Inspection on 11/08/05 for Limber

This inspection was carried out on 11th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Limber 26/11/08

Limber 28/11/07

Limber 31/01/07

Limber 06/03/06

Limber 21/01/05

Limber 23/06/04

Limber 29/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Limber 49 Church Lane Loughton Essex IG10 1PD Lead Inspector Kay Mehrtens Announced 11 August 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Limber I56-I05 S17866 Limber AI V227711 110805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Limber Address 49 Church Lane, Loughton, Essex IG10 1PD 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) 0208 5024533 0208 5081203 Mental After Care Association Care Home 11 Category(ies) of Dementia (1), Mental disorder, excluding registration, with number learning disability or dementia (11), Mental of places Disorder, excluding learning disability or dementia - over 65 years of age (11) Limber I56-I05 S17866 Limber AI V227711 110805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Persons of either sex, under the age of 65 years, who require care by reason of a mental disorder, excluding learning disability or dementia (not to exceed 11 persons) 2. Persons of either sex, aged 65 years and over, who require care by reason of a mental disorder excluding learing disability or dementia (not to exceed 11 persons) 3. One person, under the age of 65 years, who requires care by reason of dementia, whose name was provided to the Commission in February 2004 4. The total number of service users accommodated in the home must not exceed 11 persons. Date of last inspection 21 January 2005 Brief Description of the Service: Limber is a large detached family style house, situated in a residential area of Loughton, close to local shops and transport facilities. The home is registered to provide residential care and support for 11 adults and older people with mental health needs. Limber has a large lounge, a separate dining room, and a small quiet room. Service users are accommodated in nine single bedrooms and one double bedroom. The front and back gardens are maintained and accessible, with a large patio area. Limber is run by the Mental After Care Association (MACA), and the home provides 24 hour care and support for people experiencing mental health difficulties. Although staff do provide support or assistance with personal care where required, the home does not aim to meet the needs of those with a physical disability or illness, and is therefore not equipped to meet such needs (i.e. the home does not have a passenger lift, or other aids or equipment). Limber I56-I05 S17866 Limber AI V227711 110805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on the 11th August 2005, lasting 8.5 hours. The inspection process included discussions with the manager, care staff and residents. There were 11 residents accommodated at the time of the inspection. Samples of records and residents’ care plans were inspected. The inspector was invited to have lunch and tea with the residents and staff and would like to thank them for their time and hospitality. The inspection covered seventeen standards. The newly appointed manager and care staff approached the inspection in a positive and cooperative manner that was focused on achieving best practice to meet the needs of the residents. The Commission received information prior to the inspection that came with headed paper of a different name to the registered provider. The inspector raised this with the manager and was informed that the provider had “rebranded” from MACA to “Together”. The inspector advised the manager to inform the provider, as no representative was present at the inspection, of the need for them to contact the commission to provide an explanation and information regarding the change. There are still some outstanding requirements from previous visits with regard to staffing levels during the night and day shifts, premises and the requirement for a Statement of Purpose that reflects the services and changes in the home. The registered person, upon receipt of this report, must address these requirements and they will be monitored. Failure to meet these requirements will lead the commission to seek legal advice regarding enforcement action. What the service does well: The staff have a good awareness and understanding of the physical health care need of the residents. They were good at supporting the residents with their health care appointments and were frustrated with the often poor support given to the residents by the mental health professionals. They were aware of the need for them to act as better advocates for the residents to ensure that their mental health needs and rights were met. Limber I56-I05 S17866 Limber AI V227711 110805 Stage 4.doc Version 1.40 Page 6 The staff were observed to have a good relationship with the residents. They interacted with them in a pleasant and caring manner. The resident’s spoke very highly of the care staff. Mealtimes provided a pleasant and positive time for residents and staff to come together and enjoy a well-presented and nutritious meal. What has improved since the last inspection? What they could do better: The requirements from the previous inspections must be addressed within timescale. The