Inspection on 04/10/05 for Glenside Manor - Lime Tree Wing

This inspection was carried out on 4th October 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 27/07/05

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 Announced Inspection 4th October 2005 09:30 X10015.doc Version 1.40 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 Glenside Manor - Lime Tree Wing DS0000048135.V255255.R01.S.doc Version 5.0 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 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 DS0000048135.V255255.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Glenside Manor - Lime Tree Wing Address South Newton Salisbury Wiltshire SP2 0QD 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) 01722 742066 01722 744443 limetree@glensidemanor.co.uk Glenside Manor Healthcare Services Ltd Mr Robert Andrew Lee Care Home 36 Category(ies) of Dementia (35), Dementia - over 65 years of age registration, with number (35), Mental disorder, excluding learning of places disability or dementia (35), Mental Disorder, excluding learning disability or dementia - over 65 years of age (35) Glenside Manor - Lime Tree Wing DS0000048135.V255255.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users who may be accommodated at any one time is 36 The staffing levels set out in the Notice of Decision dated 12 August 2005 must be met at all times 27th July 2005 Date of last inspection Brief Description of the Service: Lime Tree Wing is a 36 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 residents. Lime Tree Wing is part of a group of homes, all on one campus owned by Glenside Manor Health Care Services Ltd. Mr Andrew Norman is the nominated responsible individual. He is supported by a senior management team The registered manager is Mr Rob Lee, he leads a team of nursing and care staff. 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 homes and a maintenance team 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 DS0000048135.V255255.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place between 9.30 am and 4.00 pm on the 4th October 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. Inspection of staff recruitment and training records took place on the 5th October 2005 and Mary Collier, pharmacy inspector, also visited the home on this date to assess the arrangements regarding medications. What the service does well: What has improved since the last inspection? What they could do better: Residents, care plans need to be reviewed more regularly and there needs to be an improvement in recording how much food and fluids frail residents are receiving. Recruitment procedures need to be more robust as not all of the required documents relating to staff were in place. The refurbishment programme needs to be maintained and include the replacement of flooring in the en suite facilities in residents, bedrooms and the replacement of old bedroom furniture. Glenside Manor - Lime Tree Wing DS0000048135.V255255.R01.S.doc Version 5.0 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 DS0000048135.V255255.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Glenside Manor - Lime Tree Wing DS0000048135.V255255.R01.S.doc Version 5.0 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 the following standard(s): 1,3,4 and 5. Standard 6 does not apply to this home Relatives/advocates have the information and opportunity to make an informed choice about the home and residents are assessed before admission. The home is suitable for the needs of people with dementia and mental health problems. EVIDENCE: A newly admitted service user had a comprehensive pre admission assessment carried out and other information from social and health care professionals was available. Pre admission information was also available in all other care plans seen. The home is able to meet the needs of those with dementia or mental illness, staffing levels are high enough to provide adequate support and supervision and staff have the skills and experience to deliver the service. Support services are available on site and the environment is safe and homely. One relative commented that the home was ‘wonderful’ and stated that ‘I couldn’t have found a better place’. Glenside Manor - Lime Tree Wing DS0000048135.V255255.R01.S.doc Version 5.0 Page 9 The majority of the residents have dementia, therefore relatives or advocates normally visit the home on their behalf prior to admission. A relative spoken to confirmed this. The home has a detailed statement of purpose and service users guide, which have been regularly reviewed. Glenside Manor - Lime Tree Wing DS0000048135.V255255.R01.S.doc Version 5.0 Page 10 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 the following 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. Staff respect residents privacy and dignity. The systems for medication handling are good and the nurses are well informed about the medicines they are using. EVIDENCE: Care plans reviewed were found to be a good reflection of assessed needs and to direct care. Records of wound assessment, treatment and review were available. Not all plans are reviewed monthly and the need for this was discussed with the manager The care of frail residents who required a lot of support appeared good and pressure relief equipment was in use where necessary, however not all fluid charts were complete Those who were assessed as nutritionally at risk were regularly weighed and staff were observed using correct manual handling equipment as defined by the residents risk assessment. The home has an allocated GP who