Care Home: Larklands House Care Centre

What the care home does well The Expert by Experience described Larklands House as `Very welcoming, with a nice warm atmosphere. The residents and their relatives, on the whole, appeared very happy with the service they were getting. My feeling was that there have been a few problems in several areas which the new manager is doing her best to address, but that it will take a little time and patience on everyones part to fully resolve.` The home has excellent arrangements in place for social activities and all those spoken with praised the activities staff for their hard work. Their monthly newsletter `Larklands House News`, sets out the regular and ad hoc activities for the coming month, as well as the dates of residents` birthdays, and the date of the monthly Residents` Meeting. Care planning arrangements are well developed and the service manager has recently audited all the care plans to ensure a high standard is maintained. Those sampled had detailed guidance for staff, and were regularly reviewed. The home now has three `Dignity Champions`. These are staff members who have had special training in how to ensure high standards in relation to maintaining respect for residents, and promoting their dignity in a care setting. Training for staff is also well developed with in-house trainers who ensure that staff are kept up to date with the annual training programme. A strict approach is taken if staff miss training courses, and senior staff at the home were noted to be committed and enthusiastic about ensuring all staff were properly trained. What has improved since the last inspection? The Requirements made at the previous inspection have now been met including better information about the home for prospective service users, and residents now all have contracts on their files, setting out their terms and conditions of stay at the home. Those funded by the local authority also have a copy of the agreement between the home and the local authority. The Requirement relating to staffing levels is deemed to have been met in that there were sufficient staff on duty during the inspection, and written rotas confirm the numbers of staff on duty at any given time. Past problems with answering call bells may have indicated that there was a shortage of staff and this subject is discussed at length under the `Staffing` section of this report. The manager will need to keep staffing levels under review to ensure their are always sufficient staff to meet the assessed needs of current residents. The home has installed call bell monitoring equipment which continuously prints out any activity in relation to call bells. This is now monitored by the manager who is able to see at a glance how quickly call bells are being answered. The home has done further work on improving the mealtime experience for residents and has introduced a comments book for any compliments or concerns relating to food. Whilst this issue still elicits very mixed comments from residents and relatives, the general feeling was that things have started to improve, and that the new manager is working hard to get things right.The new manager has also introduced a `Suggestions Box` in the reception area, and started a `surgery` on one evening per week when residents or relatives can discuss any issues with her in her office. What the care home could do better: One Requirement has been made following this inspection concerning staff recruitment records. Some Recommendations have also been made and can be found at the end of this report. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Larklands House Care Centre London Road Ascot Berkshire SL5 7EG     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: Helen Dickens     Date: 2 0 0 5 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 33 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 33 Information about the care home Name of care home: Address: Larklands House Care Centre London Road Ascot Berkshire SL5 7EG 01344872121 Telephone number: Fax number: Email address: Provider web address: larkland@schealthcare.co.uk Name of registered provider(s): Name of registered manager (if applicable): Ashbourne Homes Ltd The registered provider is responsible for running the service care home 78 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Larklands House Care Centre is a large purpose built home. The home is situated on the main London Road and is close to Ascot village centre and Ascot racecourse. Accommodation is provided on three floors with passenger lift access. Each floor has its own dining room and lounge area. All bedrooms are pleasantly furnished and decorated and all have en-suite facilities. The registration includes a large number of double rooms; these are now only let as single rooms unless two residents express a 0 5 Over 65 78 0 Care Homes for Older People Page 4 of 33 Brief description of the care home wish to share. Care Homes for Older People Page 5 of 33 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 Key Inspection was unannounced and took place over two days, taking a total of 9.5 hours. The inspection was carried out by Mrs. Helen Dickens, Regulatory Inspector, and the new manager, in post since February 2009, and the new operations manager, represented the establishment. A tour of the premises took place and a number of files and documents, including four residents care plans, staff training and recruitment files, and quality assurance information, were examined as part of the inspection process. Two follow up telephone calls were also made to health and social care professionals who know this home. The inspector arranged for an Expert by Experience to assist with this inspection, and this person spent four hours in the home on the first day of the inspection. The Expert by Experience had lunch with residents, and spoke with residents and visitors on a Care Homes for Older People Page 6 of 33 number of issues. She submitted a report to the inspector for inclusion in this Key Inspection Report. Current fees at this home start at 918.00 per person per week depending on the needs of the client. Please contact the home for more details about fees. The inspector would like to thank the residents, staff and the new manager and