provider must inform the commission of the recent change to the name and/or status of the organisation. There were areas of practice that encouraged an institutional approach to the care and culture of the home. The manager and staff need to develop residents’ rights and participation of their life in their home. The standard of the furnishing and décor needs to improve in order that the residents are provided with a pleasant, homely environment. The manager needs to work with his staff team to challenge and improve the contact and input from some health care professionals to ensure that the rights and needs of residents are respected, especially with regard to them acknowledging and recognising that they visit the residents’ home not an institution. Please contact the provider for advice of actions taken in response to this Limber I56-I05 S17866 Limber AI V227711 110805 Stage 4.doc Version 1.40 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Limber I56-I05 S17866 Limber AI V227711 110805 Stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Limber I56-I05 S17866 Limber AI V227711 110805 Stage 4.doc Version 1.40 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 The Statement of Purpose did not reflect the current service provision. EVIDENCE: The inspector was informed that the Statement of Purpose was under review by the provider as part of a national project. However, the current document does not reflect the service offered at the home and any national document must reflect local delivery. The inspector did highlight some of the shortfalls with the new manager. These include staff information, premises, complaints and fees arrangements. Previous inspections have highlighted the shortfall with regard to the requirement for a Statement of Purpose and it is of concern to the Commission that this has not yet been addressed. Residents are now provided with a copy of the most recent inspection report. It is displayed on the residents’ notice board. The home has not admitted any new residents since the last inspection so Standard 2 was not inspected. Limber I56-I05 S17866 Limber AI V227711 110805 Stage 4.doc Version 1.40 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 and 8 Care plans did not provide enough information to assist staff in meeting the needs of residents. Residents have little opportunity to be involved in consultation about all aspects of their life in the home. EVIDENCE: The newly appointed manager informed the inspector that care plans required updating and amending. The inspector supported his findings, from the sampling of one care plan. The care file sampled lacked evidence of any current CPA reviews. The manager and staff informed the inspector of their frustrations and difficulties in engaging with some health care specialists in organising CPA reviews. They recognised their need to support the residents and act as advocates, on their behalf, to ensure that their rights and care needs are met. The care plan sampled also identified several needs with regard to their physical and mental health. However, the actions set out to meet these needs were not detailed enough to ensure that they were addressed correctly. They lacked sufficient detail to ensure consistency of care by staff and understanding by residents as to their aim or purpose. Evidence from the residents’ assessment, information from staff and comment from the resident concerned indicated that some of their needs were not even identified on their Limber I56-I05 S17866 Limber AI V227711 110805 Stage 4.doc Version 1.40 Page 11 plans. This included aspects of their mental health such as anxiety. Other sections of this care plan did identify mental health needs but provided little relevant intervention or strategies to enable the resident and staff to work together to address the need. The care plans would benefit from more input from the resident so that coping strategies and actions can be identified and worked on with, rather than for, the resident concerned. Care plans were not being regularly reviewed. Whilst there was evidence of residents’ signatures, the plans were not person centred and gave little indication that the resident fully participated or understood the actions identified to meet their needs. The timescales identified for review or for meeting the identified need were so general, “on-going” and gave no clear indication of any assessment of their benefit for the resident as part of the review process. The home uses a key worker system and key worker sessions are identified on individual care plans. However, key worker sessions were done on an ad-hoc basis, with no clear record of how they are to be used. Residents meetings are regularly held and they are used to discuss issues about the home such as jobs, outings and menus. However, there was little evidence of any input by the residents in other aspects of their life in the home such as reviews of polices and procedures, (including the review of the Statement of Purpose), joining staff meetings and interviewing new staff members. The new manager was aware of the need to develop residents’ input and consultation in all aspects of life in their home. The staff have access to the National Minimum Standards but their comments and practice indicated a lack