Inspection on 06/03/06 for Limber

This inspection was carried out on 6th March 2006.

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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Limber 26/11/08

Limber 28/11/07

Limber 31/01/07

Limber 11/08/05

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 IPD Lead Inspector Kay Mehrtens Final Unannounced Inspection 6th March 2006 12:30 Limber DS0000017866.V286777.R01.S.doc Version 5.1 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 Limber DS0000017866.V286777.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Limber DS0000017866.V286777.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Limber Address 49 Church Lane Loughton Essex IG10 IPD 020 8502 4533 020 8508 1203 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) www.together-uk.org Together Working for Wellbeing Mr Martin Grinold 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 DS0000017866.V286777.R01.S.doc Version 5.1 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) Persons of either sex, aged 65 years and over, who require care by reason of a mental disorder, excluding learning disability or dementia (not to exceed 11 persons) 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 The total number of service users accommodated in the home must not exceed 11 persons 11th August 2005 2. 3. 4. Date of last inspection 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 DS0000017866.V286777.R01.S.doc Version 5.1 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 6th March 2006. This was the second statutory inspection of the year and focussed on the remaining key standards not inspected at the last inspection, as well as a review of the requirements and recommendations from the last inspection. The inspection process included: discussions with the home’s manager, care staff and residents. The inspector had the opportunity to sit and have tea with several residents and their comments will be included in this report. Information was also provided by the manager, at the request of the Commission, as part of the inspection process, and will be referred to within this report. The premises were inspected, including the grounds. Samples of records and residents care files were inspected. Additional requirements were made to those not addressed from the last inspection. There are still some outstanding requirements from previous visits with regard to staffing levels during the night and day shifts and premises issues. The manager informed the inspector that these had been considered and action is to be taken. However, the commission is awaiting correspondence from the provider detailing the steps to be taken to address these requirements. Failure to meet these requirements will lead the commission to seek legal advice regarding enforcement action. What the service does well: The residents felt that the staff were caring and they felt well supported by them, especially with their health problems. The residents are also very supportive of each other. The new manager is working hard to develop a consistent approach to the care of residents. He is aware of the need to promote residents’ rights and effect gradual changes on the culture of the home so that the residents are more involved in the running of their home. Limber DS0000017866.V286777.R01.S.doc Version 5.1 Page 6 The established staff team are aware of the residents’ individual care needs and recognise that residents’ wishes can sometimes conflict with their personal well-being and they help them to look at this. What has improved since the last inspection? What they could do better: The requirements from the previous inspections must be address within timescales set in the inspection reports. There were still some areas of practice that encouraged an institutional approach to the care and culture of the home. The manager needs to continue with his actions in developing residents’ rights and input into their home. The standard of menu planning and the nutritional content of meals were noted to be poor. The food budget is limited and so must impact upon the quality and content of the meals provided. Residents felt that the menu was boring and the availability of snacks limited. The standard of the furnishing and décor still needs to improve in order that the residents are provided with a pleasant, homely environment. There were several shortfalls in staff recruitment records and the required checks did not meet the requirements. Limber DS0000017866.V286777.R01.S.doc Version 5.1 Page 7 The inspector requested a review and monitoring of residents’ needs, during the night, with regard to the adequacy of the night staff levels. This has yet to be completed and outcomes and action plans need to be forwarded to the commission for consideration. 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. Limber DS0000017866.V286777.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Limber DS0000017866.V286777.R01.S.doc Version 5.1 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 the following standard(s): 1 Potential service users have access to information to enable them to make an informed decision with regard to the service offered. EVIDENCE: The manager has amended the Statement of Purpose so that it reflects the services provided at the home. A copy has been sent to the commission. The home has not admitted any new residents since the last inspection so Standard 2 was again not inspected. Limber DS0000017866.V286777.R01.S.doc Version 5.1 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 the following standard(s): 7 and 9 Service users need more support and encouragement to maintain control over their own lives. Identified risks are discussed with residents. EVIDENCE: The manager has done a lot of work since the last inspection, with the staff team and residents, to increase service users input into the home and enable them to make more choices. Since the last inspection, jobs in the home are voluntary for residents to do if they chose to and residents told the inspector that they preferred this. This development needs to continue, especially in response to the following comments from residents. The inspector sat with several residents and had tea and cakes. It was a useful and informative discussion time and residents talked about their life in the home. They were concerned that their comments should be made