service manager, for their time, assistance and hospitality. What the care home does well: What has improved since the last inspection? The Requirements made at the previous inspection have now been met including better information about the home for prospective service users, and residents now all have contracts on their files, setting out their terms and conditions of stay at the home. Those funded by the local authority also have a copy of the agreement between the home and the local authority. The Requirement relating to staffing levels is deemed to have been met in that there were sufficient staff on duty during the inspection, and written rotas confirm the numbers of staff on duty at any given time. Past problems with answering call bells may have indicated that there was a shortage of staff and this subject is discussed at length under the Staffing section of this report. The manager will need to keep staffing levels under review to ensure their are always sufficient staff to meet the assessed needs of current residents. The home has installed call bell monitoring equipment which continuously prints out any activity in relation to call bells. This is now monitored by the manager who is able to see at a glance how quickly call bells are being answered. The home has done further work on improving the mealtime experience for residents and has introduced a comments book for any compliments or concerns relating to food. Whilst this issue still elicits very mixed comments from residents and relatives, the general feeling was that things have started to improve, and that the new manager is working hard to get things right. Care Homes for Older People Page 8 of 33 The new manager has also introduced a Suggestions Box in the reception area, and started a surgery on one evening per week when residents or relatives can discuss any issues with her in her office. 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 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents have the information they need to make an informed choice about this home. Residents benefit by having a written copy of their terms and conditions of their stay at the home. No service user moves into the home without having his or her needs assessed and been assured that these will be met. Evidence: Four service users files were sampled during this inspection. On this first set of Standards, three Requirements had been made at the previous inspection in October 2007, and all three have now been met. The manager said the information for prospective residents has now been amalgamated into one document and all four residents files showed that they had a copy of their terms and conditions with the home. In addition, those residents funded by the local authority had a copy of their contract between the home, the local authority, and themselves. Residents files are kept to a good standard and the operations manager said she had Care Homes for Older People Page 11 of 33 Evidence: just audited all residents files including their care plans and risk assessments. She said she had found some minor shortfalls which were being dealt with. All four sampled by the inspector had full written assessments carried out by the home staff before admission, and the two local authority funded residents also had a copy of their care managers assessment. The operations manager explained that assessments follow a set format and this is then translated over into each residents care plan. All activities of daily living are covered. On one file sampled, the service manager explained that out of the 12 areas on the assessment, this resident had needs identified in eight areas which meant there would be eight risk assessments and eight care plans, and this was found to be the case. Social profiles were on file for all four residents files sampled and these were very detailed. This gives staff some of the social history of each resident and enables them to view each resident in a more person centred way. A pre-admission draft care plan is drawn up for each resident and then expanded further on admission to the home. An admission checklist covers what medication is taken, the residents birthday, and dietary needs etc. All residents have a dependency assessment on admission and this is reviewed each month. One new resident who had only been at the home for a matter of days was interviewed by the Expert by Experience. This resident said they were happy to stay; If I need anything the staff are always here and willing to help me. They put the call bell on my chair, right by my hand and if I have to use it someone comes quickly to see what I need. Care Homes for Older People Page 12 of 33 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. Residents needs are set out in their care plan, and their health needs are identified and met at this home. Medication arrangements are satisfactory, and residents are treated respectfully by staff. Evidence: Four care plans were sampled and it was noted that the care plans are generated from residents initial assessments and that these are kept under review. Care plans detail the assistance and support residents require, for example with personal care, communication, and mobility. There are risk assessments in place for each area of need identified including skin care, nutrition, falls, and moving and handling. Three of the four sampled had been reviewed regularly each month, the fourth resident was new and therefore had not reached the first monthly review. Reviews that had been carried out with family members showed that they were happy with the care given. One review from the previous month where the son and a social worker had attended, showed the son had made some favourable comments and had noted that some problems had been sorted out. The social worker noted Satisfactory Care Homes for Older People Page 13 of 33 Evidence: outcome of review. Thank you for the care being given to this resident. Another residents review noted that the family were Very happy with the care being given at Larklands House. Those files sampled had sufficient information about how residents wanted their personal care to be delivered, though some could have included a little more detail. The operations manager and the new home manager said they