of understanding of the standard with regard to residents’ participation and the need to work “with the residents” rather than their current practice of “doing things for them”. Limber I56-I05 S17866 Limber AI V227711 110805 Stage 4.doc Version 1.40 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13, 14, 15, 16 and 17 Opportunities for residents to participate in activities in the home and the local community are limited due to poor staffing levels. Residents are supported in maintaining contact with family and friends who are made welcome when visiting. Residents enjoy a social and pleasant time during mealtimes. EVIDENCE: The home is within easy reach of the local town centre. The residents are supported by staff in attending a local mental health support group and other training/social centres during the week. However, the staffing levels are not sufficient to support residents that would like to attend the social club, “Spanners”, at weekends and evenings. The opportunity for residents to go to the cinema, pub or other social venues is also limited by the low level of staffing. The staff rota indicated that only two staff are on duty in the evenings and at weekends. Several of the residents need support when going out, this was evidenced from their comments, care plans and from comments by the Limber I56-I05 S17866 Limber AI V227711 110805 Stage 4.doc Version 1.40 Page 13 manager and staff. The staffing levels do not allow these residents access to a variety of activities or the right to consider any spontaneous, unplanned event. Several activities, such as trips to collect “rent money” and “take out meals”, are routinely set events and so add to the institutional culture that exists in the home. All activities generally take place during the day when there are three staff on duty. Some residents told the inspector that they were trying to plan a holiday or day trip with the staff and were trying to plan transport. This had been discussed at a meeting and it was hoped that most residents would go. The cultural and religious needs of the residents are well respected and supported by the staff team. Residents told the inspector that they felt well supported by the staff in meeting their cultural and religious needs. There was good evidence of staff support and awareness of the cultural diversity and needs of the residents on their care. There are rules regarding smoking, alcohol and drugs that the residents were aware of. They knew what areas of the home were designated smoking rooms. The staff are protective in their approach with the residents. Whilst this demonstrated a caring attitude it did not allow the residents the opportunity to have a more adult input into their home and their lives. One example of this was the established practice of residents doing domestic tasks in the home. This was not left for residents to offer their help as they were assigned a task on a weekly rota. The inspector received several comments from residents about the “jobs rota”. They felt that it was not optional and they did not feel easy challenging the rota and the expectation that they would do the jobs listed. The inspector was concerned that residents were expected to clean toilets and empty dustbins regardless of choice, age or physical ability. This was brought to the attention of the new manager and discussed with the staff, some of which found difficulty in understanding the institutional approach of such a rota and expectation on residents. The staff are skilled and competent workers that should be using their skills to work with the residents in a way that reflects residents’ choice, independence and recognises Limber as their home, not an institution. Residents told the inspector that they could have visitors at any time and that visitors were made welcome. One resident was very pleased with a recent family gathering and party that took place at the home. They clearly enjoyed the day and felt well supported by the staff. The home does have a small, quiet space for residents to use when visitors call. They were also clear that their privacy was respected if they used their bedrooms or other space in the house. They are provided with keys to their rooms and the front door and felt that all aspects of their privacy were respected. The inspector did again raise the need for staff to be aware of the Limber I56-I05 S17866 Limber AI V227711 110805 Stage 4.doc Version 1.40 Page 14 whereabouts of residents, for health and safety reasons. The manager acknowledged the need to develop a system that provided information, without impeding on residents rights, and suggested discussions with the residents at their next meeting. The residents were very complimentary regarding the meals at the home. Individual choice and cultural needs are respected and catered for. The staff now do the cooking with some input from residents. Some residents prefer to cater for themselves and are provided with support and facilities, as appropriate. The inspector was invited to stay for both lunch and the evening meal. The mealtimes were chatty, social events with staff sitting with the residents, after they had served the meal. More residents stayed for the evening meal and everyone clearly enjoyed the food on offer. The residents are