Care Home: Larwood

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What the care home does well The care home provides residents with a warm and homely environment that is spacious. Individual resident`s rooms are personalised and reflect their personalities. Visitors to the home are made to feel welcome. Food provided to residents is of a good quality and comments from residents relating to meals provided, was positive. A good level of care is provided, to individual residents. The staff team are aware of individual residents complex needs and know how residents prefer to be supported. Rapport between staff and residents` was observed to be conducted in a respectful and dignified manner.People at the home are supported to lead an active life, to undertake a variety of activities, which meet their individual needs according to their personal preferences and to use the local community. Robust complaint and safeguarding management and procedures ensure that the needs and welfare of individual residents are paramount. What has improved since the last inspection? Since the last inspection a summerhouse and garden furniture has been purchased so as to encourage and enable residents to use the garden more frequently. What the care home could do better: Some further training is required for staff to ensure they have the skills and competence to meet resident`s needs. This refers specifically to those conditions associated with the needs of people who have a learning disability/physical disability. Practices and procedures for the safe handling, administration and recording of medicines must be improved so as to ensure residents safety and wellbeing. CARE HOME ADULTS 18-65 Larwood Fullbrook Lane South Ockendon Essex RM15 5JY Lead Inspector Michelle Love Unannounced Inspection 1st July 2008 10:30 Larwood DS0000018114.V365090.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Larwood DS0000018114.V365090.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Larwood DS0000018114.V365090.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Larwood Address Fullbrook Lane South Ockendon Essex RM15 5JY 01708 857354 01708 857354 larwood@rchl.tiscali.co.uk www.rchl.org.uk Redbridge Community Housing Limited [RCHL] Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Freda Lee Care Home 8 Category(ies) of Learning disability (4), Physical disability (4) registration, with number of places Larwood DS0000018114.V365090.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Care to be provided to four (4) adults with learning disabilitys Care to be provided to four (4) adults with a physical disability The Home to be used as a Care Home only. Date of last inspection 6th July 2007 Brief Description of the Service: Larwood is a two-storey purpose built care home in South Ockendon. It has a large secluded garden and has off road parking. It provides accommodation for eight younger adults with severe or profound learning disabilities and also caters for those with additional mobility or physical differences. All residents’ rooms have washing facilities and are spacious enough to accommodate mobility equipment and personal items. Fees as detailed within the Annual Quality Assurance Assessment (completed 5/5/08) range from £1205.97 to £1271.17 per week. The service is funded via a `spot` contract agreement with Thurrock County Council, with the cost of the service being reviewed annually by Thurrock County Council. Larwood DS0000018114.V365090.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was an unannounced key inspection. The visit took place over one day and lasted a total of 7 hours, with all key standards inspected. Prior to this inspection, the registered provider had submitted an Annual Quality Assurance Assessment. This is a self-assessment document detailing what the home does well, what could be done better and what needs improving. As part of the process a number of records relating to residents, care staff and the general running of the home were examined. Additionally a partial tour of the premises was undertaken, residents and members of staff were spoken with and their comments are used throughout the main text of the report. Where residents have been unable to express a view as a result of their poor verbal communication, their interactions with staff have been observed. Prior to the site visit, surveys for relatives, staff and healthcare professionals were forwarded to the home. Where surveys have been returned to us, comments have been incorporated into the main text of the report. It was disappointing that we only received 1 relative survey and 2 surveys from healthcare professionals. The manager, deputy manager and other members of the staff team assisted the inspector on the day of the inspection. Feedback on the inspection findings were given throughout and summarised at the end of the day with both the manager and deputy manager. The opportunity for discussion and/or clarification was given. What the service does well: The care home provides residents with a warm and homely environment that is spacious. Individual resident’s rooms are personalised and reflect their personalities. Visitors to the home are made to feel welcome. Food provided to residents is of a good quality and comments from residents relating to meals provided, was positive. A good level of care is provided, to individual residents. The staff team are aware of individual residents complex needs and know how residents prefer to be supported. Rapport between staff and residents’ was observed to be conducted in a respectful and dignified manner. Larwood DS0000018114.V365090.R01.S.doc Version 5.2 Page 6 People at the home are supported to lead an active life, to undertake a variety of activities, which meet their individual needs according to their personal preferences and to use the local community. Robust complaint and safeguarding management and procedures ensure that the needs and welfare of individual residents are paramount. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Larwood DS0000018114.V365090.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Larwood DS0000018114.V365090.