Care Home: Largiemore

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What the care home does well Satisfactory arrangements are in place to assess the needs, preferences and choices of prospective residents to make sure these can be met at the home. The prospective resident is fully involved in the assessment and the views of relatives or representatives and any appropriate professionals are taken into account. Each resident has a care plan that summarises their needs, preferences and choices and the plans reflect the family style care provided. Care plans are regularly reviewed with residents to make sure they accurately reflect the care and support required. The care plans also take account of any risks that are of concern. Where risks arise a risk assessment is undertaken and where appropriate an action plan established. These plans are also regularly reviewed and amended where required.Residents said they were very satisfied with the care and support provided and a positive and trusting relationship clearly exists with their carers. Residents are well respected and encouraged to participate in the daily life of the home. Residents are also encouraged to be as independent as possible and to make decisions about their lives. Residents said they were very "happy" at the home and felt in control of their lives. The residents also have a varied and stimulating lifestyle that reflects their interests, preferences and choices. All residents also participate in a range of leisure pursuits at the home and in the community. A varied and nutritional menu is provided that reflects the residents` needs and choices. The menu is seasonally adjusted and residents are able to have refreshments when required. Residents said they were very satisfied with the food and commented that mealtimes are flexible to accommodate their wishes and commitments. Residents` health needs are well met and health services are promptly accessed when required. Residents are also offered an annual health check and said they were confidant about the arrangements in place. Residents are also able to manage their own medication when it is safe to do so. Where the provider`s assist a resident with medicines satisfactory arrangements are in place and medication is held in secure facilities. The providers also maintain records and any unwanted medication are disposed of safely. Good arrangements are in place to deal with any complaints. Residents said they were confidant that any issues or concerns would be dealt with promptly and efficiently. Residents also said there were no barriers to raising any issues with the providers. Positive arrangements are also in place to protect residents from abuse and any allegations are reported to statutory authorities for investigation. The home is well decorated and maintained and provides a homely and comfortable environment for the residents. A good standard of cleanliness and hygiene is maintained at the home that promotes the residents health. The registered provider regularly works at the care home and provides direct care. Therefore regular contact is made throughout each week to make sure suitable standards of care and support are in place.LargiemoreDS0000070627.V362467.R01.S.docVersion 5.2Page 7The providers have established positive arrangements to make sure safe working practices occur that promote the residents` health, safety and welfare. What has improved since the last inspection? No previous inspection under current ownership. CARE HOME ADULTS 18-65 Largiemore 42 Tehidy Road Camborne Cornwall TR14 8LL Lead Inspector Mike Dennis Key Unannounced Inspection 5th.June 2008 10:00 Largiemore DS0000070627.V362467.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Largiemore DS0000070627.V362467.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Largiemore DS0000070627.V362467.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Largiemore Address 42 Tehidy Road Camborne Cornwall TR14 8LL 01209 719527 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) Mrs Maxine Milliner Mr Alan Milliner Mrs Maxine Milliner Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Largiemore DS0000070627.V362467.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability (Code LD) The maximum number of service users who can be accommodated is 3. Date of last inspection None under the new Registered Providers Brief Description of the Service: Largimore is small care home for 3 younger adults and provides family style care. It is also the principal home of the registered providers Mr and Mrs Milliner. The house is a large property situated in a predominantly residential area with substantial secluded gardens. The house is located a short distance from the centre of Camborne and near to a range of local amenities. The home aims to provide care that meets individual need, rights and dignity. The current residents are two men who have lived in the accommodation for over ten years and another resident that moved to the home during 2004. Largiemore DS0000070627.V362467.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. A planned unannounced key inspection took place on the 5th.June 2008. The opportunity was taken to tour the premises, speak with residents and Mr. And Mrs. Milliner, the registered providers as well as looking at the records and documents about the care home. The key core standards that include, care planning and health and safety were also considered. The registered providers also submitted written information about the services and facilities before the inspection took place. This was the first inspection under the new ownership and it is pleasing to note that the providers have made a competent start. This statement is supported by the comments received from residents. What the service does well: Satisfactory arrangements are in place to assess the needs, preferences and choices of prospective residents to make sure these can be met at the home. The prospective resident is fully involved in the assessment and the views of relatives or representatives and any appropriate professionals are taken into account. Each resident has a care plan that summarises their needs, preferences and choices and the plans reflect the family style care provided. Care plans are regularly reviewed with residents to make sure they accurately reflect the care and support required. The care plans also take account of any risks that are of concern. Where risks arise a risk assessment is undertaken and where appropriate an action plan established. These plans are also regularly reviewed and amended where required. Largiemore DS0000070627.V362467.R01.S.doc Version 5.2 Page 6 Residents said they were very satisfied with the care and support provided and a positive and trusting relationship clearly exists with their carers. Residents are well respected and encouraged to participate in the daily life of the home. Residents are also encouraged to be as independent as possible and to make decisions about their lives. Residents said they were very “happy” at the home and felt in control