Inspection on 27/07/05 for Glenside Manor - Lime Tree Wing

This inspection was carried out on 27th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Glenside Manor - Lime Tree Wing 12/03/07

Glenside Manor - Lime Tree Wing 04/10/05

Glenside Manor - Lime Tree Wing 04/10/04

Glenside Manor - Lime Tree Wing 10/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Glenside Manor - Lime Tree Wing South Newton Salisbury Wiltshire SP2 0QD Lead Inspector Steve Cousins Unannounced 27 July 2005 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 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 Older People. 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. Glenside Manor Lime Tree Wing v235140 d51_d01_s48135_glenside_limetreewing_v235140_270705_stage4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Glenside Manor - Lime Tree Wing Address South Newton Salisbury Wiltshire SP2 0QD 01722 742066 01722 744443 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Glenside Manor Healthcare Services Ltd Mr Robert Andrew Lee Care Home 35 Category(ies) of DE Dementia 35 registration, with number DE(E) Dementia - over 65 35 of places MD Mental Disorder 35 MD(E) Mental Disorder - over 65 35 Glenside Manor Lime Tree Wing v235140 d51_d01_s48135_glenside_limetreewing_v235140_270705_stage4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: The maximum number of service users who may be accommodated at any one time is 35 The staffing levels set out in the Notice of Decision dated 30 July 2003 must be met at all times Date of last inspection 4 October 2004 Brief Description of the Service: Glenside Manor – Lime Tree Wing is a 35 bedded care home, which accommodates elderly persons and younger adults who need nursing care due to mental health needs, mainly dementia. It was purpose-built in the early 1990s. Accommodation is provided over two floors with a range of different sitting rooms and dining rooms available to service users. The registered manager is Mr Rob Lee, he leads a team of nursing and care staff. Lime Tree Wing is part of a group of homes, all on one campus owned by Glenside Manor Health Care Services Ltd. Mr Denis Barry is the nominated responsible individual. He is supported by a senior management team. A multidisciplinary team, including physiotherapists, occupational therapists, psychologists, a speech and language therapist and social worker work across the campus. One catering and laundry department supplies all the registrations on site. A maintenance team also works across the site. The group of homes is situated in the village of South Newton, on the A36, five miles north west of the city of Salisbury. A mainline train station is in Salisbury, the A36 is on a bus route and ample car parking space is available on site. Glenside Manor Lime Tree Wing v235140 d51_d01_s48135_glenside_limetreewing_v235140_270705_stage4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 9.30 am and 4.30 pm on the 27th of July 2005. The home was full with 35 service users. The findings from this inspection are based on a tour of the premises, speaking to some service users, their relatives and visitors, the manager and staff, and inspecting a number of records. Due to the nature of their illnesses many service users were unable to communicate their opinions about the home. The inspector then met with the registered manager, Mr Rob Lee, to report the findings of the inspection. What the service does well: What has improved since the last inspection? What they could do better: There needs to be an improvement in recording how much food and drink frail people are receiving and they need to be regularly weighed. There is also a need to ensure that adequate numbers of staff are on duty at all times. New nurses’ competency to administer drugs needs to be thoroughly assessed. Bedrooms need refurbishment and some flooring in the en suites needs to be replaced. More lifting equipment and new wheelchairs are required. Glenside Manor Lime Tree Wing v235140 d51_d01_s48135_glenside_limetreewing_v235140_270705_stage4.doc Version 1.40 Page 6 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. Glenside Manor Lime Tree Wing v235140 d51_d01_s48135_glenside_limetreewing_v235140_270705_stage4.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection Glenside Manor Lime Tree Wing v235140 d51_d01_s48135_glenside_limetreewing_v235140_270705_stage4.doc Version 1.40 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 4. Service users are assessed before coming into the home and the home is suitable for their needs. EVIDENCE: Care plans showed evidence of pre admission assessment by the manager. Assessments were comprehensive and included the views of relatives and relevant others where appropriate. Other information from social and health care professionals was available. Mr Lee and his staff have received regular up-dates in caring for persons with dementia care needs and staff are experienced in caring for this complex client group. Evidence from observations of care made during the inspection, discussions with staff and significant others provided evidence that the home is able to meet the needs of this client group. The environment is safe and secure. Glenside Manor Lime Tree Wing v235140 d51_d01_s48135_glenside_limetreewing_v235140_270705_stage4.doc Version 1.40 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 and 10. Care plans are satisfactory and personal and health care needs are being met, although some recording practice requires improvement. Arrangements regarding medications were satisfactory, however staff competency needs to be fully assessed at induction to fully protect the service