involved in the menu planning and individual preferences are often included on the menu. The inspector was impressed by the relaxed, though busy, atmosphere during the serving of the meal. The staff were patient and responded to residents requests in a respectful manner. The residents received their meal through a hatch from the kitchen area. The inspector did comment of the café delivery, with the manager and staff, as it did detract from the pleasant homely feel of the dining room. The inspector and manager noted that there were not sufficient glasses for all the residents to use and the crockery and cutlery were of varying shapes and colours. After the meal everyone helped clear and tidy away and then relax in the lounge. It was a pleasant occasion and provided a positive time for residents and staff. Limber I56-I05 S17866 Limber AI V227711 110805 Stage 4.doc Version 1.40 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 20 and 21 Medication systems have improved since the last inspection. Positive and sensitive steps have been taken to seek the wishes of residents with regard to ageing and death. EVIDENCE: There were good systems in place to ensure that the medication was correctly administered. The staff have received additional training and support with regard to the administration of medication. The staff have not received recent training with regard to the use and side-effects of medication, particularly with regard to mental health. The manager was aware of the need to monitor and ensure the competencies of staff with regard to medication administration following a recent incident of wrong administration of medication. The commission was not informed of this incident and the manager was advised of the requirement to do so under Regulation 37 of the Care Standards Act. The staff and manager discussed the issues raised, at the last inspection, with regard to the institutional approach to the giving out of residents’ medication. They found it difficult to change the culture and expectations of the residents that regularly queued for their medication. They told the inspector that they Limber I56-I05 S17866 Limber AI V227711 110805 Stage 4.doc Version 1.40 Page 16 had tried to change the routine but the residents were again observed turning up in line, with a cup of water in hand, to get their tablets. The inspector acknowledged that change takes time but that the impetus needed to come from the staff as well as the residents. The staff clearly found this change hard and their comments did not indicate an understanding that their practice could be institutional, not one that would take place in someone’s home. The manager and staff team have taken positive and sensitive steps to discuss the issues with regard to ageing and death with the residents. It was raised at a residents meeting and the outcome was for each resident to discuss these issues with their key worker at a pace suitable to their own needs and wishes. The outcome of this decision will be monitored at the next inspection. Limber I56-I05 S17866 Limber AI V227711 110805 Stage 4.doc Version 1.40 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 Recording and outcomes of complaints was not consistent. EVIDENCE: The home has a complaints procedure but there was no reference to the Commission on one of the procedures available for residents. The complaints records were seen. The standard of recording was not consistent. There was poor recording and lack of information regarding one complaint and the outcome was not recorded. Another recent complaint had been well recorded and followed up with clear outcomes that were acceptable to the person making the complaint. Limber I56-I05 S17866 Limber AI V227711 110805 Stage 4.doc Version 1.40 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 and 30 The standard of furniture and fittings in the home is poor and provides residents with areas that are unpleasant and not homely. The standard of cleanliness had improved. EVIDENCE: At the last inspection, the poor condition of the carpets in the smoking room and some of the furniture were brought to the attention of the manager and provider. It was disappointing to see that the furniture and carpets remained in a poor state and the requirement set following the inspection had not been addressed. The communal areas of the home and the entrance are in need of redecoration and upgrading and the furniture needs to be replaced. The décor is “tired” and not homely. The home does employ a domestic and the standard of cleanliness had improved since the last inspection. However, there were still areas of the home that would look better if they were thoroughly cleaned. This included walls, cupboards and skirting boards in the dining and communal areas of the home. Residents are supported to maintain their own bedrooms. They are also encouraged to assist with household tasks though, as previously mentioned in Limber I56-I05 S17866 Limber AI V227711 110805 Stage 4.doc Version 1.40 Page 19 this report, the inspector was concerned that some residents were doing tasks more suited to a domestic worker such as cleaning toilets and bins. The home only provides 5 hours domestic input a day. The manager was advised to review the domestic input in view of the need for more