of their lives. The residents also have a varied and stimulating lifestyle that reflects their interests, preferences and choices. All residents also participate in a range of leisure pursuits at the home and in the community. A varied and nutritional menu is provided that reflects the residents’ needs and choices. The menu is seasonally adjusted and residents are able to have refreshments when required. Residents said they were very satisfied with the food and commented that mealtimes are flexible to accommodate their wishes and commitments. Residents’ health needs are well met and health services are promptly accessed when required. Residents are also offered an annual health check and said they were confidant about the arrangements in place. Residents are also able to manage their own medication when it is safe to do so. Where the provider’s assist a resident with medicines satisfactory arrangements are in place and medication is held in secure facilities. The providers also maintain records and any unwanted medication are disposed of safely. Good arrangements are in place to deal with any complaints. Residents said they were confidant that any issues or concerns would be dealt with promptly and efficiently. Residents also said there were no barriers to raising any issues with the providers. Positive arrangements are also in place to protect residents from abuse and any allegations are reported to statutory authorities for investigation. The home is well decorated and maintained and provides a homely and comfortable environment for the residents. A good standard of cleanliness and hygiene is maintained at the home that promotes the residents health. The registered provider regularly works at the care home and provides direct care. Therefore regular contact is made throughout each week to make sure suitable standards of care and support are in place. Largiemore DS0000070627.V362467.R01.S.doc Version 5.2 Page 7 The providers have established positive arrangements to make sure safe working practices occur that promote the residents’ health, safety and welfare. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Largiemore DS0000070627.V362467.R01.S.doc Version 5.2 Page 8 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 Largiemore DS0000070627.V362467.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4, 5. People who use 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. Admission to the home is based on an assessment of prospective residents so that they can be assured the home will be suitable to meet their needs. They are given sufficient information about the home prior to admission. EVIDENCE: No new residents have moved to the home since the new providers have been registered. The providers do have suitable arrangements in place to assess the needs of prospective residents to make sure their care and support needs can be met. A Statement of Purpose/Service Guide is given to all residents. Every effort is made to involve the prospective resident in the assessment process in order to take account of their views, choices and preferences. New residents would be encouraged to visit the home prior to admission. Largiemore DS0000070627.V362467.R01.S.doc Version 5.2 Page 10 In completing an assessment the prospective residents relatives or representatives are consulted and the views of any professionals involved with the individual are taken into account. The current resident group all have contracts with the home. Largiemore DS0000070627.V362467.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. People who use 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. The resident’s care plans summarise the care and support required and positively take account of any unreasonable risks that are encountered. Residents are able to make decisions about their lives and are encouraged and supported make choices where necessary. EVIDENCE: Largiemore DS0000070627.V362467.R01.S.doc Version 5.2 Page 12 Each resident has a care plan that outlines the care and support required and reflects the family style care provided. The plans are regularly reviewed with residents and amended where required. Residents said they were very satisfied with the care and support provided and clearly have built positive and trusting relationship with carers. Residents are encouraged to make decisions about their lives and the providers offer support and encouragement where required. Therefore residents feel in control of their lives and are able to make lifestyle choices. Risks are managed satisfactorily and where any situations of concern arise a suitable risk assessment and action plan is established. The plans are regularly monitored and reviewed to make sure they minimise any situations that could compromise the well being of residents. Largiemore DS0000070627.V362467.R01.S.doc Version 5.2 Page 13 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): 11,12,13,14,15,16,17 People who use 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 are able to take part in a range of activities in and out of the home, which are appropriate to their ages, individual needs, interests and cultural backgrounds so that they develop their skills and confidence. They are supported to maintain valued social relationships so that they are not isolated or institutionalised. They are informed of their rights and responsibilities so that they are aware of what is expected of them. They are provided with a wholesome and varied diet so that they enjoy their meals and stay healthy. EVIDENCE: The residents experience a varied and stimulating lifestyle that reflects their choices and preferences. They participate in a range of recreational and social activities at the care home and in the local community. The residents said they were very satisfied with the arrangements in place. Largiemore DS0000070627.V362467.R01.S.doc Version 5.2 Page 14 There are also no barriers to residents maintaining personal and family relationships and visitors are welcomed at the home. The residents said they had no concerns about the arrangements in place. The providers treat residents in a dignified and respectful manner that encourages independence and individual decision-making. Residents said they felt in control of their lives and were able to actively contribute to the day-today running of they home. Residents said they were very pleased with the daily routines in place and felt the providers treated them in a positive manner. The residents also stated they were very satisfied with the menu and meals provided. A varied nutritional menu is in operation that is seasonally adjusted and reflects the residents’ preference and choice. Meal times are flexible in order to accommodate the residents’ routines or commitments. Refreshments are also available when required by each resident. Largiemore DS0000070627.V362467.