Care Home: Larchwood Nursing & Residential Home

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What the care home does well The home is now well run with a committed team of staff who have the resident`s best interests at heart. The residents make positive remarks about the staff and the care that they receive. One resident told us "the staff are very kind and they do what they can to help me", another said "the help I get is terrific" whilst another said "on the whole the staff are alright". A relative told us "the staff are attentive". The home provides a good selection of food for the residents to choose from; one resident said "food is very good and I get a choice". Another resident told us "I just love the way the chef cooks the fried fish and chips". The home provides a good range of activities for the residents to participate in. There is a robust system in place for recruitment. What has improved since the last inspection? The overall management of the home has improved since the new manager has been in post and working practises have changed for the better. The staff team are now more cohesive and work well together; one staff member said"I love coming to work, its the best move ever". The care plans have improved with more emphasis on the specific details of need The system for staff supervision has improved with staff now receiving more frequent sessions. A much improved system is in place for record keeping. The service now keeps us informed of all incidents that occur in the home. Staffing levels have improved. There is now in place a competent manager who is more robust in all areas of management of the home. What the care home could do better: The service could continue to make more improvements in the care planning so that all areas of need are addressed. Although the home has been rated good overall the environment remains inadequate and is in need of refurbishment. Keep a record of all concerns however small. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Larchwood Nursing & Residential Home 133 Yarmouth Road Thorpe St. Andrew Norwich Norfolk NR7 0RF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Marilyn Fellingham     Date: 3 1 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 25 Information about the care home Name of care home: Address: Larchwood Nursing & Residential Home 133 Yarmouth Road Thorpe St. Andrew Norwich Norfolk NR7 0RF 01603437358 01603702046 larchwood@bondcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Bondcare (Larchwood) Limited care home 48 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: No more than 48 Service Users may be accommodated. One person with dementia whose name is held on CSCI records may be accommodated. Once this person is no longer resident, the registration reverts to 48 older people. Up to forty-eight (48) Older People may be accommodated in the category OP. Up to forty-eight (48) Service Users who have a physical disability may be accommodated in the category PD, who are aged 55 years or over. Date of last inspection 0 4 1 1 2 0 0 8 0 48 Over 65 48 0 Care Homes for Older People Page 4 of 25 Brief description of the care home Larchwood Nursing and Residential Home is owned by Bondcare Ltd and is situated on the outskirts of Norwich, within Thorpe St Andrew. The home lies within easy access of a large supermarket, post office and small local shops. It is a two-storey building with access to the first floor by shaft lift and stairs. The home can accommodate up to 48 older people, 25 with nursing needs and 23 with residential needs. The service has 36 single and 6 shared bedrooms. All the bedrooms have en-suite toilets and washbasins. There is an enclosed patio area with seating and with raised flowerbeds that are accessible to wheelchair users. The home has car-parking facilities at the rear of the premises. Fees for the home are £482 to £600 per week. Residents are expected to pay extra for hairdressing, chiropody, newspapers and personal items. Care Homes for Older People Page 5 of 25 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: two star good 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 was an unannounced inspection that took place over seven and a half hours. The key inspection for this service has been carried out using information from previous inspections, information from some residents, relatives, visitors to the home and people who work in the home. We also used information from the Annual Quality Assurance Assessment (AQAA) that the manager had provided for us before the inspection. The main method of inspection used was case tracking. This involved selecting individual care plans and information available about people living in the home and tracking their experience as a result of the support provided. During our visit a tour of the premises was undertaken and residents records and staff Care Homes for Older People Page 6 of 25 files were looked at. What the care home does well: What has improved since the last inspection? What they could do better: The service could continue to make more improvements in the care planning so that all areas of need are addressed. Although the home has been rated good overall the environment remains inadequate and is in need of refurbishment. Keep a record of all concerns however small. Care Homes for Older People Page 8 of 25 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 set out 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 25 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 25 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. Prospective residents and their relatives are given sufficient information to make an informed decision about whether they wanted to live in the home. Evidence: We looked at the assessment of needs records for two newly admitted residents to the home; we noted that a full assessment of needs had been carried out for both residents. The assessments were detailed and contained relevant information about both residents. The manager told us that after they had established that the needs of these residents could be met, letters were sent to the prospective residents or their representatives to confirm that their needs could be met. The manager also showed us copies of contracts that are given to all residents. We also saw copies of the letters sent to the prospective residents. We spoke with one visitor who was visiting their relative and they informed us that they had been given sufficient information about the home before they made a decision regarding their relatives move into the home; they also told us that they were Care Homes for Older People Page 11 of 25 Evidence: given the opportunity to look around the home first and that everyone had been very welcoming. Care Homes for Older People Page 12 of 25 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. The practice regarding the planning and delivery of care means that the residents can be sure that their health and personal care needs will be met. Evidence: We spoke with four residents who were living in the home and one relative, they all commented that they felt very well cared for; one resident said I took a little time to settle in, there are bits I dont like but thats nothing to do with the home. They went on to say staff are all good and they are nice to me and do what they can to help. Another resident said the help I get is terrific, staff pop in all the time. One resident told us I dont have any thing to grumble about, I am lucky; and