generally to the manager and that no one should be named. The inspector assured them that their confidentiality would be respected. They said that they liked being in the home but sometimes felt that staff did not listen to them or treat them with respect. They would not name staff but did say that the manager is good and does listen to them. They felt that staff Limber DS0000017866.V286777.R01.S.doc Version 5.1 Page 11 duty times and the number of staff limited their choices about going out and going to bed as “there is nothing else to do after medication and snack except bed and TV”. The residents said that they didn’t feel confident telling the staff what they wanted to do. They referred to themselves as “patients” and seemed reticent about challenging staff and the culture of the home. Some said that staff shout at each other, they can hear it and don’t like it but don’t know what to do about it. The residents did tell the inspector that they would like new furniture and carpets but did acknowledge that their smoking caused some of the mess on the carpets. They also told the inspector that they now go to staff and residents meetings but were not sure what was discussed. Care files contained detailed and well written risk assessments. Residents are involved in them though did not always agree with the risks identified. The assessment contained detailed information about possible triggers and linked in to general care plans so cross-reference and information sharing was good. The action plans provided good information to ensure consistency of care and support from staff. Limber DS0000017866.V286777.R01.S.doc Version 5.1 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 the following standard(s): 12 Opportunities for residents to participate in activities in the home and the local community are limited. EVIDENCE: The last inspection highlighted concerns regarding the limited activities available for residents especially at weekends and evenings. Residents told the inspector that this has not changed much. Some are supported to attend work placements and some activities during the day but they said that they would like more trips, outings and things to do in the evenings and weekends. The homes’ Statement of Purpose states that “service uses activities, hobbies and interests are supported through the service user plan”. However, the staffing arrangements at the home are not flexible enough or sufficient to meet this statement. The manager is aware of these comments and concerns and informed the inspector that a review of staffing and activities was being done. The commission has requested the outcome of the staffing review, at previous inspections. Limber DS0000017866.V286777.R01.S.doc Version 5.1 Page 13 Whilst standard 17 regarding nutrition was not fully inspected, residents did share some comments with the inspector about the meals provided in the home. The inspector brought these comments and her own observations to the attention of the manager. The menus, (a copy of which was sent to the commission as apart of the inspection information), was very repetitive and limited. There was little difference in each week’s menu. There was a great dependency on easily prepared meals such as sausages, pies, chops, fish fingers and fishcakes. Other meals that regularly occurred were chicken curry, lamb stew and a roast dinner but not every week. There was little evidence of the use of fresh vegetables. Residents always have a “take away” meal on a Friday night. There was no spontaneity allowed in the planning and little input from residents into the menu. Residents told the inspector that they found the menu boring but did like the Friday night take out. They also said that their favourite foods were not often served up as no one asked them when menus were planned. The inspector provided cakes for the discussion group in the afternoon and the residents commented upon the lack of snacks and cakes at the home. They said that they were not always provided and they really enjoyed the cakes brought in by the inspector. The compliance with this standard has changed since the last inspection. The home no longer employs a cook and staff, with some input from residents, do all the food preparation. These issues were brought to the attention of the manager during the inspection. The inspector enquired about the budget for meals. The information provided by the manager indicates an allowance of approximately £3.36 a day for each resident. It does appear that this allowance needs to be reviewed so that a varied and more nutritious menu can be provided, with input from the residents. This standard will be monitored at the next inspection. Limber DS0000017866.V286777.R01.S.doc Version 5.1 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 and 19 The general and specialist health care needs of residents were well met. EVIDENCE: Information was gathered from the residents during the discussion at the inspection. They said that staff help them with their health care needs. That liked that staff went with them on doctor’s visits, CPN visits and also said that the staff help them with their medication. They were pleased with the support that they get from the manager and staff when ill or anxious. The staff spoken to were very aware of the individual health needs of the residents. Their comments were well informed, professional and caring. The staff were observed to interact with the residents in a pleasant and polite manner. Residents told the inspector that the staff respected their privacy and always knocked on their doors before entering and left them alone if they wanted them to. Information on care plans and in the information sent to the commission showed that the home had worked well with residents and health care professional to achieve a positive and consistent outcome for the residents. The manager recognised the need for continued development of working relationships with visiting doctors and health care specialists. Limber DS0000017866.V286777.R01.S.doc Version 5.1 Page 15 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 the following standard(s): 23 Staff training was not sufficient to ensure the protection of residents. EVIDENCE: The staff had a good understanding about different areas of abuse and how to report it to their manager. However, they were not sure about the local POVA procedures or the need to refer concerns to different agencies. There was no evidence on staff records of any recent Protection of Vulnerable Adults training for staff or evidence of the level of understanding from the agency staff used by the home. Limber DS0000017866.V286777.R01.S.doc Version 5.1 Page 16 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 the following standard(s): EVIDENCE: These standards were not inspected at this inspection. However, the requirements raised at the previous inspections had not been addressed. Limber DS0000017866.V286777.