Care Home: Larkhall Springs

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What the care home does well Staff and resident interactions were seen to be friendly and caring upholding the dignity of the residents. All of the residents and visitors spoken with during the inspection commented positively on all aspects of the home. The impression of the home is that it is a friendly comfortable and safe place to live. Larkhall is a well equipped home with a good standard of accommodation provided for the residents. The environment is of a good standard and clean. Opportunities exist for residents to participate in a range of meaningful activities. What has improved since the last inspection? Supervision and appraisal arrangements have been formalised and actioned throughout the staff team and take place regularly. The disposal bin for discarded drugs has a lid to ensure the content are secure. The nurse clinical training records are updated. Hot water temperatures are monitored at the outlet to ensure they are hot but do not exceed 45 degrees. What the care home could do better: Have more regular managers and staff meetings. Complete Regulation 26 visits and write related reports. Review the arrangements for dental care. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Larkhall Springs Swainswick Gardens Larkhall Springs Larkhall Bath Bath & N E Somerset BA1 6TL     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: Andrew Pollard     Date: 2 0 0 8 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 26 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 26 Information about the care home Name of care home: Address: Larkhall Springs Swainswick Gardens Larkhall Springs Larkhall Bath Bath & N E Somerset BA1 6TL 01225466266 01225478939 larkhall@cedarcarehomes.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Cedar Care Homes Limited care home 35 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 35 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Larkhall Springs is a registered care home providing nursing care for up to 35 older people. The home is situated in a suburban position and can be accessed by car or bus, which would be required for easy access to local shops and venues. The home is a converted property providing single and en-suite rooms on two floors and lounge space Care Homes for Older People Page 4 of 26 Over 65 35 0 Brief description of the care home and a dining room in 3 areas. There is a lift to all parts of the home. Care Homes for Older People Page 5 of 26 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 announced inspection conducted as part of the annual inspection process. The inspection lasted one day. Following the previous inspection requirements and recommendations were made, there are no outstanding requirements. The following methods of evidence gathering has been used in the production of this report; observation, discussion with residents, relatives and staff, tour of the home and sampling policies, records, care plans and a meals. Thirteen surveys were returned from residents, which were positive. Information from these has been collated and are detailed throughout the report. A number of residents and visitors were spoken with about the quality of care provided at the home. Members of staff were observed on duty and several were consulted individually. General feedback was given to the manager on the day of inspection. Care Homes for Older People Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 7 of 26 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 8 of 26 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 clients and their families are given relevant information in written or verbal form about the home. Contracts and terms and conditions of services are provided to all clients. The assessment procedure is clearly written and a thorough assessment of prospective residents care needs is carried out. Evidence: A statement of purpose and a service user guide plus additional helpful information is made available at the initial stage of enquiry to prospective residents and families. This provides good information about the services and facilities available and includes the terms and conditions. A review of the service user guide is carried out regularly. Visits by prospective residents to the home are facilitated for the day or perhaps for lunch dependent on their wishes. All the resident surveys returned stated that they had received good information to help them decide if Larkhall was somewhere they would like to live and that they had Care Homes for Older People Page 9 of 26 Evidence: received a contract on admission. Contracts were seen in case files and extras were clearly stated and charges were made appropriately for extras such as hairdressing and chiropody. The home has an admission procedure and maintains a checklist to ensure the smooth running of the initial period for residents within their new home. Pre-admission assessments are comprehensive, covering activities of daily living, health screen and personal history. The prospective resident and relatives are involved in the assessment and all information is used to inform the care plan. Where possible the manager or senior nurse carry out assessments and obtain information from other professionals for example, social workers, district nurses and hospital staff. Assessment is an ongoing process and following admission to the home a full detailed assessment of the residents care needs are established over the initial few weeks. This information is used to up date the Care Plan. Assessments had been regular evaluated and reviewed, this included the risk assessments. A months trial period on both sides is usually