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 People who use 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’ personal and healthcare needs are well met so that they are able to live full and active lives in and out of the home. There are systems in place to support them with medication. EVIDENCE: Residents said they were pleased with the way the providers offer the care and support they require. It is clear that positive and trusting relationships have been established and that residents are supported to be as independent as possible. Residents’ health needs are well met and medical services are promptly accessed when required. The providers support residents to attend any appointments and residents are also offered an annual health check. Largiemore DS0000070627.V362467.R01.S.doc Version 5.2 Page 16 Residents are also able to administer their own medication when it is safe to do so but the providers will offer assistance where required. A satisfactory policy and procedure is in place and medication is stored in secure facilities. Where the providers assist with medicines records are maintained and suitable arrangements are in place to safely dispose of any unwanted medication. Medication is supplied by the local pharmacy. The providers then enter the details on to the medication administration records (MAR). These hand written entries must be accompanied by the signature of the person making the entry and witnessed by a second person to ensure accuracy. At the present time only one resident is in receipt of medication. Largiemore DS0000070627.V362467.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23. People who use 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 are listened to and respected so that their views, concerns and complaints are taken seriously and acted upon. There are formal and informal systems in place to ensure that they are able to feel safe in the home. EVIDENCE: The providers or Commission have not received any complaints since this home was registered to the new providers. The providers have established good arrangements to deal with complaints and residents are encouraged to raise any concerns or issues. A suitable policy and procedure is in place and residents said there are no apparent barriers to raising issues with the providers. Residents were also confidant that any concerns or issues would be dealt with promptly and satisfactorily. Appropriate arrangements are also in place to deal with allegation of abuse. Any allegations are reported to the statutory authorities and formally investigated where required. Both of the registered providers have attended Adult Protection Courses. Largiemore DS0000070627.V362467.R01.S.doc Version 5.2 Page 18 The providers have also put in place suitable whistle blowing arrangements. Any concerns can therefore be notified to third party where a person feels they cannot raise the issue directly with the providers. Largiemore DS0000070627.V362467.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 People who use 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. The home’s environment provides residents with an ordinary, domestic setting so that they can develop their skills and independence in a non-institutional setting. It is safe and clean so that residents are protected from risks of crossinfection. EVIDENCE: Residents are satisfied with the facilities provided that are maintained to a good standard and provide a homely and comfortable environment. The resident’s bedrooms have been personalised by the occupants and all rooms presented to a good standard. Largiemore DS0000070627.V362467.R01.S.doc Version 5.2 Page 20 Toilets and bathrooms facilities are in close proximity to the resident’s bedrooms and are also maintained to a good standard. Dedicated facilities are provided for the residents. There are no restrictions to residents using the communal facilities downstairs and this includes the family lounge at the front of the house. A good standard of cleanliness and hygiene is maintained at the home and no offensive odours were evident. Satisfactory laundry facilities are in place and dirty linen is managed appropriately. The equipment in the laundry is also regularly serviced and maintained. The water temperatures in the home are suitably managed to avoid any risks to residents. There is parking space to the front of the property and to the back there is a secure walled garden of ample proportions. It is suggested that the fire authority be contacted at some future point to confirm that bedroom doors are to a required standard. Largiemore DS0000070627.V362467.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35. People who use 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. Staff cover at this home is provided by the registered providers who have been deemed ‘fit’ to fulfil this role. EVIDENCE: Staff are not employed at this home as the registered providers jointly fulfil this role. They have been fully vetted and interviewed by the CSCI Largiemore DS0000070627.V362467.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,40,41,42. People who use 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. The home is competently managed for the benefit of residents. There are formal and informal systems in place to ensure that residents’ views are taken into account in the ongoing management of the home. The home is maintained to a good standard to ensure that it is safe for all those who live, work and visit the home. EVIDENCE: Largiemore is owned and managed by Mr. And Mrs. Milliner. They both have extensive experience in working within the care and teaching fields. Largiemore DS0000070627.V362467.R01.S.doc Version 5.2 Page 23 Both are well qualified to include diplomas and certificates of training. Appropriate arrangements are in place to promote residents’ health and safety and provide a safe environment. The providers have established a range of policies and procedure to guide and direct the actions taken and to make sure good safety standards are maintained. Records required by legislation are in place and are under constant review. A good standard of record keeping exists. In particular we inspected the records pertaining to residents’ finances and found that clear audit trails are maintained. Residents benefit from competent and accountable management of the service. Largiemore DS0000070627.V362467.R01.S.doc Version 5.2 Page 24 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 X 4 3 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 X 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X 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 3 Largiemore DS0000070627.V362467.R01.S.doc Version 5.2 Page 25 N/A 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. 1 2 Refer to Standard YA20 YA24 Good Practice Recommendations Medication entered to the MAR sheets should be witnessed by two signatures. It is suggested that the fire authority is contacted to ascertain that bedroom doors are to an acceptable standard. Largiemore DS0000070627.V362467.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Largiemore DS0000070627.V362467.R01.S.doc Version 5.2 Page 27 - 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. 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