visits weekly and psychiatric support services are available. The GP sees new admissions in the week of their arrival and care plans indicated that staff responded quickly to any deterioration in health. Glenside Manor - Lime Tree Wing DS0000048135.V255255.R01.S.doc Version 5.0 Page 11 Staff interacted well with residents, offered appropriate support when required and treated residents with respect. Personal care was delivered in private. The personal hygiene needs of residents appeared to be met and there was good attention to maintaining their dignity via their personal appearance. The home has a comprehensive medication policy and up to date homely remedies list. All records are appropriately kept and medication stored securely. A disposal system for medication is in place, in line with current legislation. Bulk prescriptions are used for some items; the prescriber’s instructions are printed on the medication administration record. New nurses are trained in medication administration in the home; this may be extended in the future. The nurses work closely with the GP in the management of conditions, particularly constipation and insomnia. Glenside Manor - Lime Tree Wing DS0000048135.V255255.R01.S.doc Version 5.0 Page 12 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 the following 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 works in the home four afternoons a week. Records of activity are kept. Most of the residents are not able to participate in group activities or participate in activities for any period of time. The use of a ‘life profile’ for individual service users may help in providing ideas on what they may enjoy. Some residents attend religious services. Visiting hours are unrestricted and residents can receive visitors in private. There were visitors in the home during the inspection and they had a good rapport with the staff and manager. There was a choice of meal at lunchtime and a choice of sweet. Menus were varied and food offered was nutritious. Most residents eat in the main dining room. The frail residents on the first floor require assistance to eat; all their meals are taken upstairs together on an unheated trolley, which means that they may lose heat before they can be given to the resident. A small kitchenette is being installed upstairs and it was recommended that a hot trolley be provided. Glenside Manor - Lime Tree Wing DS0000048135.V255255.R01.S.doc Version 5.0 Page 13 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 the following 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 since the previous inspection. 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 residents are deemed vulnerable and have a care plan relating to this. Staff attend abuse awareness training and a vulnerable adults policy is available along with a copy of the ‘No secrets in Swindon and Wiltshire’ booklet detailing local procedure for reporting suspected abuse. No staff are involved in handling service users money or in their financial affairs. Recruitment procedures need to be more robust with regard to obtaining CRB checks and references. Findings are detailed in the ‘Staffing’ section of this report and there are three statutory requirements relating to this. Glenside Manor - Lime Tree Wing DS0000048135.V255255.R01.S.doc Version 5.0 Page 14 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 the following standard(s): 22, 23, 24 and 26 Specialist equipment to aid residents is available and in use. Residents bedrooms are being refurbished which should enhance the current facilities. The home is clean and hygienic. EVIDENCE: A refurbishment plan is currently in progress and the ground floor kitchen was being refitted. Bedroom furniture, curtains and bedspreads are being replaced. The flooring in en suite toilets and bathrooms requires replacement and Mr Norman stated that this work was included in the plan. Parts of the ground floor corridors were heavily marked and require repainting. The home was clean and there were no unpleasant no odours. Mobility, lifting and pressure relief equipment is in use and there is a variety of adapted furniture, such as adjustable chairs and beds. New wheelchairs had been provided. The main laundry is housed in a separate two-storey building on site. The laundry staff provide a service to all the units at Glenside; infection control Glenside Manor - Lime Tree Wing DS0000048135.V255255.R01.S.doc Version 5.0 Page 15 measures were in place and all equipment was working. Two staff were on duty the day of the inspection and they confirmed that they were generally able to cope with the workload during the week, however at weekends staff sickness levels had caused some concern. The management team were aware of this issue. The current layout of the laundry over two floors necessitates staff carrying laundry upstairs to be ironed and stored. Mr Norman reported that there were plans to redesign and extend the laundry to incorporate all services on the ground floor and to provide an extra washing machine. Glenside Manor - Lime Tree Wing DS0000048135.V255255.