undertaken to ensure that everyone is happy with the arrangements and to ensure that the placement is suitable. Care Homes for Older People Page 10 of 26 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. Care plans are detailed and relate to residents care needs. They are well written giving clear directions to staff who treat the residents in a warm and respectful manner. The staff provide appropriate personal and nursing care to maintains residents health, well being and dignity. Good arrangements are in place for residents to access primary healthcare services. The staff properly store, administer and record medication on behalf of residents. Evidence: Case files were reviewed, they contained individualised care plans in relation to each assessed need and gave clear directions to staff thus enabling them to deliver appropriate care to the residents. It is intended that each resident has a brief biography written and person centred assessments where their wishes, likes and dislikes are put at the centre of the care provided. It is intended that peoples health and social needs including, psychological, emotional, and cultural needs will be detailed to demonstrates that the home takes a holistic approach to the provision of care, the manager has made good progress with Care Homes for Older People Page 11 of 26 Evidence: this process. Risk assessments were in place with detailed information to ensure good care for example, manual handling, correct use of bed rails and reduction of risk from falls and pressure sores. Health Care assessments included continence, nutritional, Waterlow and others where relevant. Where able residents or relatives sign care plans and consents for bed rails. Entries in the daily progress note showed that care was being given as per the care plan. Care staff are encouraged to make notes about the care of residents or as their role as key workers. The residents surveys stated that eight people felt that they always receive the care and support they need and five people said usually. Comments received were complimentary of the staff and the care they provided. All the residents or relatives spoken with said, that the staff were friendly and caring. Staff were observed interacting with residents in a caring and respectful manner. One person stated, I am happy with the standard of care here and another stated, The staff are really nice. The case files had records of visits from the health professionals, General Practitioners, Chiropodists and Opticians. There are no arrangements to offer routine dental examinations, although people with particular needs are referred to the dentist. The manager is considering making routine dental checks part of annual care reviews. A link nurses with the Dorothy House Hospice oversees end of life care planning. Residents are encouraged to think ahead about the care they would like to receive if their health deteriorates. The plans are sensitively completed with residents and their families. Policies and procedures for receiving, storing, administering and disposing of medications are in place and meet with current legislation. The receipt, administration, disposal and controlled drug records were up to date and in order. The pharmacist who supplies the medication also receives unwanted medication for disposal. None of the current residents is able to self medicate at present but appropriate policies and risk assessments are in place if required. The home has a pharmaceutical storage fridge the temperature of this is checked daily. There were photographs of each resident on their medication charts to help ensure that medication was dispensed to the correct person. The administration charts were Care Homes for Older People Page 12 of 26 Evidence: legible up to date and in order. Nurses have all recently completed training by the Pharmacist. Care Homes for Older People Page 13 of 26 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 range of social and recreational activities is arranged that seek to enhance the quality of life for the residents and seek to meets individual preferences. Residents are able to maintain close contact with families and friends. Residents families are informed of issues related to their relatives and to take part in activities running in the home. The food is of a good standard and provides a balanced diet for residents. Evidence: Care plans contained a social assessment form, which is completed by the resident and their family on admission to enable the home to plan a suitable activity based on the details given. The activities coordinator works 32.5 hours per week and provides a varied programme of activities for the residents. She is knowledgeable of the residents needs and wishes. A monthly timetable of activities and forthcoming events is placed in communal areas throughout the home to ensure that all residents and visitors are aware of the planned events. The lounge assistants also engage with social and recreational activities. Care Homes for Older People Page 14 of 26 Evidence: The home operates an open house visitors policy. Regular social activity is provided in the afternoons including singers and entertainers and recreation arranged by the activity organiser. Special events are arranged throughout the year such as Fetes and celebration of festivals and visitors are invited to attend. The activity organiser is responsible for documenting a record of any activities the residents have taken part in. Individuals have records of their social and activity choices. The residents level of dependency is such that trips out are not feasible at present. There are annual fund raising events organised and all proceeds go to the residents funds. The surveys