Care Home: The Larches

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What the care home does well There are good systems in place to make sure people have enough information and opportunities to visit and get to know the home before any decision to move in permanently is made. They have followed good assessment procedures by gathering a wide range of information about all aspects of the person’s needs. They have been able to demonstrate that they have taken good care to make sure they will be able to meet each person’s needs before agreeing to admit people into the home. Medicines are stored and administered safely.The LarchesDS0000070349.V376224.R01.S.docVersion 5.2The home offers a good choice of home cooked and tasty meals to suit all tastes and dietary needs. People have been consulted over the menus. People can be confident that any concerns or complaints they have will be listened to and acted upon appropriately. Good policies and procedures are in place on all aspects of protection and staff have received training on the protection of vulnerable adults. The home is bright, clean, comfortable and well maintained.. Staffing levels are good. People told us there has always been sufficient staff on duty, and this was confirmed by the staff rotas we saw. A number of new staff have been employed in the last year and we checked their recruitment and induction files and found that the home has carried out safe procedures including taking up references and criminal records checks before new staff have started work. Thorough induction training has been provided to all new staff. There are good recording systems in place for all aspects of the care and services provided including cash held by the home on behalf of those people who do not want to keep cash in their rooms. Records checked include the fire log book, accident records, and risk assessments.. What has improved since the last inspection? Over the last year many improvements have been made in all areas of the home and care provision. The care plans have been developed and now contain well written and detailed information about all aspects of the support each person needs ever day. They are clear, easy to read, and give sufficient detail about all personal and health care task the person wants to be assisted with. The care plans are now an invaluable tool for staff and provide good evidence to show that the staff are aware of potential health problems and have taken steps to prevent them developing. There are also good daily recording and monitoring tools in place to help the manager check that all tasks have been carried out. Comments we received from local GP’s included – “Caring, personal and friendly. Residents are well looked after and happy.” “Looks after patients well and cheerfully. Asks for medical advice appropriately.” “Seems to be a well run place – residents well cared for.” The level of activities has increased and there is now an activities organiser employed who has planned and organised a good range of interesting things for people to do. There are detailed records in place showing that the staff have spent considerable time talking to each person and getting to know the things they are interested in, and the things they would like to do, and this The Larches DS0000070349.V376224.R01.S.doc Version 5.2 information has been used to help them draw up a plan of the activities and outings they will provide each month. The level of staff training has improved. Over half of the staff team hold a relevant qualification. All staff have received regular training on all health and safety related topics, and also health and care topics relevant to their work. The home is well managed. A new manager had begun work in the home just a few days before this inspection and we heard many people praising her for the improvements she had made within her first few days. This included sorting out the laundry and bed linen. We saw lots of smiles and people gave examples of why the home is now a very happy place to live or work in. What the care home could do better: No requirements or recommendations were made as a result of this inspection. Key inspection report CARE HOMES FOR OLDER PEOPLE The Larches Canal Hill Tiverton Devon EX16 4JD Lead Inspector Vivien Stephens Unannounced Inspection 11:00 10 and 13th July 2009 th DS0000070349.V376224.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. The Larches DS0000070349.V376224.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address The Larches DS0000070349.V376224.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Larches Address Canal Hill Tiverton Devon EX16 4JD 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) 01884 257355 01884 253270 enquiries@ccstiverton.eclipse.co.uk ww.ccstiverton.co.uk/larches.htm Anne Gray Care Limited Manager post vacant Care Home 20 Category(ies) of Dementia (20), Old age, not falling within any registration, with number other category (20), Physical disability (20) of places The Larches DS0000070349.V376224.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia (Code DE) Physical disability (Code PD) The maximum number of service users who can be accommodated is 20. 