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A formal assessment process is in place and prospective people can be assured they will have their needs assessed prior to admission. EVIDENCE: Since the last inspection one new resident has been admitted into the care home. There is a formal pre admission assessment format and procedure in place, so as to ensure that the care team are able to meet the prospective resident’s needs. The pre admission assessment for the newest resident was observed to be detailed and comprehensive and there was evidence to show that the person had received a transition to the care home, consisting of both day visits and overnight stays. This is seen as positive as it enables the prospective resident an opportunity to meet existing residents, members of staff and to get use to the care home environment. The resident’s next of kin confirmed the above and advised that he had received a copy of the service’s Statement of Purpose and Service Users Guide. They also verified that they receive sufficient information from the home so as to make decisions on behalf of their member of family. The relative advised, “It’s the best thing that could have happened to my [member of family]”. Larwood DS0000018114.V365090.R01.S.doc Version 5.2 Page 9 The Annual Quality Assurance Assessment details under the heading of `what we do well`, “All new service users moving into Larwood have a stringent assessment, involving all professionals, family and the current residents. The transition is agreed on an individual basis, to suit the service users needs, but only after a full assessment has been completed”. Additional information is also sought from healthcare professionals and individual care managers so as to inform the pre admission assessment process. The Annual Quality Assurance Assessment states, “Our working relationship with the Local Authority has greatly improved, with both parties working towards what is best for the service user”. There was evidence to show that a review had been undertaken 6 weeks after commencement of the placement and that the new resident had been offered a permanent placement. Larwood DS0000018114.V365090.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be sure they have an individual plan of care in place and that this is reflective of their individual care needs and that these will be met. EVIDENCE: There is a formal, comprehensive and detailed care planning system in place to identify, the care needs of individual residents and to specify how these are to be met by care staff. On inspection of the care file for the newest resident, information recorded was observed to be thorough, informative and descriptive, detailing the person’s care needs and how these are to be met by care staff in relation to their emotional, physical, health and social care needs. The care file clearly recorded the areas whereby the resident can become anxious and distressed in relation to aspects of their personal care and there were clear guidelines for staff detailing how this should be proactively managed. Other aspects of the care file were similarly recorded. Larwood DS0000018114.V365090.R01.S.doc Version 5.2 Page 11 In addition to the above, each resident has a `Life Book`. This depicts their personal preferences, likes and dislikes and provides useful information to new members of staff and/or agency staff deployed to the home about how to support each resident with their daily care needs and life skills. Risk assessments were devised for all areas of assessed risk, clearly identifying the risk, those people affected and risk reduction measures to minimise the risk. The Annual Quality Assurance Assessment under the heading of `what we do well` states, “All service users have an in depth assessment of needs which is reviewed annually, with care plans and support plans in place”. It also details under the heading of `our plans for improvement in the next 12 months`, to further improve consistency when completing records/documentation. One relative survey returned to us advised, “The level of care is so good that I can’t see any improvement is needed” and they confirmed that they felt the care home met the needs of their member of family. During the site visit, from discussions with 2 residents and from general observations, there was evidence to show that wherever possible people living at the care home are actively encouraged and supported to make decisions about their lives and to encourage participation where appropriate with household chores. The Annual Quality Assurance Assessment details that intensive occupational therapy assessments and guidance have been provided to empower residents towards independence/developing independent skills wherever possible. Staff interaction with residents was observed to be respectful and appropriate and residents were noted to have a good rapport with both the manager and individual staff on duty. We recognise that as a result of individual resident’s complex needs, not all residents are able to verbally communicate, however residents were observed to be relaxed with staff and two residents spoken with, advised the inspector that they liked living at Larwood and liked the staff working at the home. One healthcare professional’s survey returned to us recorded that residents privacy and dignity are given up most care and staff respond well to the differing needs of the people who live at the care home. Larwood DS0000018114.V365090.