Care Home: Larpool Lane (1) - North Yorkshire County Council

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What the care home does well The home provides a service that meets the expectations and needs of people. It enables people to remain part of their local community in which they have spent their lives. They are also able to receive care and support for their health and physical needs. The management team works to ensure the people who live at Larpool Lane can live the lives they want to. There are regular meetings for the people who live in the home and the staff. This allows people to express their wishes. People who live at the home said that the staff were "wonderful" and "they will do anything for you" and "they try to spend time with you when they are not busy". Relatives also said "the staff are always friendly and cheerful" "they always treat people with respect" The staff who work at the home are thoroughly checked before they start their employment and they receive support and training to ensure they have the skills needed to do their job. The home is clean and well maintained and people can access all areas of the building. There is a nice garden where they can sit and enjoy the fine weather. What has improved since the last inspection? Since the last inspection the care plans have been updated and now include more detail about the level of support each person requires. The associated risk assessments have also been updated and improved. The meal times have been extended to allow people a greater choice as to when they have their meal. This has given people a greater choice in their daily routine. The registered manager has worked hard to ensure there are always enough staff on duty by offering overtime to other staff, the use of relief staff and where necessary agency staff. The staffing levels are set to increase over the next six months and this should ease the situation further. The conversion of the remaining cubicle style lavatories has begun and two further toilets have been adapted with a further one set to be completed within a month of this report. The call bell system has been adapted to include a system called Telecare, this runs alongside the call bell system and allows staff to monitor people who are at greater risk of falls. What the care home could do better: There were no major areas of concern at this inspection. However, there were some areas of good practice identified. The information provided to people thinking about moving in to the home should include an equality and diversity statement that outlines the different strands of the larger community whose needs could be met at Larpool Lane.Staff should review any falls and accidents as part of the monthly review of the care plans. This may help them to identify any changes in someones health or any pattern if someone is falling frequently. Staff should ask what people want for their meal the next day at a different time so that they can enjoy one meal before being asked about the next meal. The registered manager should supply the Commission with a plan of works showing when the remaining double cubicle style toilets will be replaced. This will ensure that people`s privacy and dignity are respected. Staff should be provided with training appropriate to their job and covering topics related to the aging process. This will give them a greater level of skill and understanding of their role. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Larpool Lane (1) - North Yorkshire County Council 1 Larpool Lane Whitby North Yorkshire YO22 4JE     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: Pauline ORourke     Date: 1 5 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Larpool Lane (1) - North Yorkshire County Council 1 Larpool Lane Whitby North Yorkshire YO22 4JE 01947603582 01947602806 larpool.lane@northyorks.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : North Yorkshire County Council care home 45 Number of places (if applicable): Under 65 Over 65 45 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 1 Larpool Lane is a care home providing personal care and accommodation for older people. It is registered to provide accommodation for up to 45 people. The home is located on the outskirts of Whitby and is a two-storey building with a passenger lift and stairs between floors. Accommodation is provided in single bedrooms. There is a large and pleasant garden where suitable garden furniture is provided for those service users who wish to sit outside. The home is suitable for people with mobility difficulties as there is level access from the car park to the ground floor level of the home. Care Homes for Older People Page 4 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The Care Quality Commission inspects homes at a frequency determined by how the home has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. More information about the inspection process can be found on our website www.cqc.org.uk We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been Care Homes for Older People Page 5 of 25 deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The key inspection has used information from different sources to provide evidence for this report. These sources include: Reviewing information that has been received about the home since the last inspection. Information provided by the registered person in an Annual Quality Assurance Assessment form (AQAA) Comment cards returned from people living at Larpool lane and from other people with an interest in the service. A visit to the home by one inspector that lasted for seven hours. During the visit to the home twelve people who live there, four staff and one health professional were spoken with. Care records relating to four people who live at Larpool Lane, four staff members and the management activities of the home were inspected. Care practices were observed, where appropriate, and time was also spent watching the general activity within the home. This enabled the inspector to gain an insight of what life is like at Larpool Lane for the people living there. Information about the home is available in a Service User Guide and the weekly cost of staying at Larpool Lane is between one hundred and eight pounds and four hundred and seven pounds. The amount payable is dependent on a financial assessment. The Registered Manager was available for feedback at the close. What the care home does well: What has improved since the last inspection? What they could do better: There were no major areas of concern at this inspection. However, there were some areas of good practice identified. The information provided to people thinking about moving in to the home should include an equality and diversity statement that outlines the different strands of the larger community whose needs could be met at Larpool Lane. Care Homes for Older People Page 7 of 25 Staff should review any falls and accidents as part of the monthly review of the care plans. This may help them to identify any changes in someones health or any pattern if someone is falling frequently. Staff should ask what people want for their meal the next day at a different time so that they can enjoy one meal before being asked about the next meal. The registered manager should supply the Commission with a plan of works showing when the remaining double cubicle style toilets will be replaced. This will ensure that peoples privacy and dignity are respected. Staff should be provided with training appropriate to their job and covering topics related to the aging process. This will give them a greater level of skill and understanding of their role. 