14th July 2008 2. Date of last inspection Brief Description of the Service: The Larches is a residential home registered to provide care to 20 people. The home is situated on the outskirts of Tiverton with views of the surrounding countryside. The home has 4 floors linked by a lift. There are two lounges with a dining area and conservatory attached to one. Eleven rooms have en-suite facilities and there are two double rooms. On the site of the home there are also some self contained ‘close care’ flats for older people. There is plenty of car parking in the grounds. At the time of this inspection fees started from £500 per week depending on individual needs. Additional costs, not covered in the fees, include chiropody, continence products, hairdressing, outings and personal items such as toiletries and newspapers. A copy of the latest CSCI report is normally on display in the entrance hallway. Further copies of the report can be requested through the manager. The Larches DS0000070349.V376224.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. Several weeks before this inspection took place we asked the home to complete an Annual Quality Assurance Assessment (AQAA). They completed and returned the form by the date we asked for it. It gave us very good information about all aspects of the management of the home and daily life for the people who live there. We sent some survey forms to the home and asked them to distribute them. We received 4 completed forms from people living in the home, 6 from staff who work in the home and 5 from health and social care professionals. Their responses were informative and helped us to reach the judgements we have made in this report. This inspection took place over 1 ½ days. On the first day we met the newly recruited manager who began work just a few days before our visit. We also talked to three people who lived in the home and four members of staff. We carried out a tour of the home and looked at some of the records the home is required to keep including care plans and medicine administration. On our second visit to the home we looked at the recruitment and training records for those staff employed in the last year. We also met the providers and the Director of Care. On the day of this inspection there were 12 people living in the home. What the service does well: There are good systems in place to make sure people have enough information and opportunities to visit and get to know the home before any decision to move in permanently is made. They have followed good assessment procedures by gathering a wide range of information about all aspects of the person’s needs. They have been able to demonstrate that they have taken good care to make sure they will be able to meet each person’s needs before agreeing to admit people into the home. Medicines are stored and administered safely. The Larches DS0000070349.V376224.R01.S.doc Version 5.2 Page 6 The home offers a good choice of home cooked and tasty meals to suit all tastes and dietary needs. People have been consulted over the menus. People can be confident that any concerns or complaints they have will be listened to and acted upon appropriately. Good policies and procedures are in place on all aspects of protection and staff have received training on the protection of vulnerable adults. The home is bright, clean, comfortable and well maintained.. Staffing levels are good. People told us there has always been sufficient staff on duty, and this was confirmed by the staff rotas we saw. A number of new staff have been employed in the last year and we checked their recruitment and induction files and found that the home has carried out safe procedures including taking up references and criminal records checks before new staff have started work. Thorough induction training has been provided to all new staff. There are good recording systems in place for all aspects of the care and services provided including cash held by the home on behalf of those people who do not want to keep cash in their rooms. Records checked include the fire log book, accident records, and risk assessments.. What has improved since the last inspection? Over the last year many improvements have been made in all areas of the home and care provision. The care plans have been developed and now contain well written and detailed information about all aspects of the support each person needs ever day. They are clear, easy to read, and give sufficient detail about all personal and health care task the person wants to be assisted with. The care plans are now an invaluable tool for staff and provide good evidence to show that the staff are aware of potential health problems and have taken steps to prevent them developing. There are also good daily recording and monitoring tools in place to help the manager check that all tasks have been carried out. Comments we received from local GP’s included – “Caring, personal and friendly. Residents are well looked after and happy.” “Looks after patients well and cheerfully. Asks for medical advice appropriately.” “Seems to be a well run place – residents well cared for.” The level of activities has increased and there is now an activities organiser employed who has planned and organised a good range of interesting things for people to do. There are detailed records in place showing that the staff have spent considerable time talking to each person and getting to know the things they are interested in, and the things they would like to do, and this The Larches DS0000070349.V376224.R01.S.doc Version 5.2 Page 7 information has been used to help them draw up a plan of the activities and outings they will provide each month. The level of staff training has improved. Over half of the staff team hold a relevant qualification. All staff have received regular training on all health and safety related topics, and also health and care topics relevant to their work. The home is well managed. A new manager had begun work in the home just a few days before this inspection and we heard many people praising her for the improvements she had made within her first few days. This included sorting out the laundry and bed linen. We saw lots of smiles and people gave examples of why the home is now a very happy place to live or work in. 