users EVIDENCE: Care plans reviewed were found to be a good reflection of assessed needs and to direct care, however records of interventions such as fluid intake and nutritional intake for two frail service users who were nursed in bed were not always complete. Not all service users had been regularly weighed as directed by their nutritional risk assessments. Service users relatives have been approached as to what action is to be taken should a service user become acutely ill. Care plans gave a good indication that health needs were being promptly addressed and there was evidence of GP visits when required. Lots of pressure relief equipment was in use and there were no service users with pressure sores. Staff were very calm and understanding, particularly with one service user who was very challenging. Staff were also observed using appropriate manual handling equipment and techniques. Glenside Manor Lime Tree Wing v235140 d51_d01_s48135_glenside_limetreewing_v235140_270705_stage4.doc Version 1.40 Page 10 Service users were all clean and well dressed and all personal care was given in private. Nearly all of the service users experience problems with continence, so it is much to the home’s credit, that no odours were observed in any area of the home. Many service users also exhibit complex behaviours and may not be aware of their own needs for privacy. Where such behaviours were shown, staff reacted promptly and discreetly to maintain the persons dignity. Relatives and visitors were very complimentary about the level of care. One saying that staff ‘paid good attention to details’ such as hair, nails and matching clothes thereby allowing service users to maintain some dignity. Others said ‘staff are excellent’ and ‘wonderful’. The procedures regarding medicines were satisfactory. There is minimal use of sedatives. Arrangements for the disposal of medicines were being put in place now that they were unable to be returned to the issuing pharmacy. There were no current service users who were self medicating. 0ne incident relating to medicine administration had highlighted the need for new nurses to have a more formal competency assessment as part of induction training. Glenside Manor Lime Tree Wing v235140 d51_d01_s48135_glenside_limetreewing_v235140_270705_stage4.doc Version 1.40 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13 and 15 As far as is possible, service users social, cultural and religious needs are being met and they maintain contact with family and friends. An appealing balanced diet is available and service users receive appropriate support to eat. EVIDENCE: An activity person has been recruited and works in the home four afternoons a week. Records of activity are kept. Most of the service users are not able to participate in group activities or participate in activities for any period of time. The activity person was seen engaging service users in one to one activity during the afternoon. All service users have care plans in place in relation to their likes and dislikes and preferences. Religious services are held. There were many visitors in the home during the inspection and there was a good rapport between them and the staff. Visiting hours are unrestricted and service users can receive visitors in private. Those spoken to felt that communication with staff was good. The meal served looked well cooked and nutritious and there were positive comments from service users and their relatives. Staff were assisting some service users to eat in an unhurried manner. Due to the number of service users requiring assistance on the first floor, there was some delay before two service users who were in bed received their meals. Glenside Manor Lime Tree Wing v235140 d51_d01_s48135_glenside_limetreewing_v235140_270705_stage4.doc Version 1.40 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18. Complaints are listened to and acted upon. As far as possible, service users are protected from abuse. EVIDENCE: A complaints procedure is available and complaints are logged and reviewed. The record indicated that no major complaints had been received. Two complaints had been recorded and these had been dealt with promptly and to a satisfactory conclusion. Relatives spoken to were aware of whom to complain to, although none said they had needed to. There have been no complaints received by CSCI. All service users are deemed vulnerable and have a care plan relating to this. The manager stated that more staff needed to attend abuse awareness training. A vulnerable adults policy was available. A copy of the ‘No secrets in Swindon and Wiltshire’ booklet was left in the home, detailing local procedure for reporting suspected abuse. The manager reported that no staff were involved in handling service users money or in their financial affairs. Glenside Manor Lime Tree Wing v235140 d51_d01_s48135_glenside_limetreewing_v235140_270705_stage4.doc Version 1.40 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 20, 22, 24 and 26 There are accessible, comfortable communal areas and the home is clean and hygienic. Many of the service users rooms require refurbishment. EVIDENCE: The communal spaces were generally well decorated and the furniture satisfactory. The upstairs lounge was due to be re-carpeted and a small kitchenette installed. Access to external areas is controlled for service users safety. As noted in the previous inspection, some of the furniture and fittings in service users rooms are worn and would benefit from replacement, including curtains and bedspreads. The flooring in some en suite areas has deteriorated. Both these matters were requirements of the previous inspection. Some