returned and conversations with people indicated that there were activities arranged that residents could take part in and one to one support if it were more appropriate. Comments included, There is a good atmosphere in the home and good events, helpful and friendly staff. Local parish clergy conducts services and communion on a regular basis and makes pastoral visits on request. At present there is one resident from a Buddhist cultural background, which is fully understood by the Manager who is Nepalese. The menu on the day is displayed in the dinning room. The menus consist of a varied, well balanced choice of traditional home cooked meals. Each day residents have a choice of two meals and in addition to this such things as omelet, fish or ham is also made available on a daily basis. The menu includes choices for residents who are diabetics or those requiring a pureed diet. There was plenty of fresh fruit bowls available from which residents could take their choices. No resident currently requires any culturally specific diet. Residents spoken with at lunch stated that they enjoyed their meal. One resident stated, The food is always good. Residents surveys indicated that the food was good and there was choice Residents assisted by staff during the mealtime were helped in a sensitive and dignified manner. Food hygiene training is up to date for all staff. Risk assessments were in place and up to date. An Environmental Health Officer inspection found all to be in good order. Care Homes for Older People Page 15 of 26 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. There are good arrangements in place for staff training and awareness related to safeguarding of adults.There are robust and comprehensive policies in place to protect residents investigate complaints or manage any allegations of abuse. Evidence: A copy of the complaints procedure is on public display and is part of the information provided to people on admission. The complaints policy and procedure is detailed and contains all the required information. There have been only minor complaints received since the last inspection which were resolved to the satisfaction of the complainant. A large number of letters of complimentary letters and thank you letters were seen. All residents who completed a survey indicated that they knew who to talk if they were not happy and how to make a complaint. Comments included, I have nothing to complain about. Relatives also said they would speak to their key workers or the manager to discuss any concerns they have. The home has written procedures for adult protection, whistle blowing and management of money and valuables. The Local Authority No Secrets document was available. All staff are instructed in adult protection and prevention of abuse as part of their induction. Care Homes for Older People Page 16 of 26 Evidence: Staff attend update training in safeguarding adults and the manager is arranging further Local Authority update sessions to be run in the near future. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of furnishing and decor is good to the benefit of residents. The home provides a safe and well maintained environment for the residents. The bedrooms and communal rooms and facilities are suitable and well presented for their purpose and meet the peoples needs. The standard of cleanliness is good. Evidence: The building is an older spacious converted property, built over three floors, with a range of suitable adaptations in place throughout the home to assist people who may have limited mobility such as handrails in corridors, assisted bathing facilities and assisted toilet facilities. Pressure relieving equipment is available as required. There is lift access to each floor. The home is well decorated, clean and maintained to ensure that all areas are safe and homely. Bedrooms are well decorated and personalised. There are a range of bathroom facilities to meet varying needs. There are a number of lounges. Suitable dining room seating and table facilities are provided so that residents can enjoy their meal times in a comfortable setting. All bar one residents surveys confirmed that the home is and clean and fresh the other saying usually. All of the bathrooms and toilets were in good order, clean and fresh. Baths have Care Homes for Older People Page 18 of 26 Evidence: thermostatic mixer valves and the monitoring hot water temperatures take place. There are adequate laundry and sluicing facilities. Care Homes for Older People Page 19 of 26 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 recruitment procedures and records are in good order to protect residents. The home is well staffed with appropriately trained and experienced staff for the number of residents. Training records and nurse clinical updating are in order. Good arrangements are in place to train staff for the benefit of residents. Evidence: Discussion with the manager showed that the home has a sufficient staffing level to meet the needs of the residents. The staffing levels are in accord with or exceed the old staffing notice for 31 residents The atmosphere in the home is warm and the staff and resident interactions were respectful, caring and good-humoured. In conversation staff demonstrated a caring attitude to their roles and responsibilities in ensuring they provide quality of care to the residents. Residents indicated that staff listen to and act on what they say. Surveys stated that six people thought that staff were always available when needed and seven said usually. The home operates a key working system to enhance the resident and staff relationships. One resident survey stated that, The staff make me happy. Visitors comments included, The