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 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. The Larches DS0000070349.V376224.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Larches DS0000070349.V376224.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 5, 6 People using the 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 given good information and opportunities to visit and get to know the home so that they can be sure The Larches is the right place for them to live. The home follows good assessment procedures to make certain they will be able to meet the person’s needs. EVIDENCE: Since the last inspection 4 new people have moved into the home. We looked at four care plan files to see what information the home had gathered before people had moved in. We found that the home had comprehensive assessment forms in place that guided the person carrying out the assessment to gather a wide range of information about all aspects of the person to help them The Larches DS0000070349.V376224.R01.S.doc Version 5.2 Page 10 understand the person’s likes and dislikes, their family and social support network, their health, and the support they wanted with all aspects of their personal care. The home had also obtained assessments from health and social care professionals where available. We were satisfied that the home was able to meet the needs of those people who had moved in since the last inspection. We talked to the daughter of one person who moved in since the last inspection. She told us she was very happy with the information she had received from the home before her mother had moved in, and the admission process. She was sure it was the right place for her mother. We also found that the home had a good range of written information about the home in a document called the Service user Guide. This included photographs and information about the home, the staff, and the management. There is also an internet website that was in the process of being updated and improved. We also heard that the home had provided some short stays in the last year and this has given people opportunity to get to know what it is like in the home without giving up their own home. A copy of the most recent inspection report can normally be found in the entrance hallway, or can be requested from the manager. The home does not provide intermediate care. The Larches DS0000070349.V376224.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans contain well written and detailed information about all aspects of the support each person needs each day and provide an invaluable tool for staff to help them understand the tasks they must carry out. Medicines are stored and administered safely. EVIDENCE: Since the last key inspection the care plans have been completely redesigned and rewritten. We looked at four care plan files to find out what information the home had gathered about each person. The home had designed their own care plan forms that guided the person completing the forms to look at all aspects of the person’s care needs. The plans were drawn up with the person, The Larches DS0000070349.V376224.R01.S.doc Version 5.2 Page 12 and in their own words. They were clear and easy to read, and gave just the right level of detail about each task the person needed help with. They provided good evidence of the way staff were instructed to give people choices about all aspects of their daily routines, and also explained how staff should respect the person’s privacy and dignity. The care plan files contained a form showing the signatures of the care staff team who had been asked to read the files and understand the tasks each person wanted help with, and how the tasks should be carried out. We also saw daily evaluation sheets for each person. These provided tick boxes to confirm that specific personal care tasks had been carried out. This provided a very good monitoring tool to make sure each person had received the help they needed. The forms also contained a section for staff to give a brief overview of how the person had been that day, and any important information or changes in their care needs. These forms were used for staff handover sessions, and were then filed in individual care plan files at a later date. The plans contained detailed risk assessments on all potential individual health or safety risks. We saw evidence of regular checks on people’s weight, skin, diet and nutrition, moving and handling, and specific health risks. The files contained good records of all communication with, and visits by health and social care professionals. We also found evidence to show that the food and fluid intake of each person had been monitored to make sure they were not at risk of dehydration or malnutrition. A new key worker system was in the process of being implemented. Each person had been allocated a member of staff who would take responsibility for specific tasks including checking that the person’s clothing was in good order and labelled. At the time of this inspection there were no people seriously ill or close to death. We saw evidence to show that the new manager had worked alongside the care staff to help people find solutions to individual continence problems. We received five completed survey forms from health and social