would review this aspect of their care plans. The previous inspection noted some concerns about whether the home had enough staff to meet residents needs. Both the inspector and the Expert by Experience made observations in relation to this issue throughout the day and this is discussed under Standard 27 on staffing. Residents are registered with local GPs who visit the home weekly and when called, and foot care, dentistry and optical treatments are available by arrangement. Service users files showed their health needs had been identified and risk assessments carried out as necessary. For example, risk assessments were seen relating to oral health, skin, pressure areas, nutrition, moving and handling, falls, urinary continence, and bowel care. Specialist advice is sought as necessary for example the manager was about to refer a resident to the tissue viability nurse as they have developed a small pressure ulcer which is not improving. The manager said this was currently the only pressure sore at the home. Larklands appeared to have a good supply of pressure relieving equipment and this was seen when visiting residents rooms. One relative who was interviewed said they were very pleased that their spouse had now started to walk again, as the home had arranged for a physiotherapist to visit. And another resident said they were visited regularly by the diabetic nurse. One resident being nursed in bed on the day of the inspection said staff had made her comfortable and she was noted to have a special airflow mattress to aid pressure relief. The manager said that turning charts were used for residents who are nursed in bed and at risk of pressure sores. This resident was pleased to say she has no pressure sores. Another resident who was new said she is Looked after very well by staff and another who was being nursed in bed said she liked the staff on this unit, especially the new sister. The home tries to encourage residents to eat fresh fruit and this resident Care Homes for Older People Page 14 of 33 Evidence: confirmed that she enjoyed the daily fruit round whereby the activities organiser offers prepared fruits to residents who would like it. Asked about how she called for help if she needed to, she said that as her room is near to the nurses station, she just shouts and staff come. The maintenance man was carrying out the weekly check on the call bells in this room and a nurse came within one minute to check why the bell was ringing. Another resident interviewed confirmed that their diabetic diet was catered for and the chef visited them each week with the coming weeks menu to ask them what they would like and whether anything different was required. This resident was then given their own weekly menu plan. Another resident interviewed by the inspector commented: They are good with my tablets, they never miss. And the staff are wonderful, so helpful and caring. I have to call them a couple of times in the night and there are never any complaints. A telephone interview was held with one of the GPs who visits the home each week. She said that following a period of many staff changes, she feels the home has reached a steadier patch at the moment. Whilst there have been problems for example getting prescriptions in a timely way, and communication difficulties when giving telephone advice to the home (this was passed on to the manager for attention), she felt things were now moving in the right direction. Policies and procedures are in place for the safe administration of medication. Only trained nurses give medication at Larklands House. The local GPs review short term medications on their weekly visit (e.g. antibiotics). Arrangements are inspected by the local pharmacist who last visited Larklands House the week before the inspection. Three minor issues were highlighted which the manager said have now been addressed, including ensuring two nurses signed for any hand written changes to the medication records. One medication session was observed on the top floor. Staff administering medication wear a red Do not Disturb tabbard to reduce the number of distractions and interruptions, which in turn reduces potential mistakes. Medications are kept secure in a locked trolley in a locked room. The nurse administering on this occasion did so in a very professional manner and was seen to go to residents first, without the medication, to let them know he was bringing their medication along. He was also noted to be very knowledgeable on individual residents medications and how they liked to be supported when taking their Care Homes for Older People Page 15 of 33 Evidence: medication. There were no unexplained gaps on the medication charts seen. The Controlled Drugs were checked and the inspector looked at one residents Controlled drugs record which was correct according to the amount left in the cupboard. The nurse informed the inspector that Controlled Drugs are checked at handover twice a day. One resident mentioned to the Expert by Experience that they had concerns about the time at which their medication was given, and this was passed on to the manager for her attention. Larklands House are working towards a high standard in promoting the dignity of residents. The Expert by Experience noted in her report that: There are three Dignity Champions within the home to ensure that each resident is treated in a nonjudgemental and non-discriminatory way. Amusing and meaningful cartoons relating to this topic are displayed along the corridor walls for everyone to see and read. There were many examples of residents privacy being protected for example, personal care was being carried out in private, and staff were seen to knock on residents doors before entering. There are a number of double rooms in this home but the manager said they are only used for two residents where they have expressly asked to share; currently there is only one shared room which belongs to a married couple. The room was visited and found to be spacious, with enough room to set up a small dining table to enable them to eat together in their room according to their preference. Care Homes for Older People Page 16 of 33 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. Residents benefit by having excellent arrangements in place for social