nurses have a caring nature and are friendly. Care Homes for Older People Page 20 of 26 Evidence: At present there are no Nurse or carer vacancies. The home has a small bank of staff and no agency is used. The domestic, catering, admin and laundry staffing levels are well provided for. The inspector viewed the personnel records for several staff. The files seen showed that employment procedures and records were in good order. Criminal Records Bureau disclosures are carried out prior to recruitment. Registered Nurse verification of registrations has been validated with the Nursing and Midwifery Council. An electronic check was carried out during the inspection. RN training records were in order and are updated as part of appraisal. The induction programme is comprehensive and based on the Skills for Care standards. The home has a mentor system where all new staff are linked with and shadow a senior staff member during each shift to enable continuity and continued training throughout the induction process. After completion of the common foundation training care staff enrol on the National Vocational Qualification programme to at least level 2. Mandatory ongoing training, including Fire, Manual Handling, Health and Safety, the Protection of Vulnerable Adults, first aid, food hygiene and infection control takes place. All staff have an annual appraisal, which identifies learning needs, and the manager provides regular one to one supervision. Care Homes for Older People Page 21 of 26 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. The home is well managed and run taking into account the views and wishes of the relatives and residents and as they are able. There are good arrangements in place to maintain and service the equipment and facilities in the home. The Home protects the health and safety of residents and staff. The staff supervision and appraisal arrangements are good. Evidence: The manager Ms Singh is a registered general nurse, she has a Bachelor of nursing qualification from Nepal and a Masters In Community Health from Liverpool University. This is her first post as manager, she is in the process of making an application for a fitness assessment with the Care Quality Commission. Ms Singh was able to demonstrate an understanding of the needs of the individuals living in the home and seeks to ensure that high standards of care are achieved and maintained. The home has comprehensive policies and procedures in place in order to support and provide a service for older people who have a varied range of needs. Care Homes for Older People Page 22 of 26 Evidence: It is intended that there are bi-monthly managers meetings, which are not always happening. A weekly management report is sent to the RI and clinical director. There are six monthly staff meetings, which the manager is considering increasing to three monthly. Regulation 26 visits and reports are not being completed by the responsible individual at present. Ms Parker the clinical coordinator and Ms Desai the RI and they visit the home on a regular basis to support the manager and other staff. The last relative and resident meeting was in July when twenty five people attended. The home has a Health and Safety policy and audits and relevant training takes place. Generic and individual risk assessments are in place and kept under review. Manual handling risk assessments are completed for all residents. Health and safety records showed that relevant inspections and maintenance has been carried out at the required intervals for the fire alarms and equipment, gas and electrical services, hoists and lifts. The fire logbook was up to date and in order. Staff fire safety drills and training are taking place at the required intervals. Accidents are properly recorded and reviewed as required. The manager uses judgement about what was serious enough to warrant notification to the Commission. The home audits it quality of service using different tools. These include feedback from health professionals, relatives and residents. One to one discussions with residents where any concerns raised are resolved as soon as possible. A residents money audit, care plan reviews and monthly health and safety checks take place. A report was submitted of a recent survey on the admission process, which showed an overall positive outcome in all areas. Some comments from surveys stated, Its great here and I am very happy and nothing is too much trouble for the staff. One person said it would be nice if staff had more time to listen to me and two people commented on the standard of English being not good enough. The atmosphere in the home was positive and calm. Staff spoken with stated that people were working as a team and morale had improved. There was a high degree of satisfaction expressed by all of the residents and relatives spoken with. Based on the comments made and through the inspectors observation it is evident that the home is run in the residents best interests and to ensure their needs are being met. Care Homes for Older People Page 23 of 26 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 24 of 26 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 33 26 That the responsible 01/10/2009 individual or other appointed person carry out unannounced inspections of the home interviewing staff and residents about the quality of the service and then write a monthly report. To ensure the proper conduct of the home. 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 32 That More regular staff meetings take place and that managers meetings are quarterly. Care Homes for Older People Page 25 of 26 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. 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