Care Home: Larklands And Church View

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Larklands And Church View St Johns Road Ilkeston Derbyshire DE7 5PA two star good service The quality rating for this care home is: 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: Tony Barker Date: 1 8 0 9 2 0 0 8 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. They reflect the things that people have said are important to them: 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 Adults (18-65 years) 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. 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. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Larklands And Church View St Johns Road Ilkeston Derbyshire DE7 5PA 01522560950 01159323209 churchview@unitedhealth.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): United Health Limited Name of registered manager (if applicable) David Wagstaff Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 10 0 care home 10 learning disability Additional conditions: Date of last inspection 2 7 0 7 2 0 0 7 A bit about the care home Church View and Larklands is a purpose built care home with nursing offering 10 places for adults with a severe learning disability, set in 2 bungalows. It is close to the town centre of Ilkeston with easy access to local facilities. Its physical environment was designed for the current group of residents who were all admitted in 2000 as part of the closure of Aston Hall Hospital. Because of the high levels of learning disability in the resident group the Home offers an intensive package of support and the number of staff is accordingly set high. 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home This key inspection was unannounced and took place over one day. The last key inspection at this service was on 27th July 2007. The Commission had requested the Service to complete an Annual Quality Assurance Assessment (AQAA) before this inspection. We had also received ten completed survey forms from relatives, staff and external professionals. The information provided in these documents is included in this report. The people living at the Service all had high levels of dependency and therefore were not able to contribute directly to the inspection process, though they were observed working with and being cared for by staff. Two particular people’s experience of the quality of the service was focussed on, through their personal records and discussion with staff. The Manager, Deputy Manager and one social care worker were spoken with at this inspection and records were inspected. There was also a tour of the premises. The weekly fees at the time of this inspection ranged from £1200 to £1400 What the care home does well Individual written needs assessments and plans of care were in place showing that peoples health, personal and social care need were being met. The Service provided activities, personal support and other services that were valued by people and promoted their independence in a person centred way Good procedures for handling complaints and abuse were in place ensuring people were fully protected. People were living in a clean, safe and well-maintained environment which was furnished and maintained to a high standard. The Service had a good level of welltrained and well-recruited staff to ensure that people living there were safe and their needs were met. The Service was well managed so that people living there were protected and their best interests were promoted by the systems in place. What has got better from the last inspection What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Tony Barker CSCI CPC1, Capital Business Park Fulbourn Cambridge CB21 5XE Tel: 01223 771300 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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 . Individual written needs assessments were in place before people were admitted to the Service so that their diverse needs were identified and planned for. Evidence: The Statement of Purpose was not assessed on this occasion. However, it was noted that it had not been updated: it still had the Commissions Derby address and telephone number as a contact point. The Service Users Guide included financial arrangements and what fees include and do not include. However, no actual fees were recorded in this document. All the service users were admitted to the Service in March 2000. Information gained at previous inspections, from the examination of individual files, indicated that service users had extensive assessments of their requirements carried out before they came to the Service. The process of assessment had continued after they had settled at the Service, with additional inputs from outside professionals. The Manager confirmed he was aware of the need to ensure that a full assessment of need is provided before admission, in order to guide staff in meeting peoples needs. Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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 . Service users had individual plans of care which demonstrated that their health, personal and social care need were being met. A person centred approach was being taken to ensure that service users unique needs were focussed on. Evidence: The file of one case-tracked service user was examined, to assess the quality of care plan documents. Action Plans were well worded, extensive and holistic. They were being reviewed at monthly meetings between key social care workers and named staff indicating that regular monitoring of individuals needs and preferences was taking place. At these monthly meetings a report from the Activity Coordinator is also considered so ensuring that recorded care planning objectives underpin daily activities. This system is a significant improvement from the last inspection. The service