another saidI had a lovely bath this morning. The relative who we spoke with said that the staff are very attentive, they are all good and helpful. They went on to say that they never minded leaving their relative as staff are so good. We looked at the care plans for three of the residents we spoke with, they were very detailed and covered all areas of assessed needs. The service has improved the care planning system and it is working well. Each of the care plans we looked at had records for manual handling and risk assessments in place for those residents known Care Homes for Older People Page 13 of 25 Evidence: to have a history of falls. The care records had evidence of assessments for nutritional status and skin integrity; there were also physical and social assessments in place. All three residents had a plan in place for emergency evacuation in case of a fire. One resident we noted was prone to chest infections and there were good guide lines for preventative care in place for them; they also were unable to feed themselves and the care notes were very detailed about the care they should have in respect of this so that their needs could be met. Another resident had been prescribed patches for relief of pain, there was a care plan for this but would have also expected to see evaluation of the skin when patches removed. There were good guidelines for care in relation to communicating with this resident and a plan in place to reduce the risk of isolation. There was a good care plan for a diabetic who also had a skin tear, the care plan was very informative with good guidelines for care. We did note that a number of residents had been prescribed prn (as required) medicines but had no care plans for this to justify their continued use; we also noted that some ointments had not been given a date of opening this is necessary as some have a short shelf life. The fridge in the clinical room which is used to house certain medicines had daily temperature recordings made. A random audit of medicines was undertaken and we found that the amount of medicines in stock tallied with the medicine record charts relating to the prescribed medication. The home does its own auditing of the medicines and we saw policies and procedures for the administration and handling of medicines along with a policy for giving homely remedies if required. The nurses do give flu jabs every year as agreed to by the residents, however the service did not have the necessary injections in the home to deal with anaphylactic shock should it ever occur, the manager immediately agreed to ensure this was addressed. We were told that a new system has been introduced so that the staff who are administering the medicines are not interrupted whilst they are doing this. The service is aware that it must now take into consideration the mental capacity of its residents and the manager is ensuring that staff will have training for this and that it will become part of the care planning system. All the care plans we looked at had evidence of continued review and changes made to care when needs changed. Records are kept of all GP visits and discussions with residents and their families. The staff we spoke with had an overall understanding of the care planning process. Care Homes for Older People Page 14 of 25 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. A wide range of activities provided by the home means that the people who live in the home have many opportunities to participate in meaningful and stimulating activities that they have chosen to do. Meals are managed well. Evidence: We were able to discuss with a number of staff, residents and relatives about the activities in the home; we were also able to observe some social interactions and activities taking place. On the day of our visit one residents daughter was playing bingo with a group of residents and they seemed to be enjoying themselves. There has been a change in the way activities are organised and a carer is taking responsibility for this role. We discussed this role with them and they were very enthusiastic about it and said that they felt it is something that all carers should be involved with in conjunction with the residents daily care. They went on to tell us that the activities are geared towards what the residents like doing and that they felt that one to one activities should be encouraged. They also mentioned that the new manager has told them that all activities must be recorded in the residents files. We were told that the activities that the residents mostly enjoy are soft football exercises, also throwing and catching a soft ball, bingo, flower arranging and skittles. Care Homes for Older People Page 15 of 25 Evidence: One resident told us that they were not bored in the home and the staff always talk to me. Another told us that they always choose what they want to do and I do cooking cakes, flower arranging and I play bingo; we noted a flower arrangement in this residents room that they had created. Other residents we spoke with told us that they chose what they wanted to do, what they wore and whether they stayed in their rooms or not. Another resident told us that they sat outside when they wanted to; and another resident told us that they have their hair done once a week when a hairdresser visits the home. On the day of our visit a visitor was visiting a relative they were both sitting in the garden and enjoying a cup of tea together and the relative told us that the staff always makes sure that they can socialise with their relative when they visit and is always offered a drink. The visitor went on to tell us that they are always made welcome. We observed lunch being served and we asked a number of residents what they thought about the food, the general consensus was that it was good. One resident told us the food is good as far as I am concerned, I do not like the sweets much but I always get a choice of something else, another resident said food is alright. There are always choices on the menus and on the day of our visit the residents were having fish and chips, one resident told us I just love the way the chef cooks the fish. We noted that some residents had chosen to eat their lunch in their rooms whilst others chose to eat in the dining room. The lunchtime appeared to be unrushed with the staff being familiar with the likes and dislikes of the residents. The chef told us that there are always two choices for the main meals and that there are always yoghurts to have as well. Care Homes for Older People Page 16 of 25 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. Residents feel safe and relatives and residents feel they are listened to. The staff have been given the knowledge to recognise all aspects of abuse, this means that every effort is made to protect the residents. Evidence: The service has a complaints procedure and it is made available to all the residents their relatives and significant others. We spoke with some residents and a relative who all said they knew how to air their concerns. One resident said I would go to the manager he is lovely and always listens to me and I am quite happy to talk about any concerns I have. Another resident told us I would go to the manager he would listen to me he has helped me a lot and another resident said if I got the chance I would talk to the manager, I dont have anything to grumble about. We looked at the records for complaints, three had been made to the home and we noted how they had all