyne NE1 4PA National Enquiry Line: 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. 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