Inspection on 26/10/05 for Lime House

This inspection was carried out on 26th 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 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

Lime House 05/07/06

Lime House 24/02/06

Lime House 06/10/04

Lime House 07/04/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Lime House Newton Road Lowton Nr Warrington Cheshire WA3 1HF Lead Inspector Julie Conrad Unannounced Inspection 26th October 2005 10:00 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 Lime House DS0000005746.V260266.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. Lime House DS0000005746.V260266.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Lime House Address Newton Road Lowton Nr Warrington Cheshire WA3 1HF 01942 674135 01942 674135 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) Nugent Care Mrs Ann Hillidge Care Home 32 Category(ies) of Dementia - over 65 years of age (8), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (1), Old age, not falling within any other category (32) Lime House DS0000005746.V260266.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 32 service users to include:Up to 32 service users in the category of OP (Older People over 65 years of age) Up to 8 service users in the category of DE(E) (Dementia over 65 years of age) Up to one service user in the category of MD(E) (Mental Disorder over 65 years of age) The service should employ a suitably qualified and experienced Manager who is registered with the CSCI. The Registered Person must ensure that all staff working in the home have dementia awareness and dementia care training, which equips them to meet the assessed needs of the service users accomoodated, as defined in the individual plan of care. The service should at all times employ suitably qualified and experienced members of staff, in sufficent numbers, to meet the assessed needs of the service users with dementia. 6th October 2004 2. 3. 4. Date of last inspection Brief Description of the Service: Lime House provides residential care for up to thirty-two residents who are elderly, of either sex. This includes up to eight residents over sixty-five with dementia and one resident over sixty-five with a mental disorder. The home is part of Nugent Care, whose head office is based in Liverpool. Lime House premises are leased from Wigan Council. Lime House is set within its own landscaped grounds in a residential area. The home has a main house and a lodge, which are connected by a link area. The majority of residents live in the main house, which has two lounge areas and a dining room with a sitting area. The lodge has a combined lounge and dining room. The home is in Lowton. There is a reasonable level of public transport, shops and local facilities in the area. Lime House DS0000005746.V260266.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 26th October 2005, from 9.20am until 12.20pm. The registered manager was present throughout the inspection. Records were checked and a tour of the premises took place. The inspector spoke with a small number of residents, as the residents in one lounge were asleep and some residents who were either reading or sitting quietly did not wish to converse. The residents spoken to, a visitor and staff, all said good things about the home. What the service does well: What has improved since the last inspection? Since the last inspection part of the home has been re-decorated and recarpeted. New furniture for the lounge has been purchased and new windows in the lodge have been fitted. Staff have received information on stoma care. Lime House DS0000005746.V260266.R01.S.doc Version 5.0 Page 6 Staff training continues to take place, this includes mandatory training and specialist courses. All staff have received training in dementia care and the manager and three supervisors are trained in dementia care mapping. What they could do better: 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. Lime House DS0000005746.V260266.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 Lime House DS0000005746.V260266.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 The home’s statement of purpose and service user guide, provide prospective residents and their representatives with details of the service, which enables them to make an informed decision about admission to the home. EVIDENCE: The inspector read the homes statement of purpose and service user guide, entitled, ‘Welcome to Lime House’. The guide includes information on finances, key-worker system, meals, your property and your room, reviews, medication, visitors and laundry. It also includes a photograph and names and job title of all staff and staff qualifications. The guide is well presented and written in a user friendly, easy to read way. The guide also includes information on local places of interests, theatre, churches, public houses and transport. The service user guide has information on contacting Commission for Social Care Inspection, however, it needs to update the name of the new Business Relationship Manager. The guide also needs to include the homes complaints Lime House DS0000005746.V260266.R01.S.doc Version 5.0 Page 9 procedure, this information is in the statement of purpose, but also needs to be in the guide. Two residents files were seen which included their initial assessment by the home and by the Social Services Department. All prospective residents receive a full assessment of need prior to admission, to ensure the home can meet the individuals needs. The assessments seen were satisfactory, initial assessments are followed by an ‘on admission assessment’ which is completed within twenty-four hours, and a ‘getting to know you’ sheet, care plans and risk assessments are completed with participation of the resident and their representative, which they are asked to sign. Lime House DS0000005746.V260266.