users files contained useful person centred planning (PCP) documents giving good insights into people’s needs and life preferences. One relative who responded to the postal survey said the Service had personal knowledge of (the service users) personality and likes/dislikes. The Annual Quality Assurance Assessment (AQAA) questionnaire referred to Life Books having been developed for each service user. The Life Book examined took a person centre approach and provided a valuable record for staff. It included comments from the service user, photographs and pictures drawn by the person. The social care worker spoken to gave examples of service users making their own decisions and choices, with staff assistance. She said some service users are able, and are encouraged, to choose between items of clothes to wear and between items of food to eat. With one case tracked service user, the social care worker said, the person Evidence: will let you know if they dislike something. Recorded risk assessments were of a high standard and appropriately included elements of risk management. They were being comprehensively reviewed on a regular basis. Discussion with the social care worker indicated that the Service was regularly practising responsible risk taking to enable service users to develop confidence in daily activities. She gave two examples of responsible risk taking: staff ensuring that surfaces are safe for the person to run on and the person experiencing, and thoroughly enjoying, white water rafting. Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 Service provided activities and services that were age-appropriate and valued by service users and promoted their independence. Evidence: There was evidence of service users taking part in valued and fulfilling activities. For example, the social care worker reported that one case tracked service user loves moorland and open spaces. This persons face will show pleasure, she added. The Service has a full time Activities Co-ordinator in post who accompanies service users shopping, on walks, on trips to local parks and to the swimming pool. She also spends time with service users in the Art Room in Larklands. She does not take on the sole responsibility for providing social activities for service users - the Manager spoke of her facilitating and supporting staff in this role. Service users files contained Activities Social/Leisure sheets, providing valuable written feedback on these daily activities. The social care worker described how service users walk, with staff, into town where they go to the hairdressers, cafes and restaurants. One case tracked service user went into town with staff, on the day of this inspection, to shop for trousers. The AQAA stated that the Service had secured a specialised swimming session at the local pool and was planning to promote more evening activities such as theatre, cinema and concerts. Public transport was used and the Service had a minibus too. Family contact with some service users was regular while with others it was limited. Two service users have no known family. Relatives visit the Service and often take Evidence: service users out. While service users generally related to staff, within the Service, there was evidence of a close relationship between two service users who had known each other at Aston Hall Hospital before their admission to the Service. The social care worker spoke of service users visiting each others bungalow, and another care home nearby, for a meal. There was evidence of this at this inspection. The social care worker provided evidence of daily routines promoting service users independence. These included choosing clothes from individuals wardrobes and food to eat at mealtimes. She added that although staff help service users to eat, they are given as much independence as possible. All service users needed some degree of prompting as part of their personal daily routines and some required physical help with dressing or toileting, for example. Each bedroom door was lockable and keys were kept outside the room, either in the door lock or hung beside the door. Service users had unrestricted access to their rooms. Hot and cold water supplies, to all taps to which service users had access, were controlled by a key-operated switch. Some service users were prone to drink excessively and this system addressed their personal safety, as well as minimising the risk of flooding. Key pads were fitted to a number of doors to address service users safety and hygiene. Food stocks in the kitchen were at a good level. A rolling menu was examined and this showed that service users were being provided with a varied and nutritious diet. A large white board had been introduced in Church Views dining room headed Todays Choices. This included photographs of meals, as recommended at the last inspection. Text beside the board encouraged staff to think about providing service users with choices of food. Each service user had their own Diet Book where what they ate was recorded and what likes, dislikes and preferences they have. This was particularly important for those service users with dietary needs. The AQAA referred to improvements to menus following advice from dietician. The Manager explained, at the inspection, that two service users had been overweight and the dietician’s recommendations for smaller portions, more fruit and less processed food had been followed. He added that take away meals are provided on the last Friday in each month. Service users were observed eating lunch at Larklands in a relaxed manner. The degree of thought given to catering practices is commendable. Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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 Service was providing service users with personal support in the way they preferred and required and was meeting their physical and emotional health needs. Evidence: The social care worker described how service users privacy and dignity were respected. She spoke of doors being closed when service users are dressing or undressing and when washing. She also gave examples showing how daily routines were flexible. There was evidence of communication systems in place, such as Makaton sign language and the use of recorded signs and symbols, so that staff could better pursue their person centred approach. The Activity Coordinator was undertaking training in Makaton, British Sign Language and Intensive Interaction - a practical approach to interacting with people who have profound learning disabilities. Equipment was in place to maximise service users independence included one Parker bath and two walk-in showers, a Rotunda transfer platform for the use of one service user, eating aids and a Rompa swing seat in the garden. One member of staff who completed a postal questionnaire said that the Service promotes individuality and independence wherever possible. An advocate from Derby Advocacy Service was involved with all the service users and was attending each of the formal six-monthly care plan review meetings. During the inspection, staff were observed talking respectfully to service users. One health professional who responded to the postal survey said, The residents are always well dressed and seem happy…I am always made to feel welcome. Another health professional said, Care for the residents is on an individual basis…(there is) good care and a welcoming home. One case-tracked service users file examined showed details of a good range of external health professional contacts and provided evidence of health appointments being met and the service users health needs being well considered. A health Evidence: information sheet was on file to be taken with a service user to hospital should the need arise. Some of the service users had complex health problems and the nurses and care staff were supported by the local GP practice. All service users were having six-monthly health checks with their GP, the Manager said. He also described close contact with psychologists who have assessed service users needs and trained the staff in Intensive Interaction. Medication Administration Record (MAR) sheets were examined and were satisfactory. There was a record of sample nursing staff signatures/initials and photographs of each service user, to minimise mistakes. The Manager described good medication practices with audit trails. He said, following the last inspection, he had personally made direct observation of all nurses medication administration practice although this fell short of being structured refresher training in the safe use of medicines. There were protocols in place for the use of prn, as and when required, medication in order to minimise staff making different interpretations of service user behaviour and ensuring their safety. However, one case tracked service users pain relief medication had no associated written protocol. The Services Administration of Medicines policy now made reference to the administration of prn medication. There were no controlled drugs in use although a dedicated storage cabinet was in place in Larklands and one had been ordered for Church View. Medication was being safely stored. From the AQAA and discussions with staff it was clear that the Service had dealt with the death, this year, of a service user with sensitivity and respect. The Liverpool Care Pathway - a dedicated plan for the persons end of life care - was used by the Service to ensure the service users needs and wishes, and those of their family, were always at the forefront of staff members minds. The district nurse, GP and Macmillan nurse were all involved. Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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 . Good procedures for handling complaints and abuse were in place ensuring service users were fully protected. Evidence: The Service had a comprehensive complaints procedure. A satisfactory recording system for complaints received was on computer in the Services office. This appropriately addressed complainants satisfaction with the outcome. The Manager reported that there had been no formal complaints made by anyone within the past 12 months. All service users had external professionals, and an advocate, looking after their interests. All staff except three had undertaken safeguarding adults training to ensure they understood how to keep adults safe from abuse. The Companys written procedures on this topic was worded in a satisfactory manner. A copy of Derbyshires Safeguarding Adults procedures were also being held by the Service. A comprehensive Whistle Blowing policy was in place and the social care worker spoken to showed awareness of this policy. She also spoke of having received training on safeguarding adults and confirmed that she felt safe working at the Service and thought that service users were also safe. 