care professionals. These showed that the professionals were generally satisfied with the standard of care provided by the home. Comments included – “Caring, personal and friendly. Residents are well looked after and happy.” “Looks after patients well and cheerfully. Asks for medical advice appropriately.” “Seems to be a well run place – residents well cared for.” One GP commented they were surprised to be asked to apply a simple dressing one evening during the winter. We were reassured that the manager will The Larches DS0000070349.V376224.R01.S.doc Version 5.2 Page 13 ensure all staff receive training and support on skin care and wound dressings, and they will consider drawing up procedures on seeking professional advice on wound care. We watched as a senior care worker gave out medications at lunch time. Each person was given their medications individually, and care was taken to check the medicine administration record before the medicines were given. The record was correctly signed when the medications had been given. The medicine administration records contained a photograph of each person. There were good procedures in place to check new medicines received into the home, and balances were brought forward to provide a good accounting method to check stocks were correct each month. Safe storage facilities and recording tools were in place for any controlled drugs held in the home. Creams and lotions were recorded each time they were administered and there were clear instructions in the care plans on all skin care needs. The Larches DS0000070349.V376224.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has considered the interests of each person before drawing up a plan of the activities and outings they will provide each month. People are offered a good choice of healthy meals to suit all tastes and dietary needs. EVIDENCE: Since the last inspection a member of staff has been given specific responsibility for organising the activities in the home. Many people told us how much this appointment has been appreciated and enjoyed. The level of activities has increased and people told us about some of the things they had participated in and enjoyed. The Larches DS0000070349.V376224.R01.S.doc Version 5.2 Page 15 Each care plan we looked at contained a social activities section. This section contained a comprehensive and detailed assessment covering all aspects of the person’s social network and the things they are interested in. This information had been used to help the home draw up a plan of how they will meet each person’s social and leisure interests. In the entrance hallway we saw a timetable of the group activities planned for the current month. At least two activity sessions were planned each day, and sometimes three. These included a music quiz, cards and dominoes, musical entertainment, a look at the weekend newspaper and chat with the staff, art, board games, and religious services. Several people told us about outings they had enjoyed to places of local interest. During our inspection we saw groups of people taking part in activities in the dining room. We also heard how staff have spent time on a one to one basis with people, either escorting the person for a walk, sitting and chatting, or supporting the person with individual interests. Several staff members told us how much they enjoyed the increased level of activities the home has provided. They described how it has improved their job satisfaction and said they enjoyed seeing everyone smiling and happy. They recognised the health benefits to people who were more active both physically and mentally. One member of staff talked about more activities she would like to introduce in the future. Building works in the grounds have been completed and there are now areas with raised flower beds and seats where people can sit outside if they wish. A garden fete is planned for 15th August 2009 During our visit we talked to two relatives who were visiting the home. We also saw many more visitors being welcomed into the home. The staff were friendly and welcoming, and offered people drinks. We heard that regular residents and relative’s meetings are held in the home. These have been minuted and relatives who have been unable to attend the meetings can see the minutes and be informed of the topics discussed. We talked to the cook about the way the menus had been planned. The menus showed that people have been offered two choices of mail meal and puddings (hot or cold) at lunchtime. There was also a good choice of lighter meals every evening. The cook told us that people had been consulted over the menus a year ago and she thought there were plans to review the menus in the near future and people would be asked once again for their suggestions and comments. We heard that each time a new person has moved into the home the cook has been shown the care plan and made aware of any dietary needs and likes and dislikes. The cook has then talked with the person to get to know them and The Larches DS0000070349.V376224.R01.S.doc Version 5.2 Page 16 make sure the person always received food that suited them. There were records held in the kitchen of the food actually eaten by each person. The care staff completed these records and were responsible for alerting the manager if they had any concerns about the food or fluid intake of any person. We saw a report issued by the Environmental Health Officer who had visited in the last year to check the kitchen. The report showed that good systems had been followed to ensure all areas were hygienic and safe. The kitchen units were old and worn, although still in working order. We heard that there are plans to upgrade the kitchen in the future. We received some positive comments from people who live at The Larches who completed survey form. These included, “Clean living accommodation. Clothes are washed daily. Regular activities. A good selection of food.” “There is always a cheerful and helpful atmosphere. Nothing is too much trouble for the staff. The residents are good company and we all get on well together. I am well looked after and appreciate being taken out occasionally.” A member of staff also told us about some of the things the home does well, “Good care for residents. Entertainment for residents. Keep things clean and comfortable.” The Larches DS0000070349.V376224.