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have the opportunity to have an active lifestyle and to have their social care needs met. EVIDENCE: Individual activity sheets were displayed within the office. This showed that only one resident currently receives formal day care, whilst others have an activity programme designed and implemented by the staff team at the home both `in house` and within the local community. Activities undertaken by individual resident’s include going to the library, cooking, going out for lunch, assisting with food shopping for the home, attending adult education classes, gardening, going to the video shop, massage, cinema etc. Additionally there was evidence to indicate that residents attend the local Gateway Club, local markets and parks and enjoy on occasions fast- food outlets. Larwood DS0000018114.V365090.R01.S.doc Version 5.2 Page 13 The Annual Quality Assurance Assessment details that within the past 12 months the programme of activities has increased for all residents, there is more flexibility and choice available and following occupational therapy assessments, further interests/hobbies are being explored for individual people. It is hoped for the future that more activities/leisure pursuits will be found so as to support service users to experience improved social integration within the local community. Finding facilities within the local community has proved difficult and challenging for the service. The inspector was advised that all residents receive the opportunity to have an annual holiday, either within the UK or abroad. The deputy manager advised that the registered provider contribute £150.00 per person towards each holiday. Photographs of resident’s holidays are displayed within the home and there was evidence that people had enjoyed holidays to Florida, Jersey and Guernsey, Tenerife, Spain and Norfolk. Visiting at the home is very open and residents are actively encouraged and enabled to maintain contact with family members and friends. There is a rolling 6-week menu and this is completed in conjunction with residents and takes into account their personal preferences. There was sufficient evidence to show that people living at the home are receiving a varied diet. The manager advised that the current pictorial menu book is in the process of being reviewed and updated, so as to ensure that residents are able to make an informed choice wherever possible. Staff spoken with confirmed that both staff and residents sit together for their meals. Residents spoken with confirmed that meals provided at the home are “good” and one resident was observed to do the `thumbs up` sign. Currently 2 residents at the home require a specialist diet (pureed/liquidised) as a result of their healthcare needs and requirements. Larwood DS0000018114.V365090.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to receive appropriate support so as to ensure their healthcare needs are met. EVIDENCE: Records showed that residents’ have access to a range of healthcare services and professionals as and when required e.g. GP, Consultant Psychiatrist, Behaviour Therapist, Nurse Specialist etc. Records showed that residents’ health is monitored and clearly documented, detailing the rationale for the visit, appropriate actions and outcomes. Additionally, records showed that individual resident’s are, supported by staff to attend appointments and other healthcare checks. The Annual Quality Assurance Assessment details under the heading of `what we do well`, “All service users have regular check ups with outside professionals and we ensure all service users receive the care and support they are entitled to”. The document also details that the management team of the home have been proactive in utilising private healthcare support so as to enable individual residents to have a more improved lifestyle. Larwood DS0000018114.V365090.R01.S.doc Version 5.2 Page 15 As part of the inspection process, practices and procedures for the safe handling of medication were examined. The majority of medication is managed through a monitored dosage system (blister pack). Storage systems within the home were observed to be safe and secure. Both the manager and deputy manager were advised to ensure that the only medication stored within the medicines cabinet is medication belonging to residents. This refers to the medication for a member of staff being stored within the medication cupboard. On inspection of Medication Administration Records (MAR) for individual residents, medication records were not up to date as there was no record of some medicines having been given to the resident when they were due, as the entries on the Medication Administration Record (MAR) had been left blank and not signed/initialled by staff. Both the manager and deputy manager expressed their concerns and disappointment that this had happened and advised that an audit would be devised and implemented to ensure the above does not happen in the future. A list of those staff deemed competent to administer medication was readily available and included staff initials and signatures. From examination of staff training records it was evident that some staff’s formal medication training required updating and renewal. Additionally, records were only available for one member of staff in relation to medication competency assessments. Both the manager and deputy manager were advised that the latter is seen as good practice and ensures that staff, remain competent and able to administer medication to residents. Following the inspection the manager has devised a competency assessment form for staff to complete and this is viewed as positive. Larwood DS0000018114.V365090.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and others can be confident that any concerns or complaints raised will be listened to and appropriate actions taken. The management of safeguarding within Larwood ensures that residents are protected from abuse. EVIDENCE: The complaints procedure is clearly displayed by the front entrance of the home. The format is both written and pictorial and is `user friendly`. The manager; was advised the complaints procedure needs to be amended to reflect the Commission for Social Care Inspection no longer investigates complaints and any issues raised should be forwarded to individual resident’s placing authority. One relative spoken with at the inspection, advised they were aware of how to raise concerns with the management of the home, should the need arise. They also commented, “I have never had any complaints about this home since [name of relative] has lived here, however I am confident that should this happen, issues will be dealt with”. On inspection of the complaint log, the management team of the home has received one complaint since the last inspection. Records relating to the specific nature of the complaint, investigation and action taken were clearly recorded. Although this was seen as positive, the Annual Quality Assurance Assessment records that over the next 12 months, further improvement is required to record all