thorough cleaning and less reliance on residents’ input into the cleaning regime. The laundry are had been re-organised and tidied. Hazardous materials were now stored in secure cupboards and staff were aware of the need to monitor the area. Limber I56-I05 S17866 Limber AI V227711 110805 Stage 4.doc Version 1.40 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 and 34 Staffing levels are not sufficient to meet the needs of the residents. Staff recruitment practices are not sufficient to ensure residents’ protection. EVIDENCE: Standard 35 was not inspected at this inspection as the manager had only been in post for 3 weeks. It will be monitored at the next inspection. A copy of the staff rota was taken at the inspection. It showed that only two staff were on duty after 5.30pm during the week and only two for the whole day at the weekends. The inspector was told that additional staff are brought in to help with some planned event or appointments. The home is only staffed with one sleep-in member of staff at night with access to an on-call person. There was no evidence of the role or ease of access of the on-call person. The issue with regard to night staffing levels has been raised at previous inspections. The inspector requested a review and monitoring of the needs of residents at night and suggested that the manager seek advice from health and safety agencies with regard to the adequacy of the night staff levels. This has yet to be achieved by the provider and the inspector was concerned that this action had not been undertaken or considered by the previous manager and provider. Limber I56-I05 S17866 Limber AI V227711 110805 Stage 4.doc Version 1.40 Page 21 The low staffing levels, for the day shifts, have also been raised at previous inspections. The inspector was informed, at the last inspection, that additional staff time would be provided from the hours once allocated for a cook. However, the staff now undertake cooking tasks and the increase in staffing hours has not occurred. The staffing levels are not sufficient to meet the needs of the resident group. The effect is a reduced opportunity for the residents to be part of the local community and to develop their independence and life skills. As previously mentioned in other sections of this report, some care practices were very institutional in their approach and outcomes. These were discussed with the manager and the care staff. The manager recognised the need to change some of the practices and to increase staff training and development, particularly with regard to the National Minimum Standards, so that staff have a better understanding and awareness of care standards that should be in place to encourage and develop the independence and skills of the resident group, especially when highlighted as an identified need and goal in some of their care plans. The inspector had the opportunity to speak to several members of staff during the inspection. Some acknowledged the need to change the culture of the home and enable the residents to build on their personal skills and independence. Other staff did have difficulty in recognising some practices as institutional in approach and not enabling for residents. The staff did demonstrate a caring and positive approach with the residents. Their sense of frustration with some professional health workers was a good indicator of their focus on the residents. Their comments highlighted an institutional approach to the residents by these health care professionals, such as a failure to keep appointments and insisting on administering injections in the home rather then the surgery. They need to work, with the manager, to challenge these failures and attitudes and make changes for the residents. The staff records for a newly employed member of staff were sampled. The required information and checks were seen and were satisfactory. However, the manager does not have the same detailed information with regard to CRB checks, experience and qualifications for agency staff. There was no information available for one agency staff working in the home. Limber I56-I05 S17866 Limber AI V227711 110805 Stage 4.doc Version 1.40 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 and 43 Practices and procedures ensure that the health and safety of residents are protected. There was insufficient information with regard to the financial management of the home. EVIDENCE: The new manager had only been in post for five weeks and was busy getting to know the home, residents and routines. An application for registration has been received by the commission and will be processed. The manager was positive about the inspection, seeing it as a useful tool to gather information about the home, standards and expectation of the residents and staff team. He was very aware of the need to develop residents’ rights and participation in their home. He was positive in his comments regarding the need to develop staff training, recognising that the current level of NVQ qualified staff was not adequate. Limber I56-I05 S17866 Limber AI V227711 110805 Stage 4.doc Version 1.40 Page 23 The management aspect and staff training will be monitored at the next inspection. The laundry area had greatly improved since the last inspection. It was clean and well