been dealt with and what action taken; we did note that the home does not keep a record of small concerns. The home now keeps a record of all incidents that occur in the home. The staff we spoke with were aware of issues relating to safeguarding, training records show us that all staff have received training in safeguarding issues; they were well informed and knew to raise any concerns with the manager. We spoke with one relative who told us that the staff always listen to any concerns, always deal with them and take comments on board. Care Homes for Older People Page 17 of 25 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The poor condition of the decor and fixtures and fittings means that the residents live in an inadequate environment. Evidence: We undertook a tour of the home and found it to be very drab and in need of some refurbishment. We noted some wallpaper coming off the walls in places and paintwork where the paint had worn off. There were a lot a artificial flowers around that were faded and harbouring dust. Some of the curtains were old and could do with replacing. We did however find the home to be free from offencive odours, tidy but very dusty in places. We spoke with three residents who all told us they liked their rooms, one resident said I like my room and I am happy here, we noted that they had personal items around their room. One visitor to the home told us that when their relative was moving into the home they were told by the manager that they could bring some items from home, they also told us that the room had been re carpeted and painted before their relative had moved in. Care Homes for Older People Page 18 of 25 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. The residents are supported by a cohesive staff team who are aware of the peoples needs. The residents are protected by the homes recruitment practices. Evidence: We looked at the duty rosters for the home, these showed that the home was reasonably staffed to meet the needs of thirty six residents who were living in the home on the day of our visit. The manager is on all the duty rosters and works in a supernumerary capacity, there is always one registered nurse on duty, and one on night duty, six carers and three domestics work the day shifts. The manager told us that they had stopped using agency caring staff and were reducing the need to use agency nurses, this was evident when we looked at past duty rosters. The residents we talked to were all very positive about the staff, their caring attitudes and the care they received. One resident told us the staff are terrific and another said the staff come to me when I want them. We spoke with a relative who told us that they thought the staff were very attentive. The members of staff we spoke with felt that on the whole they were well staffed and were able to give the care the residents needed. One staff member told us that it was nice to come to work and that there was a great atmosphere in the home with staff and residents. Records for newly appointed staff were looked at, these were seen to reflect a robust Care Homes for Older People Page 19 of 25 Evidence: checking system before staff are employed. We spoke with a new member of staff who told us about the thorough induction they had been given and how they worked with another member of staff for a few shifts. We saw records for induction and these indicated that the induction had covered all mandatory subjects. The new staff member told us that they had undergone training in manual handling, fire training and food hygiene and that they knew that they were going to do training for safeguarding adults. The staff that we spoke with all commented about how lovely the atmosphere was in the home and how everyone worked amicably together. One staff member told us that the manager had implemented better working practices and we all work together much better now and I enjoy it. We looked at the training matrix, all the staff with the exception of one new member have done safeguarding training and manual handling. Four staff have NVQ 2 and more staff are starting the NVQ training soon. One nurse is going to do a leadership course and some have done some training relating to the Mental Capacity Act. The manager is aware of what training needs to be done and is hoping to extend it further with particular emphasis on subjects related to the specific needs of individuals living in the home. Further discussions with staff confirmed that they had a good understanding of their roles and that they were well supported by the new manager. Care Homes for Older People Page 20 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a very good management structure in place which ensures that the service is being well run and in the best interests of the people who use the service. The health and safety of the residents is being protected and promoted because of thr managment stucture of the home. Evidence: We spoke with residents, a relative and staff about how the home was managed; the comments made were very positive and complimentary about the manager. Staff comments made were the manager has improved working practices, the manager is firm but fair; one relative said I can always talk to the manager. One resident said the manager is lovely he has helped me and he listens. We noted on our visit that the communication between the manager and staff was good and there were minutes in place for meetings that had already been held since the manager had been in post. All the comments we received suggest that the residents, staff and relatives were getting the support they needed from the manager. The staff we spoke with confirmed that they now received supervision sessions and we Care Homes for Older People Page 21 of 25 Evidence: saw records for this; all staff have now had at least three sessions since the new manager has been in post. The service carries out its own monitoring of the quality of the service it provides, we saw evidence of this. Every month four residents, four staff members, and four relatives are given surveys to complete, this information is then audited and we could see from the records how this information was used to improve areas of the service. We looked at health and safety information, this showed that there were servicing arrangements for all equipment, these included hoists and the lift. Fire safety records were seen and we also noted that records were in place for all fire training and these were up to date. All residents have an evacuation plan in case of a fire and the service does carry out fire drill practices which are always unannounced. We saw records for PAT tests and for water temperature checks and for emergency lighting. Care Homes for Older People Page 22 of 25 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 23 of 25 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 1 9 13 People who use the service 18/09/2009 must have care plans in place for prn (as required medication) and given at the discretion of the staff. This will ensure that the continued use of this medication can be justified. 2 19 23 All parts of the home must be kept clean and reasonably decorated. This will ensure that the people who use the service live in comfortable surroundings 20/11/2009 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 1 16 It is recommended that the manager keeps a record of all small concerns that are brought to his attention. Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!