conversations and actions. Larwood DS0000018114.V365090.R01.S.doc Version 5.2 Page 17 Records of compliments were evident and included from one relative, “I turned up unexpected and found [name of resident] immaculately tidy and well dressed. The staff are all very friendly and very helpful and [name of resident] is very happy” and “I picked [name of resident] up today and I was most impressed with their cleanliness and I would like to express my gratitude to all the staff for this as they really love it at Larwood and can’t wait to get back”. Another relative recorded, “Just a letter thanking you all for everything you do for my [name of relative]. It’s wonderful to see how much progress you have had over the time they have spent with you, we are so pleased. The things they do now and the quality of life they have is all down to the loving care you have given, thanks to you all. We are so pleased they are living where they are, having holidays, going shopping and days out, are all things mum and dad tried to do, but with not much success. They would be so happy if they could see [name of relative]. Thanks again, you are all very special people doing a great job”. Additionally comments from the NVQ Assessor recorded, “ I found staff’s attitude and approach to the clients they support respectful and unrushed. I found Larwood to be a homely environment and a pleasure to be here” and from an external trainer, “How nice to enter such a happy friendly home environment. My thanks and best wishes to you all”. Safeguarding policies and procedures were available within the home and the manager was aware that new guidelines have been implemented recently. No safeguarding issues have been highlighted since the last inspection. Both the manager and staff spoken with during the site visit were able to demonstrate a good understanding and awareness of how to deal with a safeguarding issue should it arise. Staff training records, show that not all people employed at the care home had received training relating to safeguarding. We recognise that this predominately relates to people who have been recently employed at the care home. Larwood DS0000018114.V365090.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Larwood provides a comfortable, safe and homely environment for residents, which meets their needs. EVIDENCE: A partial tour of the premises was undertaken as part of this key inspection. The home is pleasantly decorated, clean and odour free. On inspection of resident’s bedrooms, all were seen to be personalised and individualised and reflected their personalities and interests. Residents indicated that they were happy with their personal space. There are sufficient and appropriate adaptations and equipment within the home to support residents. The ground floor is wheelchair accessible e.g. wider door openings, lowered light switches and `user friendly` shower room and bathroom. The garden to the rear of the property is well maintained and secure and it was positive to note that this is accessed by residents,’ on a regular basis. Within Larwood DS0000018114.V365090.R01.S.doc Version 5.2 Page 19 the past 12 months, a summerhouse and garden furniture has been purchased. No health and safety issues were highlighted at this inspection. The manager advised the inspector that there is an external maintenance contractor available as and when required which is utilised by the registered provider to undertake on-going maintenance works at the care home. On inspection of the maintenance book this clearly recorded the repairs required, date/time, action taken and date issue completed. A fire risk assessment for the home was readily available. Records of fire alarm and emergency lighting checks were evident and these are conducted weekly. Fire equipment was last serviced in February 08 and the last recorded fire drill was also February 08. The manager was advised to ensure that all staff, participate in regular fire drills at the home. Larwood DS0000018114.V365090.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home benefit from an effective staff team, however further development is required in relation to recruitment practices and procedures and ensuring that staff receive appropriate training to meet residents needs. EVIDENCE: The manager advised that staffing levels at the care home remain at 4 staff between 07.00 and 21.30 and 2 waking night staff between 21.15 and 07.15 each day. In addition to the waking night staff there is a `sleep-in` person on duty each night. The manager’s hours are supernumerary and in addition to managing Larwood, she provides support at a local supported living scheme, which is owned by the registered provider. From discussions with the manager and staff at the care home, this does not negatively impact on the management of the home. On inspection of four weeks staff rosters following the site visit, these evidence that staffing levels as detailed above have been maintained so as to ensure residents safety and wellbeing. The home utilises on occasions, staff from an external agency. The manager advised that the number of hours Larwood DS0000018114.V365090.R01.S.doc Version 5.2 Page 21 provided by agency staff has reduced significantly and this was confirmed by the figures in May and June 08. Wherever possible the same agency staff are utilised at the care home so as to provide continuity for residents. The manager was advised to ensure that the full names of staff (agency staff) are recorded within the staff roster. A random sample of 3 staff files, were examined for those people newly recruited to Larwood. It was positive to note that all records as required by regulation had been sought and each file was well maintained and organised. Staff profiles were evident for agency staff used at the home over a 4-week period, detailing that the external agency had undertaken all recruitment checks in line with regulatory requirements. Records of induction were not available for those agency records examined. The manager was advised to ensure that these are undertaken for the future. At the time of the site visit, there was one staff vacancy for a project worker (37 hours per week). One relative survey returned to us recorded, “Staff are