and community activities, and they are given opportunities to make choices in their daily lives. There continue to be mixed reviews about the food at this home and work is in progress to continue the recent improvements. Evidence: The Expert by Experience was briefed to concentrate on activities, mealtimes and staffing, and the following summary uses excerpts from her report. The ground floor corridor was busy and bright and interesting. Staff were going in and out of rooms, and there were lots of really nice pictures on the walls. The activities coordinator had just finished her fruit trolley round. This was much appreciated by all the residents I spoke to. Of the seven residents/families I chatted to, five were very enthusiastic and full of much deserved praise for both of the activities ladies. A number of very positive quotes were noted by the Expert by Experience, including: The activities are excellent; we do so many different things. The activities staff are wonderful, they cant do enough for me, they are so kind. Care Homes for Older People Page 17 of 33 Evidence: I go to every activity every day. I really look forward to it. The activities are very well organised and most enjoyable. The home has a monthly newsletter which is given to all residents and displayed in each unit. Activities for May included a trip to the river at Windsor, the monthly residents meeting, visiting entertainers, bingo, and a visiting Tibetan terrier as part of the Pat the Dog scheme. Regular activities include religious services, hairdressing and armchair Keep Fit. The newsletter reminds residents that the activities staff will be coming to speak to them about their one to one where they can have a variety of personal support for example to get their nails done, sort out any problems they have, or get help to write a letter. Residents use local facilities such as health services, and have contacts with local faith groups. Every month there are trips to local places of interest to enable residents to enjoy their local community. Residents are supported to maintain family and friendship links, and those relatives spoken with had a number of positive comments to make, including: No real complaints. The new manager is marvellous. Havent heard anyone have anything bad to say about her. Residents are given opportunities to make choices for example in relation to their meals, activities, where they wish to spend their day within the home, and whether they want to participate in outside activities. Those who need support to manage their finances are offered the chance to have the home hold some money for them for example for chiropody, hairdressing, and toiletries. Residents who wish to use this facility enter into a written agreement and choose which services will be covered. Residents are able to bring personal possessions with them, and most of the rooms visited were very individual with pictures, photographs, and other personal memorabilia. Residents can also bring some of their own furniture. The home has a monthly Residents Meeting and this was scheduled for the day of the inspection. The inspector and Expert by Experience attended the meeting, as did the manager, chef, activities organiser, deputy manager, and the operations manager who was in the home that day. Twelve residents came to the meeting. Whilst residents were heard to be given information about work in progress, especially problems highlighted at the previous meeting, involvement from residents was hampered by several not being able to hear what was being said. The activities organiser went around the room to each resident at the end to ask if they had any further comments but few were made. Asking for a show of hands, perhaps on the question of whether Care Homes for Older People Page 18 of 33 Evidence: residents felt things had improved, might be more worthwhile as some residents did seem to lack confidence when asked to speak up on their own. The manager and deputy manager said they would ensure that a microphone was arranged in time for the next meeting. The Expert by Experience was asked to spend part of her visit to the home talking to residents about their mealtime experience at Larklands House. She also had lunch with residents on the first floor. The following excerpts from her report summarise the responses she received and her own observations. Residents have a good variety of choice for breakfast, including almost any combination of cooked breakfast, cereals, fruit juices etc. Most of the residents spoken with seemed to be aware of these choices but the majority selected cereals and toast. The lunch menu was soup, followed by a choice of fish risotto, spaghetti bolognese, or salad. This was followed by ginger sponge and custard, or ice ceam. On the first floor residents were brought to the dining room by 12.15 for 12.30pm lunch though some were not served with their main course until after 1pm. Staff were taking meals to rooms at the same time as serving in the dining room. The issue about having to wait a long time in the dining room came up later at the residents meeting and there seemed to be some confusion among staff and residents about what time lunch was actually served. The chef who attended the meeting made a note to deal with this issue. The Expert by Experience said the spaghetti bolognese was very tasty, though she declined to have the broccoli as it was mushy and yellow. There have been a number of complaints about the food, first highlighted to the inspector in the Annual Service Review in January. The new manager and the chef have been working to resolve some of the problems, including introducing a comments book regarding meals. The Expert by Experience noted that 12 comments had been made between March 11th, and May 13th. Some remarks praised the food, e.g: Fish and chips cooked well. Fish Pie. Pastry lovely. Good sponge pudding. Lunch today excellent. Others were not so positive; Beef thick...impossible to cut. I think yesterdays plums were used up today both days the skins tough, impossible to Care Homes for Older People Page 19 of 33 Evidence: eat them. Was supposed to be vanilla sponge...it got burnt! The inspector spoke with residents on the ground and second floors about the food and there were no complaints made