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 People using the 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 can be confident that any concerns or complaints they have will be listened to and acted upon appropriately. People are protected from abuse by well-trained staff and good recruitment procedures. EVIDENCE: Since the last inspection no complaints or concerns have been received by the Commission. The home told us in their AQAA about two complaints they have received. We were satisfied these were investigated dealt with appropriately. Neither complaint related to the care or facilities provided to any person living in the home. The complaints procedure was set out in the Service User Guide. People told us they knew how to make a formal complaint and said they were confident they could speak to someone if they were unhappy about anything about the home or the care they received. All staff have received training on the protection of vulnerable people. Policies and procedures on all aspects of potential abuse are in place and staff have The Larches DS0000070349.V376224.R01.S.doc Version 5.2 Page 18 been asked to read these. Staff supervision sessions have been used to give additional training on this topics where necessary. The staff we talked to, and those who completed a survey form, told us they knew who to speak to if they had a concern and they were confident the right action would be taken to address their concerns. The Larches DS0000070349.V376224.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 23, 25, 26 People using the 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 bright, clean, comfortable and well maintained home. EVIDENCE: The home is situated in a residential area on the outskirts of Tiverton. To the rear of the home there are lovely views over the Grand Western canal and surrounding countryside. In the last year building works in the grounds have been completed and there is now plenty of on site car parking and a garden area with raised beds and garden furniture. Offices for a domiciliary care services and day centre are also situated in the grounds. The Larches DS0000070349.V376224.R01.S.doc Version 5.2 Page 20 Accommodation is on four floors and there is a passenger lift to each floor. We carried out a tour of the home checking most bedrooms, and all bathrooms, toilets, lounge and dining rooms, kitchen and laundry. We found that all areas were clean and free from any unpleasant odours. The standard of decoration was generally good. The carpets and flooring were in good order. Most bedrooms have en suite toilet facilities. At the last inspection one bedroom was found to be very dark following alterations caused by building works in the grounds. At this inspection the room was vacant but we heard there were plans to decorate, re-carpet and refurnish the room and they hoped this would create a brighter impression. Two cleaning staff were employed each day. We found that they had taken great care to ensure all areas were kept clean at all times. The home has taken advice from the Health Protection Agency in the last 2 years and they have comprehensive policies in place covering all aspects of infection control. Regular health and safety checks have been carried out by an independent company to ensure all areas remain safe. All radiators have been covered to prevent the risk of burns or scalds. Pre-set valves have been fitted to hot water taps to provide water close to 43c. The laundry room was neat and tidy and provided good storage facilities for clean laundry. We saw items of clean laundry that had been neatly ironed before being returned.We were assured that the home follows safe procedures when dealing with soiled laundry. One person told us that sometimes their clothing has not been returned promptly after being washed. We talked to the new manager and the staff to find out why this had happened. We heard that some clothing has not been properly marked and sometimes staff have not known who to return items to. The manager told us that it will be the responsibility of key workers to check people’s clothing and make sure it has been marked and returned to the correct person. The Larches DS0000070349.V376224.