ceiling tiles in room 25 were stained. Equipment was provided to help service users maintain some independence however some wheelchairs required replacement. Staff felt there was a need Glenside Manor Lime Tree Wing v235140 d51_d01_s48135_glenside_limetreewing_v235140_270705_stage4.doc Version 1.40 Page 14 for more standing hoists. The home was clean and there were no odours. A new washer disinfector had been installed in the sluice room. Glenside Manor Lime Tree Wing v235140 d51_d01_s48135_glenside_limetreewing_v235140_270705_stage4.doc Version 1.40 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The number of staff available is not always sufficient and does not meet the homes minimum staffing notice, which states the minimum level of staff that must be on duty at all times. EVIDENCE: There were 35 service users in the home. Two staff were off sick on the morning of the inspection and review of the duty rota’s indicated that on several occasions the home was not meeting the minimum staffing notice for the morning period. For the afternoon period, between1.00 and 4.30 p.m. the staffing total was routinely seven or eight, but the minimum staffing notice requires a total of nine. This is a breach of the homes Conditions of Registration. During lunch, there were two care assistants upstairs supporting eight service users to eat, all of whom needed some assistance. This resulted in a delay in two frail service users who were in bed receiving their meal, which may have been cold by the time they received it. Comments by some relatives included ‘they need more staff, they are very busy’ and ‘sickness effects the number on duty and it can get very busy, particularly at mealtimes’. Staff spoken to said they enjoyed working in the home, had good opportunities to undertake training and felt valued. There were some concerns regarding staff shortages due to sickness. Glenside Manor Lime Tree Wing v235140 d51_d01_s48135_glenside_limetreewing_v235140_270705_stage4.doc Version 1.40 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 and 33 The manager is competent and fit to run the home and it is run in the best interests of the service users. EVIDENCE: Mr Lee is an experienced manager and registered mental health nurse. He demonstrated during the inspection that he had the knowledge and skills to manage the complex needs of the range service users. Mr Lee has completed an NVQ 4 in management and is supported in his role by a deputy and the senior managers at Glenside. There were positive comments from staff and relatives about Mr Lee Regular monthly visits are undertaken by one of the Glenside senior management team. Records of these visits are of a very high standard and relate to national minimum standards and quality of care. Quality audits are undertaken, using a range of tools. Glenside Manor Lime Tree Wing v235140 d51_d01_s48135_glenside_limetreewing_v235140_270705_stage4.doc Version 1.40 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION x 3 x 2 x 2 x 3 STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x 3 x x x x x Glenside Manor Lime Tree Wing v235140 d51_d01_s48135_glenside_limetreewing_v235140_270705_stage4.doc Version 1.40 Page 18 Yes Are there any outstanding requirements from the last inspection? 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 OP8 Regulation 14(2a) Requirement The registered manager is required to ensure that service users who have been assessed as nutritionallly at risk, are regularly weighed. The registered manager is required to ensure that staff competency regarding the administration of medicines is thoroughly assessed during their induction period. The registered provider is required to ensure that any wheelchairs in poor condition be replaced. The registered person is required to ensure that the number of lifting aids available is sufficient. The registered provider is required to replace any worn bedroom furniture The registered provider is required to ensure that the ceiling tiles in room 25 be replaced. The registered provider is required to ensure that the deteriorating flooring in en-suite bathrooms is replaced. Requirement outstanding in part, from inspection held 4th October Timescale for action 27/07/05 2. OP9 13(2) 27/07/05 3. OP22 23(2n) 01/11/05 4. 5. 6. OP22 OP24 OP24 23(2n) 16(2c) 16(2c) 01/10/05 01/12/05 01/09/05 7. OP24 16(2c) 01/12/05 Glenside Manor Lime Tree Wing v235140 d51_d01_s48135_glenside_limetreewing_v235140_270705_stage4.doc Version 1.40 Page 19 2004. 8. OP24 16(2c) 01/11/05 The registered provider is required to ensure that worn curtains and bedspeads are replaced. Requirement outstanding from inspection held 4th October 2004 The registered manager is 27/07/05 required to ensure that the staffing levels set out in the Notice of Decision dated 30th July 2003 are met at all times. 9. OP27 18(1a) 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. Refer to Standard 8 18 Good Practice Recommendations It is recommended that, in order to evidence care, fluid and nutritional record charts are fully completed. It is recommended that all staff attend abuse awareness training. Glenside Manor Lime Tree Wing v235140 d51_d01_s48135_glenside_limetreewing_v235140_270705_stage4.doc Version 1.40 Page 20 Commission for Social Care Inspection Suite C, Avonbridge House Bath Road Chippenham Wiltshire SN15 2BB National Enquiry Line: 0845 015 0120 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 Glenside Manor Lime Tree Wing v235140 d51_d01_s48135_glenside_limetreewing_v235140_270705_stage4.doc Version 1.40 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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