on that day. The conclusion the inspector has drawn is that whislt the home are trying hard to improve the mealtime experience for residents, there is still some way to go. Some further comments made to the Expert by Experience regarding mealtimes were passed to the manager for attention, including special cutlery for one resident that keeps going missing. An observation was made on the first floor, that once residents were given their meals staff did not check back with them to see if they needed anything, or if their meal was satisfactory. This was also passed on to the manager. Care Homes for Older People Page 20 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents complaints are taken seriously at this home, and there are procedures in place which should protect vulnerable adults from abuse. Evidence: The home has a complaints procedure in place and this is displayed in the main reception and in each unit. There are several other opportunities to raise issues including the new managers weekly surgery on a Thursday evening which is open to residents and relatives, and the new suggestions box in the main reception area. The new manager has also introduced a Comments Book for food issues and this is being well used. Residents meetings are held monthly, though residents participation would be improved by better arrangements to make sure everyone can hear what is being said, and by having the agenda in advance. Monthly visits to the home (Regulation 26 visits) on behalf of the provider also include speaking to residents and looking at any complaints. The Annual Service Review by CSCI in January 2009 noted 12 complaints had been made. The new manager said the number of complaints had now reduced and she feels progress continues to be made. New monthly audit arrangements being introduced on 1st June were shown to the inspector by the operations manager. This will follow the National Minimum Standards very closely and will look at, among other things, whether the complaints procedure is available to residents and visitors, whether the timescale for dealing with complaints has been adhered to, and whether Care Homes for Older People Page 21 of 33 Evidence: complaints older than 3 months have been reviewed to check remedial actions remain in place. The inspector observed that whilst some residents seemed to lack confidence when asked to speak out publicly in the Residents Meeting, on a one to one basis, residents spoken with were very keen to air their views. Those who had spoken with the new manager directly, said they were happy with the response and this included visitors as well as residents. Procedures are in place for safeguarding vulnerable adults including a copy of the local authoritys procedures, and guidance to staff during their induction and subsequent training. On the day of the inspection there was a training session on safeguarding adults. Three staff files sampled showed that two were up to date with this training, and the third, as a new member of staff, had covered this in their induction. There have been six safeguarding adults referrals made in regard to residents at this home since the Annual Service Review in January 2009, one of these was reported to the inspector during this inspection. Three of these matters have been satisfactorily resolved, whilst three others are still under investigation. The safeguarding coordinator from the local authority was interviewed by telephone following this inspection. Following some discussion it was concluded that, whilst there needed to be some improvement in how two of the matters had been dealt with by the home, it was felt that the new manager and operations manager were committed to ensuring this process worked well from now on. The operations manager accepted that there had been aspects of their procedures that needed improving, but also expressed the view to the inspector that she wanted to work more closely with the local authority from now on. Care Homes for Older People Page 22 of 33 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. Larklands House offer a pleasant and comfortable environment for residents to enjoy. The home is generally clean and fresh throughout, though one small area needs more work to fully meet this Standard. Evidence: A partial tour of the premises took place and the inspector visited all four floors including the basement. Residents accommodation is on the ground, first and second floors. Adaptations and special equipment is fitted as necessary e.g. special baths, grab rails and hoists. There is a lift to all floors. Larklands House is decorated in a homely way though some areas needed freshening up, and torn wallpaper was noticed in two areas. The manager said there are plans for redecorating the home. Six residents bedrooms and all communal dining/lounge areas were visited. The home is generally clean and tidy, with individual bedrooms being personalised by residents, and dining/lounge areas nicely set out. The new manager wants to improve the dining areas to make them more like a restaurant, and she outlined her plans to residents at the residents meeting. Residents spoken with were happy with their rooms, and comments included; My room is fine. My room is lovely, they hoover every day and everything is very clean. Care Homes for Older People Page 23 of 33 Evidence: Very comfortable room. The laundry area was visited during the inspection and found to be clean and tidy. There are 3 commercial washing machines and 2 dryers. One full time person is employed to look after the laundry. Several residents commented that clothes had been lost in the laundry, and during the tour of the laundry, the inspector was told that there was quite a collection of unclaimed laundry items. This was thought to be because labels had either come off or faded, or new clothes had been laundered before being marked. It was suggested that the unclaimed items might be laid out in a central place, for example before the next residents meeting, for residents and visitors to see and claim any lost items. The laundry floor is washable which enables staff to keep the area clean and odour free. Staff do infection control training, and their are arrangements in place for the removal of clinical waste. A regular visitor to the home