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34 and 35 Staff recruitment practices are not sufficient to ensure residents’ protection. Staff training is limited. EVIDENCE: Examination of one staff file showed that the required information, as part of the recruitment process, had not been sought or copied. This included the following shortfalls. There was no evidence of the persons’ proof of identity; no copy of a birth certificate; no copy of a passport; no evidence of a Protection of Vulnerable Adults (POVA) check; no record of interview with the staff member regarding their Criminal Records Bureau (CRB) checks and gaps in their employment history. This member of staff had started work at the home prior to the return of their CRB check. This in not best practice and there was no evidence of any agreement with the staff member with regard to supervised working and risk assessments until the required checks were returned. The new members of staff had started their induction training. Staff files and training records showed that recent training only covered statutory courses on health and safety, food hygiene and medication. There was no evidence that staff had completed any training relevant to the specific mental health needs of the resident group. There was no evidence of any training on the use and side–effects of the specialist medication taken by residents, only medicine administration. Limber DS0000017866.V286777.R01.S.doc Version 5.1 Page 18 The information sent to the commission, as part of the inspection process, showed that the home currently has only 5 permanent staff members. This has led to a dependency on agency staff and the use of other staff as “relief carers”. This has also meant that there are few staff on duty with National Vocational Qualification qualifications and only 2 of the permanent staff have achieved NVQ level 2 or 3. The high level of agency staff does not provide a consistent staff team for the home or one that is sufficiently qualified or skilled in working with people with mental health issues. There was no evidence of checks regarding the competency of the agency staff with regard to understanding the Protection of Vulnerable Adults and mental health issues. The manager did inform the inspector that he was hoping to recruit to the remaining care staff and activity/social care hours, within the next month. This inspection and previous inspections have raised concerns regarding the staffing levels and the impact on residents’ activities and access to the local community. This will be monitored at the next inspection. Limber DS0000017866.V286777.R01.S.doc Version 5.1 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 Some quality assurance strategies are in place. EVIDENCE: The provider had started a quality assurance audit but it was not complete. The manager informed the inspector that an annual survey, which included resident’s input, had been done. The manager said that they had lots of responses from residents and staff they had produced the results in a service user-friendly format. He was also developing the role of a resident’s representative in the quality assurance process. The inspector recommended an action plan to accompany the survey results and discussions regarding issues raised, as part of the process. For example, comments from residents about going to bed when staff do and not having copies of their care plans. What was being done to address these issues? The inspector requested copies of the review/survey outcomes. This standard will be monitored at the next inspection. Limber DS0000017866.V286777.R01.S.doc Version 5.1 Page 20 Limber DS0000017866.V286777.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 X 3 X 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 2 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 X 14 X 15 X 16 X 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 X X X X 2 X X X 2 Limber DS0000017866.V286777.R01.S.doc Version 5.1 Page 22 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 YA14YA13 Regulation 12 Requirement 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. This standard was not fully inspected and will be moniotred at the next inspection. The registered person must ensure that residents are provided with wholesome and nutritious food which is varied and properly prepared. The registered person must ensure that staff receive training with regard to the Protection of Vulnerable Adults. The registered person must 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 DS0000017866.V286777.R01.S.doc Timescale for action 03/05/06 2 YA17 16 03/05/06 3 YA23 13 03/05/06 4 YA24 24 03/05/06 Limber Version 5.1 Page 23 05.05.05 were not met. 5 YA18 33 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 the required checks and information are held on staff files, as part of the recruitment process, as detailed in the report. The registered person must provide the Commission with a business and financial plan for the home. This is a repeat requirement. 03/05/06 6 YA34 19, schedule 2 03/05/06 7 YA43 25 (2) 03/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA7 YA20 YA39 Good Practice Recommendations The manager should work with the residents to develop opportunities for them to feel more confident about voicing and making decisions about their lives and their home. The manager should ensure that staff receive training with regard to the use and side-effects of medication, particularly with regard to mental health. The registered provider should ensure that the quality assurance reviews and action plans are completed. This will be monitored at the next inspection. Limber DS0000017866.V286777.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 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 DS0000017866.V286777.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!