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 8 of 25 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who decide to use this service can be assured their needs will be met as staff will have access to their assessment information outlining the support each person is required. Evidence: People thinking about moving in to Larpool Lane are all referred though the care management process. A comprehensive assessment is completed and forwarded to the home. A member of the management team also visits the person either in their own home or in hospital to ensure their needs can be met taking in to account the staffing levels, the environment and the current population of the home. Four case files were seen and they each contained an assessment form from which a care plan had been developed. People spoken with during the inspection confirmed that someone from the home had visited them before they moved in. They also said they had received information about the home when they had arrived. A copy of this information was Care Homes for Older People Page 10 of 25 Evidence: seen in each room. This document could be further improved by including an equality and diversity statement that outlines the different strands of the larger community whose needs could be met at Larpool Lane. Some people met their key worker prior to or on the day of their admission and it is planned that everyone admitted to the home will meet their key worker before or on the day of admission. Intermediate Care is not provided at Larpool Lane. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive the care and support they need. Staff provide support in a sensitive way that promotes the independence of people living at Larpool Lane Evidence: Four case files were seen and they each contained a care plan. The care plans were detailed and included requests from people where they specified the gender of the carers they preferred. They also identified any risks associated with the support offered. The care plans are reviewed each month and staff should use this opportunity to look at any patterns in behaviours or accidents that may affect the care plan. The care plans and reviews were signed by the individual they were about. People spoken with were aware of their plans and confirmed that staff discussed them with them on a regular basis. People spoken with said that their health care needs were met and they could see a doctor on request. The case files seen contained evidence of visits to the doctor, chiropodist, optician and specialist appointments relating to their individual health Care Homes for Older People Page 12 of 25 Evidence: needs. A visiting nurse spoken with said that the staff worked well with them and followed instructions about treatments. The case files also contained a record of peoples diets and staff were observant and took notice if people were not eating properly. A log of all visits by health professionals is kept in the individual case file. Medication is provided in a monitored dosage system and is administered by the staff for those people unable to self medicate. Staff responsible for medication have received the necessary medication training The medication and the records checked were up to date and in order.The storage of the medicines is appropriate and there is a separate controlled drugs cupboard as well as a dedicated medication fridge. One person self medicates and a risk assessment was seen in relation to this person. People were observed to be treated with with dignity and respect by staff during the inspection. People spoken to praised the staff and confirmed that they were always treated with respect. A comment received from someone living at Larpool Lane was I am very satisfied with my care, I am very happy and content. Several visitors spoken with said that staff were always pleasant and friendly and treated people with respect at all times. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to make choices on a daily basis and are supported to do this by staff. They have a varied diet and a social and recreational programme that helps them retain their interests. Evidence: Throughout the inspection people were observed making their own choices about where they spent time and if they went to the dining room for their meals. People spoken with said that they could rise and retire when they wanted. They also said they could spend as much or as little time in their rooms as they wished and there was no pressure to join in. Activities are provided usually on an afternoon when the staff and clients of the day centre come in to the dining room and people from the home are encouraged to join in. A game of bingo was enjoyed by several people during the inspection. Staff spoken with did say that they are allowed time in their rota to take part in activities and this is to be further expanded by two hours a month per member of staff. However, staff did say that utilising this time for activities was dependent on how well staffed the home was. The manager has also increased contact with local schools to increase outings and interactions. There are regular meetings for people living in the home that allow them to identify activities and outings they want Care Homes for Older People Page 14 of 25 Evidence: organised. A newsletter is also provided four times a year to keep people aware of events and of the activities that are being arranged. Visitors are welcome at any time and people spoken to stated their visitors were made welcome by the staff. A visitors policy is in place and visitors sign a visitors book on entering and leaving the building. The registered manager has installed a computer with a web cam and web links can be facilitated so that people can keep in touch with family and friends especially those who live far away. People spoken with said that the meals were very good and there was always enough. Several said that people in the home could have drinks and snacks on request at anytime day or night. A choice is offered at each meal time and special diets can be catered for if necessary. Staff spoken with expressed their concern about the quality of the meat provided and on several occasions it has been unfit to use. Alternatives have been sourced from local providers in some instances. The meal times were unhurried and people could take as long as they wanted to with their meal. Whilst people were eating their main course at lunch time a member of staff was observed asking what people wanted for their lunch the following day. This task should be done at a different time to allow people the chance to enjoy their meal. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Larpool Lane and their representatives are able to express their concerns through the complaints procedure and are protected from abuse, so their rights are protected. Evidence: The home has a detailed complaints policy. A copy of the procedure is given to people living in the home and copies are displayed around the home. There have been no complaints to the Care Quality Commission. There has been one complaint made to the home in the past year, this was investigated within the necessary timescale and was upheld. People spoken with said that they would speak to any member of staff if they were concerned about any issue. The home has a copy of the abuse procedure and all staff spoken to knew what action to take in the event of an alleged abuse situation occurring. Staff have received training in safeguarding adults. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a warm, comfortable and safe environment. They can access all areas of the home, which encourages independence. Evidence: All areas of the home seen were clean, odour free and well maintained. There is a passenger lift giving people access to all areas of the building. There are several lounges around the building and some smaller areas allowing people to speak to their visitors in private without going to their room. There are double cubicle style toilets in the building and two of these have been converted in to large disabled toilets. During the inspection workmen spoke to the manager about converting one more of these toilets. This will leave 5 double cubicle style toilets in use and whilst one side of these toilets has been closed to use, the registered manager should provide the Commission with a detailed plan of when the remaining toilets will be converted. One of the lounges has been refurbished and can be used as place where daily living skills can be practiced or where people can entertain relatives and friends in a more relaxed sitting room. The call bell system has been added to by installing Telecare overlay system to run along side the established system. This system can be used to monitor people getting up through the night where there may be a risk of them falling. There are further plans for redecoration and for the external pathways to be extended to provide easier access to the lower garden. Care Homes for Older People Page 17 of 25 Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff that have been thoroughly vetted prior to the commencement of their employment support people. Evidence: On the day of the inspection there were four members of staff on duty in the morning and four in the afternoon as well as management support. The rotas showed that four members of staff during the day time hours is the optimum staffing level. However there are times were four staff cannot be found and the shifts then operate with three staff. Staff spoken with did confirm that there were usually four staff on duty unless someone had rung in sick at short notice. The staffing levels have been a subject of concern at previous inspections but the manager has worked hard to ensure that the levels of staff remain at four during the day and two at night. Permanent staff are doing overtime, relief staff are being used and where necessary agency staff have been employed. The feedback from staff and other professionals indicated that when the staffing levels are not met then only the basic needs of people in the home can be met. The manager did indicate that the care staffing levels are going to be increased by November 2009 by approximately 129 hours. The care staff are supported by ancillary staff. There are twenty one carers employed at Larpool Lane and nineteen of them are Care Homes for Older People Page 19 of 25 Evidence: trained to national vocational qualification level 2 in care. Agency staff used are all trained to this level. All staff have their statutory training and this is renewed at regular intervals. There are opportunities for staff to do E-Learning and they also use distance learning courses and several have done The safe handling of medication; dementia awareness and infection control. There was little evidence that staff have access to other types of training covering topics such as Parkinsons, Diabetes and continence care. Four staff files were seen and these contained all the necessary pre-employment checks. Evidence of supervision and appraisals is kept in the supervisors file and staff spoken with confirmed that they receive supervision every four to six weeks. All the files contained a copy of an employment contract. Evidence was also available that the agency staff used have been properly vetted before they had started working for the agency. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is well managed and systems are in place to protect their health and safety. Evidence: The registered manager is qualified in the care of older people and in the management of the service, she is supported in the management of the home by three deputies. People said during the visit that the manager and her deputies are available if they want to speak to them. Staff said that the manager operates an open door policy and will always make time for them if they need it. The manager has revised her work pattern to enable her to have a minimum of three days a week off rota for management tasks. There is a quality assurance system in place. Each North Yorkshire County Council home has a quality champion and they have to visit other homes and mark them against the standards. The quality champion at Larpool Lane said that they enjoyed Care Homes for Older People Page 21 of 25 Evidence: visiting other homes as they picked up good practice ideas as well as areas for improvement. A report is produced with timescales for improvements and sent to the home. It is then up to the champion to ensure that the improvements are implemented. Other information used in improving the service provided at Larpool Lane is gathered through meetings with the people who live there and questionnaires that are sent to relatives and visiting professionals. When it is necessary people can leave their personal monies in the office safe. The records and cash held were checked and all tallied. Receipts are kept and someone from North Yorkshire County Council audits the accounts every three months. The health and safety records were checked and all were found to be up to date. Risk assessments for fire, the environment, COSHH and people who live in the home. All accidents and incidents are recorded and when necessary they are reported to the Care Quality Commission. Whilst the accidents are reviewed on a regular basis it was suggested to the manager that the key workers incorporate these in to the monthly reviews carried out. This might then show any patterns of incidents and allow staff to alter the care plan accordingly. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 1 Information provided to people thinking about moving in to the home should include an equality and diversity statement that outlines the different strands of the larger community whose needs could be met at Larpool Lane. Staff should review any falls and accidents as part of the monthly review of the care plans. This may help them to identify any changes in someones health or any pattern if someone is falling frequently. Staff ask what people want for their meal the next day at a different time so that they can enjoy one meal before being asked about the next meal. The registered manager should supply the Commission with a plan of works showing when the double cubicle style toilets will be replaced. This will ensure that peoples privacy and dignity are respected. 2 7 3 15 4 21 Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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