excellent, helpful and friendly at all times. The care for [name of resident] is first class as are the staff”. The survey also confirmed that they thought that staff working at the home had the right skills and experience. The manager advised that 3 members of staff have attained NVQ Level 2, 1 member of staff has achieved NVQ Level 3 and currently 3 people are working towards attaining NVQ Level 2. The Annual Quality Assurance Assessment details that all staff have completed LDAF (Learning Disability Award Framework), with new members of staff commencing this as soon as is practicable. On inspection of the training matrix and individual staff training records, information recorded when cross referenced was not accurate in some cases and it was difficult to decipher which training was up to date and where there were gaps. Since the last inspection there was evidence to show that some staff had received a variety of training relating to infection control, health and safety, continence awareness, food hygiene, basic first aid, fire awareness, manual handling and equality and diversity. The majority of staff had also received specialist communication training (makaton). Further consideration must be made to ensure that other training associated with the needs of people who have a learning disability are also undertaken e.g. autism, epilepsy, parkinsons etc. On inspection of the staff supervision matrix, this showed of those people case tracked, that they were receiving regular supervision. The manager advised that since the last inspection a new appraisal format has been introduced. This was observed to be detailed and comprehensive with particular emphasis placed on staff competencies. Larwood DS0000018114.V365090.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People at the home, benefit from a well run home. EVIDENCE: The manager has been employed at the home since 2000. The manager has achieved a degree in education and community, has a diploma in play work (learning through play) and attained NVQ Level 4 in management and care. The manager advised that her ethos for the home is “for residents to maximise their potential, to promote residents independence and for people in the home to be treated as you and I would want to be”. The manager further stated that she feels that staff morale is good and although staff require reminding on occasions to complete necessary documentation, actual delivery of care for residents is good. Additionally it is felt that the staff group work well as a staff Larwood DS0000018114.V365090.R01.S.doc Version 5.2 Page 23 team and there is a good relationship between staff and individual resident’s. Staff, spoken with during the inspection were complimentary regarding the manager and felt that the home was well run and the manager and members of the management team were approachable and supportive. The manager advised that she receives good support from the organisation and receives regular supervision approximately every 4 weeks. There was evidence to show that the organisation has undertaken a quality assurance audit for the people within the home. The results for the period 2007/2008 were readily available and sections covered were noted to be comprehensive and included communication, money, shopping, information, home life, food and drink, leisure and social time, day services/education/work and relationships. There was evidence to show that an independent advocate was used to assist in getting the views of residents. It was positive to note that some residents were able and chose to complete their surveys without support. The manager advised that staff surveys were also completed. There was evidence to show that the organisation also undertake monthly Regulation 26 visits. All sections of the Annual Quality Assurance Assessment were completed and the information detailed gives a good account of the current situation within the service. The manager and staff team demonstrate a level of self-awareness and recognises the areas that it still needs to improve upon. There was evidence to indicate that regular staff meetings are undertaken and although there are no separate resident meetings, residents are encouraged and enabled to take an active role within the staff meeting forum. The manager advised that there is an `open door` policy so as to discuss issues with relatives and other interested parties. A health and safety policy was observed within the home. A random sample of safety and maintenance certificates showed that these had been serviced, and remain in date until their next examination. Larwood DS0000018114.V365090.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 3 X X 3 X Larwood DS0000018114.V365090.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13(2) Requirement Timescale for action 02/07/08 2. YA20 3. YA35 Records of medicines administered to residents must be completed and made at the time that medication is administered. This will show that residents receive the medicines prescribed for them. 18(1)(c)(i) Ensure that those people who administer medication to residents have up to date training so that residents can be assured that staff are competent to undertake this task safely and ensure residents safety and wellbeing. 18(1)(c)(i) Ensure that all staff receive, appropriate training for those conditions associated with the needs of people who have a learning/physical disability. This will ensure that staff, have the skills and confidence to deliver care practices in line with people’s care needs. 01/09/08 01/10/08 Larwood DS0000018114.V365090.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA20 YA22 YA24 Good Practice Recommendations Staff should be assessed at regular intervals as to their continued competency to administer medication to residents. The complaints procedure should be amended to reflect that the Commission for Social Care Inspection no longer investigate complaints. Staff working at the care home should receive the opportunity for regular fire drill practices. Larwood DS0000018114.V365090.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Larwood DS0000018114.V365090.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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