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. The home has an effective well trained staff team and residents’ needs are being met; however care staff levels need to be formalised. In some instances, recruitment procedures do not fully protected service users. EVIDENCE: Staff rotas and the manager indicated that staffing levels had improved since the previous inspection: however for the afternoon period between 1.00 and 4.30 p.m. the staffing total was routinely eight, but the minimum staffing notice requires a total of nine. As noted at the previous inspection, this is a breach of the homes registration; however it is acknowledged that these are the levels the home has been working to for some time. The manager had noticed a need for evening cover to be increased. Mr Norman and Mr Lee agreed that the current staffing levels would be reviewed and that a proposal would be sent to the Commission for agreement. New staff are recruited via the Glenside human resources department and the registered managers do not always have the opportunity to undertake interviews, although they do meet candidates to show them around the individual units. Recruitment procedure appears non discriminatory. A selection of staff recruitment records for all of the Glenside units was reviewed. In the main appropriate documentation was in place, however in one instance a CRB check had not been obtained for a staff member who had been employed for almost two years and in two other cases, references from previous employers, one of whom had been a care provider, had not been Glenside Manor - Lime Tree Wing DS0000048135.V255255.R01.S.doc Version 5.0 Page 17 obtained. Should a person with a criminal record be employed, full details of any convictions should be on file. It is also desirable that written evidence of a risk assessment process, indicating their suitability for employment, be available. Records indicated that staff had received induction, foundation and mandatory training. Further training in relevant subjects such as dementia care and cognitive rehabilitation therapy is also provided. NVQ training is provided and the training manager stated that ‘most units’ had up to 50 of staff with an NVQ. Glenside Manor - Lime Tree Wing DS0000048135.V255255.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 37 and 38. The registered manager is qualified, competent and experienced to run the home, and receives appropriate support to do so. Comprehensive quality monitoring is undertaken and policies and procedures aim to safeguard service users rights and best interests. Health and safety arrangements are satisfactory. EVIDENCE: Mr Lee is an experienced manager, a registered mental health nurse and has completed an NVQ 4 in management. He 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 and the overall management of the home. Regular monthly visits are undertaken by one of the Glenside senior management team. Effective quality monitoring systems are in place, elements of which involve seeking relatives’/supporters views. Action plans are Glenside Manor - Lime Tree Wing DS0000048135.V255255.R01.S.doc Version 5.0 Page 19 developed to address findings. Comprehensive, updated policies and procedures are available for all the Glenside services. Accidents are recorded and audited. Fire safety records were complete and fire safety arrangements were satisfactory. Staff receive mandatory fire safety training. A first aid box was available and staff are trained in first aid. A tour of the home indicated that it was free from health and safety hazards. Arrangements for maintenance of services and equipment were not reviewed during this inspection. Glenside Manor - Lime Tree Wing DS0000048135.V255255.R01.S.doc Version 5.0 Page 20 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 4 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X 3 3 2 x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X X X 3 3 Glenside Manor - Lime Tree Wing DS0000048135.V255255.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 15 (2,b,c) Requirement The registered manager is required to ensure that the service users care plans are reviewed at least once a month, updated to reflect changing needs and current objectives for health and personal care. The registered provider is required to replace any worn bedroom furniture 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 2004. The registered provider is required to review current care staff levels and forward a proposal to the Commission for agreement. The registered person is required to ensure that all staff have undertaken a Criminal Record Bureau check. The registered person is required to ensure that two written references, including, where DS0000048135.V255255.R01.S.doc Timescale for action 04/10/05 2 3 OP24 OP24 16 (2,c) 16 (2,c) 01/01/06 01/12/05 4 OP27 18 (1,a) 01/12/05 5 OP34 19(1,a,b,i )Sch(7a,b ) 19 (4,c)Sch2 (3) 03/10/05 6 OP34 03/10/05 Glenside Manor - Lime Tree Wing Version 5.0 Page 22 7 OP34 19(1,a,b,i )Sch(a,b) applicable, a reference to the person’s last period of employment, be obtained for all new staff. The registered person is required to ensure that details of any criminal offences of which a staff member has been convicted are recorded. 03/10/05 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 4 5 Refer to Standard OP8 OP12 OP15 OP19 OP29 Good Practice Recommendations It is recommended that, in order to evidence care, fluid and nutritional record charts are fully completed. It is recommended that where possible ‘personal profiles’ are compiled for residents with an aim to provide more individualised activity. It is recommended that a hot trolley is provided in the first floor kithchenette. It is recommended that the ground floor corridor be repainted. It is recommended that registered managers be involved in interviewing potential staff members. Glenside Manor - Lime Tree Wing DS0000048135.V255255.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham 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. 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