had noticed recently that there was an unpleasant odour at the top of one flight of stairs in the vicinity of the first floor bedrooms. The inspector retraced these steps and visited the five rooms nearest to the stairs with the manager. Whilst the rest of the home was clean and fresh, there was indeed a very slight odour on the first floor landing near the stairs, and also a slight odour in one bedroom. The manager said she would review the shampooing regime for the carpets in this area in the first instance, but would take other steps if this proved ineffective. Care Homes for Older People Page 24 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are benefiting by the monitoring arrangements in place to ensure their needs are met by the correct numbers and skill mix of staff. Recruitment procedures need further work to fully protect residents. Residents benefit by the well developed staff training arrangements at this home. Evidence: In their last report from CSCI the home was given a Requirement to ensure staff were available in sufficient numbers to meet the assessed needs of residents living in the home. The new manager said that currently the staffing numbers are above what they would normally have for the level of occupancy and the needs of residents. Both the new manager, and the operations manager who looked at the rotas, said there were sufficient staff on duty at all times.The operations manager said that all care plans are currently being reviewed using the new audit tool and if it is found that more staff are needed, then they will be provided. On the day of the inspection there were sufficient staff on duty and call bells were answered quickly, staff were available to attend to residents personal care needs and distribute meals at lunchtime, and activities staff were on hand for social activities and to organise the Residents Meeting. The inspector sampled the first floor staffing rota for two consecutive weekends There were two RGNs on each floor in the morning and afternoon, with three care workers all day. One unit had four care workers in the evening, in addition to the trained Care Homes for Older People Page 25 of 33 Evidence: nurses. The complaints about call bells not being answered back in January led the new manager to take a number of steps to improve the situation. The home has had printing equipment installed to enable them to monitor how long it takes for call bells to be answered. Staff are reminded to turn off the bell when they enter a room as some were neglecting to turn the bell off, even though they were in the room assisting the resident. The volume of the bells was adjusted in some parts of the home where the bells were difficult to hear. Extra bells were fitted in some areas. And finally, the manager looks at the call bell print out on a weekly basis to ensure the improvements are maintained. There have been mixed reports from residents and relatives about how quickly their bells are answered with some highlighting long waits and others saying bells are answered within a few minutes.The overall feeling was that things had improved.The inspector sampled the print out from the call bell monitoring for the previous weekend and whilst one took 12, and several others took 9 or 10 minutes to answer, the majority were answered within 2-3 minutes, and some were answered within seconds.The manager must keep this under review and keep a record of her monitoring activity so that she can demonstrate week on week how this is improving for residents. The National Minimum Standards recommend that in addition to trained nurses, the home should have a minimum of half of its care workers with a qualification in care work. This was discussed with the operations manager and it was calculated that out of 21 care staff, only six already have an NVQ qualification. She said that four more are about to register for this qualification. Two recruitment files were checked during the inspection. One person was very new and had not started work as they were doing their induction and attending training courses. Their file showed that one reference had been returned but the other had not, and a POVA first check had been carried out to ensure the person was not on the list of those people deemed unsuitable to work with vulnerable adults. This persons employment history was noted on their record, but there was a gap of one year which had not been followed up. The checklist at the front of each persons file does not have full employment history as an item to check yet this is a requirement in the Care Homes Regulations. The first file showed that photographic identification and their national insurance number had been checked. The second file was for a staff member who had transferred from a different part of Care Homes for Older People Page 26 of 33 Evidence: the company. Their personal identification number had been checked as this person is a trained nurse, this ensures they are still on the register of trained nurses. Two references had been taken up, but there was no mention of whether a full employment history had been sought or checked. This person happened to have their CV with them on the day of the inspection and added it to their file; this contained a full employment history. Their CRB number was recorded, but the actual CRB certificates were being kept at head office. Photographic identification had been checked. Following the inspection, it was confirmed by the inspector that there is no arrangement in place for Southern Cross services to keep their recruitment records at head office and therefore the service will need to arrange for all the information set out in Schedule 2 of the Care Homes Regulations, to be available for inspection at the home. Training arrangements are well developed with a central training record which enables the manager to see which staff have completed training, and when refresher training is due. The operations manager explained the training arrangements and was able to demonstrate as an example, that all staff have done their mandatory training on moving and handling. The two staff members whose recruitment files were checked also had their training records checked by the inspector and both had completed all their manadatory training courses. The