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient well trained and experienced staff to meet the needs of the people living in the home. Careful recruitment and induction procedures have been followed to ensure people are in safe hands. EVIDENCE: On arrival at the home we found there was a manager, three care workers, a cook, two cleaning staff and a maintenance person. This level of staffing was sufficient to meet the needs of the people living in the home. We were given a copy of the current week’s staff rota showing sufficient staff on duty at all times. The home employs 7 full time and 12 part time staff. Since the last inspection approximately half of the staff team have left. New staff have been recruited to replace those who have left. We looked at the employment files of eight new members of staff to check that the home had followed safe procedures before they started working in the home. We found The Larches DS0000070349.V376224.R01.S.doc Version 5.2 Page 22 each person had completed an application form providing details of their employment record and qualifications. At least two references had been taken up before the person was offered a job and where any references raised issues these had been followed up and considered. The staff we talked to confirmed that their recruitment had been thorough including the taking up of references and checks before their appointment was confirmed. A Criminal Records Bureau (CRB) check had been carried out on each member of staff. Where staff were needed to start quickly a Protection of Vulnerable Adults (POVA 1st) check had been carried out while waiting for the full CRB to be returned. However, for most staff the full CRB was in place before they began work. This demonstrated good practice. We saw evidence to show that new staff have received a thorough induction at the start of their employment. One new member of staff was undertaking her induction at the time of this inspection. Staff have received induction training following nationally recognised standards. Staff files contained copies of training certificates on all required topics including health and safety related topics. We were given a copy of the training programme for July and August providing training and updates on a wide range of topics. We were also given a copy of the training matrix showing the training each member of staff has received and when specific health and safety training must be updated. This demonstrated that the home has very good systems in place to ensure all staff receive the training they need to meet people’s needs and keep themselves safe. We were told that 11 staff either hold a relevant qualification known as National Vocational Qualification (NVQ). All staff have received supervision and we heard that the new manager hopes to provide regular supervision to all staff and also monthly staff meetings in future. Comments we received from care staff included “It has a good caring and professional work force. Residents are happy. Their health and welfare needs are provided very well by The Larches.” The Larches DS0000070349.V376224.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed. People can be confident their views will be listened to and acted upon. People’s finances are protected by good recording and checking systems. People are protected from harm by well trained staff and good systems of health and safety. EVIDENCE: A new manager has recently been employed. She began work just a few days before our inspection but we heard many positive comments about her management style and people told us how many improvements she had made The Larches DS0000070349.V376224.R01.S.doc Version 5.2 Page 24 in just a short space of time. She has previously been registered as a manager of a children’s home but told us she also has had previous experience caring for older people. The home also has a Director of Care and Deputy Director of Care. They oversee both the care home and the domiciliary care service. We talked to three staff during our visit to the home and we heard that the new manager had already introduced many positive changes. Comments included “Lots of positive changes have been made. Carers all work well as a team.” The home has a range of systems in place to check the quality of the services and make improvements. They have held regular residents/relatives meetings, and also staff and management meetings. They have issued six monthly questionnaires to residents to seek their views on all aspects of the home. They have also talked individually to each person and to their relatives and representatives. As a result of these consultations they have made a number of improvements including refurbishment of rooms, improved level of activities including more outings, changed the menus, and introduced regular film shows in the lounge. We looked at the way the home handles cash held on behalf of some people who do not want to keep the cash in their rooms. Good records had been maintained of all transactions, two signatures were shown to demonstrate transactions have been witnessed, and regular checks have been carried out to check the balances held. This demonstrated good practice. We looked at the fire log book and saw that regular checks and maintenance had been carried out to ensure all equipment was in good order. Staff have received regular training on safe evacuation procedures. A letter was on file to show that the premises had been inspected by the fire authority in the last year and all aspects of fire safety were found to be safe. Accidents had been reported appropriately and a regular audit had been carried out to look at any patterns of accidents and make certain that all action possible had been taken to prevent a recurrence of the incidents. The Larches DS0000070349.V376224.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 X X 3 x 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 The Larches DS0000070349.V376224.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Larches DS0000070349.V376224.R01.S.doc Version 5.2 Page 27 Care Quality Commission South West Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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