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 . Service users were living in a clean, safe and well-maintained environment, which was furnished and decorated to a very good standard. Evidence: Environmental standards were good at this Service, particularly considering the challenging behaviour of some of the service users, and there was no institutional feel to the premises. The Home was nicely decorated and was homely. One health professional who responded to the postal survey stated that service users seem happy in very comfortable surroundings. All bedrooms had a lockable drawer and those seen were very well personalised and clearly reflected individual interests and preferences. Several bedroom ceilings had been decorated with phosphorescent painted stars and other objects. The Manager spoke of aiming to make bedrooms gender specific as well as reflecting individual preferences. Star key locks, fitted to the outside of bathroom and shower room doors, could be misused in order to isolate service users. The Manager removed them during this inspection. The Service is commended on the quality of its environment. The Service had a comprehensive Infection Control policy and the social care worker spoken to described good practice regarding the movement of infected material within the Home and its disposal. Most staff had been provided with Infection Control training. There was a sluicing sink in each laundry room as well as a washing machine and dryer. Of the ten bedrooms all were carpeted except for three that had good quality vinyl flooring to enable easy cleaning. The Home was clean and hygienic. 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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 Service had a good level of well trained and well recruited staff to ensure that service users were safe and their needs were met. Evidence: Eight of the sixteen social care staff had achieved a National Vocational Qualification (NVQ) to level 2 or above. This met the National Minimum Standard to maintain a staff group with at least 50 percent qualified staff. Relatives who responded to the postal survey thought well of staff. One said, All the staff cant help you enough and are very friendly and sociable. The file of a recently appointed member of staff was examined. Matters relating to their recruitment were all satisfactory and Criminal Records Bureau (CRB) checks were all in place. All staff had received a copy of the General Social Care Council’s (GSCC) Code of Conduct. The Service was using the Skills for Care Common Induction Standards for training new care staff but had not pursued the Learning Disability Qualification (LDQ) for care staff - a specialist qualification for staff working in this field. The Manager stated that staff work a three-month probationary period before being put forward for NVQ level 2 training. The Service had a training matrix providing an at-a-glance view of staff training undertaken and needed. This showed that all the staff group had received training in Basic Food Hygiene and First Aid. Three staff had still to receive Moving and Handling training and most had been provided with Fire training in June 2008. A DVD was seen by those staff who had not received this Fire training. The Manager stated he and one other nurse had a professional training certificate and they had provided staff with training on the topics of diabetes and epilepsy. Training on autistic spectrum disorders was planned, he added. Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 Service was well managed so that service users were protected and their best interests were promoted by the systems in place. Evidence: The Manager had worked at the Service since August 2003 and been Manager since February 2004. He qualified (Registered Nurse in Mental Handicap) in 1994 and completed his NVQ level 4 in management in March 2006. The Company had a quality monitoring system based on monthly audits by the Services line manager. Records showed that these visits were taking place reasonably consistently although only one report of these visits, dated 6th August 2008, could be found on the day of this inspection. An Annual Plan was in place and this covered a useful range of topics with indicated timescales for achievement - an improvement from the last inspection. Satisfaction questionnaires had been sent to relatives: those returned were examined and found to be positive in their responses. The response from relatives to our postal survey were also positive. One relative stated, The Service is exemplary. The AQAA indicated that 20 external professionals had also been sent a questionnaire as part of the Services quality assurance system. The Manager explained that none had been returned. However, two health professionals responded positively to our postal survey. The Manager added that the opinion of United Health staff, as to the quality of the Service, was surveyed in early 2008. Also, agency staff are asked to complete a questionnaire. There was evidence that the Services quality assurance system had received much greater priority within the last 12 months. Cleaning materials were being safely stored in locked cupboards. Good food hygiene Evidence: practices were being followed, including safe food storage. Several environmental risk assessments were examined, dated between January and June 2008, indicating that monitoring of potential hazards was ongoing. The AQAA showed that the safety of electrical and gas equipment was being checked at appropriate intervals. Are there any outstanding requirements from the last inspection? Yes  No  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 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 Description 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 Description Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 4 1 1 20 20 The Statement of Purpose should be updated to show the Commissions current point of contact. The Service Users Guide should indicate the range of fees for the Service and be kept up to date. Nursing staff should receive a structured form of refresher training in the safe use of medicines. A written protocol, on the use of Diclofenac prn medication, should be provided in respect of one service user. New staff should undertake the Learning Disability Qualification (LDQ). The Service should ensure that all staff receive Moving & Handling training and Fire training - the latter at appropriate intervals. 5 6 35 35 Helpline: 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 We want people to be able to access this information. 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