organised with all hazardous products kept in secure cupboards. The staff have received recent training with regard to food hygiene and first aid. There was evidence of regular health and safety checks with regard to the hot water system. The manager was aware of the need to ensure the health and safety of service users and had begun the re-organisation of the health and safety files and checks. The inspector reminded the manager of the need to review and monitor the risk assessment of night staffing levels and to inform the commission of the outcome. Following the last inspection, the Commission had recently received copies of the required monthly reports, under Regulation 26, from the provider. However, following information received from the manager regarding the change of name and circumstances of the Registered Provider, the inspector requested information regarding the changes and the financial situation with regard to the home. Limber I56-I05 S17866 Limber AI V227711 110805 Stage 4.doc Version 1.40 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 1 x x x x Standard No 22 23 ENVIRONMENT Score 2 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x 2 x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 1 x x x x x 2 Standard No 11 12 13 14 15 16 17 x x 1 1 3 2 3 Standard No 31 32 33 34 35 36 Score x x 1 2 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Limber Score x x 2 3 Standard No 37 38 39 40 41 42 43 Score x x x x x 3 2 I56-I05 S17866 Limber AI V227711 110805 Stage 4.doc Version 1.40 Page 25 no 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 1 Regulation 4 Requirement The registered person must produce a Statement of Purpose that meets the requirements of the Regulation. This is a repeat requirement for the 3rd time. The timescales of 20.09.04 and 05.05.05 were not met. The Registered person must ensure that there is sufficient staff available to support and enable service users to participate in local community and social activities and outings. This is a repeat requirement for the 3rd time. The timescales of 20.09.04 and 05.05.05 were not met. The registered person must ensure that there is a complaints procedure that meets the required standard and is available to the service users. Complaints must be recorded in sufficient detail and include outcomes. This is repeat requirement. The timescale of 05.05.05 was not met. The registered person must I56-I05 S17866 Limber AI V227711 110805 Stage 4.doc Timescale for action 06.10.05 2. 13/14 12 06.10.05 3. 22 22 06.10.05 4. Limber 24 13 06.10.05 Version 1.40 Page 26 5. 33 18 6. 34 19, schedule 2 7. 43 25 (2) 8. 16 12 9. 20 37 10. 6 15 11. 8 12 (1)(2) ensure that home is kept in a good state of repair. This refers specifically to the carpets and furniture. This is a repeat requirement for the 3rd time. The timescales of 20.09.04 and 05.05.05 were not met. The Registered person must ensure that there are 2 staff available for service users at night in accordance with need and advice from health and safety officers. This is a repeat requirement for the 3rd time. The timescales of 20.09.04 and 05.05.05 were not met. The registered person must ensure that staff’s CRB checks and recruitment information are made available for inspection as stated in the regulation and schedule. This refers specifically to agency staff. The registered person must provide the Commission with a business and financial plan for the home. The registered person must ensure that care practices promote independence, individual choice and freedom of movement. The registered person must inform the commission of any incident that effects the wellbeing of residents, stated under Regulation 37 of the Care Standards Act 2000. The registered person must ensure that care plans contain details as to how the health and care needs will be met and agreed with the service user and are regularly reviewed The registered person must ensure that the residents are offered choice and the opportunity to partake in all 06.10.05 06.10.05 06.10.05 06.10.05 06.10.05 30.10.05 30.10.05 Limber I56-I05 S17866 Limber AI V227711 110805 Stage 4.doc Version 1.40 Page 27 aspects of daily life in the home 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. Refer to Standard 14 20 20 42 Good Practice Recommendations The manager should ensure that the option of funds for a holiday is provided within the contract for service users on long-term placements. The manager should ensure that practices, with regard to the administration of medication, do not infringe service users dignity. This is a repeat recommendation. The manager should ensure that staff receive training regard to the use and side-effects of medication, particulalry with regard to mental health. The manager should have procedures in place that ensure the whereabouts of people in the building are known, particularly with regard to fire safety. Limber I56-I05 S17866 Limber AI V227711 110805 Stage 4.doc Version 1.40 Page 28 Commission for Social Care Inspection Fairfax House Causton Road Colchester Essex C01 1RJ 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 Limber I56-I05 S17866 Limber AI V227711 110805 Stage 4.doc Version 1.40 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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