new staff member who was not yet working with clients had also done moving and handling, fire safety, and food hygiene training. Other mandatory courses include infection control, safeguarding adults, health and safety, and nutrition. Arrangements are in place for all new staff to do their induction following the Skills for Care format. Care Homes for Older People Page 27 of 33 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. Residents are benefiting by the new management arrangements at the home, and quality assurance processes at the home should ensure their views are taken into account. Service users financial interests are safeguarded, and there are systems in place to promote health and safety within the home. Evidence: The Annual Service Review in January 2009 identified that there was no permanent manager at the home, and four different managers had worked at the home in the previous 12 months. The operations manager was about to hold interviews and a new permanent manager was appointed in February 2009. The new manager is a trained nurse. She is yet to start her application to CQC to become the registered manager for Larklands House, but the operations manager said there is no reason why this could not be progressed. At the time of this latest visit in May 2009 the new manager has settled in and a deputy has been appointed. A new operations manager has also been employed. The Care Homes for Older People Page 28 of 33 Evidence: previous concerns regarding meals and answering calls bells have been discussed at length earlier in this report, and whilst there is still more work to do, both residents and visitors report some improvements in these areas. The new manager is being given extra support during her first months in post, and this includes the operations manager and a senior member of staff from another home being at the home on one day per week. Residents and relatives who made comments on the manager thought she was already making some improvements and took any complaints seriously, one visitor described her as Marvellous. There is a quality monitoring system in place which includes monthly Regulation 26 visits on behalf of the provider, and monthly reports to head office on operational matters. A number of reviews and audits have been carried out, including the care plan audit noted earlier, and the results are providing a focus for management and staff in the coming months. The home monitors incidents and accidents, including falls, and a quarterly summary was seen. This included the type of falls and the outcomes. An incident which happened on the first day of the inspection was noted to be correctly logged on the quarterly return by the next morning. The new operations manager showed the inspector the new Key Outcome Audit Tool which is being implemented in June 2009. She said staff have now been trained to use this tool, which is based on the National Minimum Standards. It includes a review of all Regulation 37 notifications, case tracking two residents, for example anyone who has been the subject of a complaint, a new admission, or has a pressure ulcer, and also speaking to relatives and staff members. The new manager has also introduced a suggestions box in the main reception, a comments book for compliments or concerns about the food, and a surgery every Thursday evening where she is available to speak with any residents or relatives who wish to speak with her. The home does not get involved in managing residents finances, but those who need support to deal with their day to day expenses are offered the opportunity to have the home hold some money for them for example for chiropody, hairdressing, and toiletries. Residents who wish to use this facility enter into a written agreement and choose which services will be covered. Records are kept of all transactions and the arrangements are managed by the home administrator, and records checked by the manager. Systems are in place for managing the health and safety arrangements within the home. The operations manager looks at the regular monitoring information on Care Homes for Older People Page 29 of 33 Evidence: accidents and incidents for example, and health and safety audits are carried out. Health and safety meetings are held, and the maintenance man does regular checks for example on call bells, water temperatures, and bed rails. The weekly call bell checks were being carried out by the maintenance worker on the day of the inspection. The maintenance and health and safety books are checked and signed by the manager and operations manager on a monthly basis. Arrangements are in place for the prevention of legionella including checking water temperatures, and running unused shower heads. Fire evacuation arrangements are in place with a risk rating given to each individual resident. The April health and safety audit noted that staff had received health and safety training in March 2009, though new staff needed to attend the fire extinguisher training, and the manager must attend the 3 day health and safety supervisors training. There was no record of an environmental health officers visit to the home, and the manager was asked to speak with the local council to check if a visit was overdue, or to ask them to supply a copy of the previous inspection report. Care Homes for Older People Page 30 of 33 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 31 of 33 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 29 19 Recruitment information, as 19/06/2009 required under Schedule 2 of the Care homes Regulations, must be sought for all staff and made available at the home for inspection. For the safety of service users. 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 27 The home should continue to monitor the arrangements for ensuring residents needs are met in a timely way. This should include the call bell monitoring, in order to demonstrate that the recent positive progress is maintained and residents experiences continue to improve in this regard. The home should contact the local environmental health department, as no record of an environmental health officers inspection was available at the home. 2 38 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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