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, 10 The care planning system and risk assessments in place ensure individual health, personal, and social and emotional needs are met, enabling residents to live a full a life as possible. EVIDENCE: Four care plans, risk assessments and manual handling assessments were seen, which included one resident with a mental disorder, two residents with dementia and one older person. The care plan identifies the need, the resident’s preference on how the need should be met, when and who by. The care plan includes waking, personal care, activities, family and friends, socialising, health care needs, behaviour and choices and bedtime preferences. The care plan records demonstrate they are reviewed monthly. The risk assessments identify risks and how these should be managed. One resident is prone to behavioural changes, another depression, other risks include mobility, risk assessments inform staff how to manage these risks. Risk assessment records demonstrate they are reviewed monthly. Lime House DS0000005746.V260266.R01.S.doc Version 5.0 Page 11 The statement of purpose informs staff and residents of the individuals right to privacy and dignity. Resident’s right to privacy and respect is part of the homes philosophy. Staff were observed treating residents with respect and courtesy. Residents may spend time in the privacy of their own room or in the communal areas as they choose. Staff will always knock on bedroom doors before entering. Residents were observed as doing their ‘own thing’, a number of residents were sleeping. A resident who was reading and a number of residents who were sitting quietly, made it clear to the inspector, that they did not wish to converse. One resident said ‘staff are very good’. Lime House DS0000005746.V260266.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, 14, 15 The activities, outings and entertainment at the home are excellent and are planned around residents preferences, ensuring all residents have the opportunity of participating in something they enjoy. The meals at the home are good, offering choice and variety and catering for special dietary needs. EVIDENCE: The homes activities co-ordinator provides twenty hours a week input at the home. There is a weekly activities programme, which is displayed on the notice board. Recent weekly activities are as follows; Monday, musical quiz, Tuesday, cheese and wine tasting, Wednesday, mystery tour. The mystery tour takes place regularly, residents are taken out in a mini bus to a secret destination, one resident told the inspector about the mystery tours and how much she enjoyed them, even when it was raining. Some residents go to the Tuesday club held at St. Catherine’s, Thursday, pub lunch and sing-a-long, Friday, reading circle and cream tea. Other activities that are well attended by the residents are bingo, reminiscence, film, hot pot supper, gentle exercise, movement to music, baking and clothes parties. Lime House DS0000005746.V260266.R01.S.doc Version 5.0 Page 13 A resident said, ‘activities are good, I get involved in them all’. Residents recently went on a trip to Martin Mere. A resident told the inspector that last week they went to Blackpool illuminations and enjoyed a fish and chip supper on the way home, she said, ‘the fish and chips were brought to us on the bus, they were the best I have ever had and I didn’t have to get off the bus, which I prefer because I am unsteady’. In May this year, some of the residents and staff had a three-day break in Keswick. There are eight residents at the home with dementia, these residents are able to participate in most of the activities that the majority of the residents involve themselves in, however, sensory activities are included such as, baking, nail care and hand care. Some evening activities take place to prevent the residents with dementia from becoming restless. Visitors are always made to feel welcome, a visitor at the home on the day of the inspection stated ‘I have visited Lime House for fifteen years, I have always found staff to be friendly, I would recommend Lime House to anyone looking for a home’. Visitors can make themselves a drink in the kitchen in the lodge area of the home, or join residents for tea and coffee when it is being served. Links with family, friends and the local community are promoted. Some residents go to St. Catherine’s or St. Mary’s. Mass is held at the home once a month and the Church of England representative visits once a month also. The Eucharist minister visits the home every Sunday. There are no residents of other faiths residing at the home at present. The menus were seen, these offer choice and a balanced diet. Breakfast consists of an assortment of cereals, fruit juice, a cooked breakfast to order, toast, tea and coffee. Lunch is the main meal of the day, an example of this weeks menu is; Monday, potato and sausage bake with peas, or a tuna salad, followed by fruit flan. Tuesday, Chicken and vegetable pie, creamed potatoes and broccoli or cottage pie and broccoli, followed by summer pudding and vanilla ice cream. Wednesday, Beef and red pepper casserole, boiled potatoes and cabbage, or turkey salad, followed by lemon sponge and custard. A lighter meal is served at tea-time and an alternative of soup, sandwiches or salad is always available. Between lunch and tea, cheese and crackers, yoghurt or biscuits are available. At supper time there is a choice of toasted tea cakes, toast, crumpets or biscuits. A choice of drinks includes tea, coffee, hot chocolate, horlicks or hot milk. Lime House DS0000005746.V260266.R01.S.doc Version 5.0 Page 14 All the residents spoken with said the food was ‘very good’. A visitor also said ‘the food always looks good’. Lime House DS0000005746.V260266.R01.S.doc Version 5.0 Page 15 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, 18 The home has a policy and procedure on complaints and the protection of vulnerable adults, which ensures residents rights and well-being is protected. EVIDENCE: The homes complaints log was seen, which demonstrated there has been no complaints since April 2004. The complaints log is checked and signed every month by a member of the senior staff group, who is responsible for complaints. The complaints procedure is displayed in the main reception area and the hallway, it is also explained in the homes statement of purpose. The inspector has made a requirement in this report, that the complaints procedure also be included in the service user guide. A resident told the inspector, ‘I have no complaints’. The manager informed the inspector that all staff have received training in the protection of vulnerable adults, this is carried out at induction, during NVQ level 2 and training carried out by Nugent Care. The home has the Nugent Care policy and procedure and Wigan Local Authority’s policy and procedure on the protection of vulnerable adults. Lime House DS0000005746.V260266.R01.S.doc Version 5.0 Page 16 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): 19, 20, 24,26 Lime House offers residents a relaxed, homely environment in which to live. The enclosed gardens ensure residents can enjoy sitting and walking in the garden safely. EVIDENCE: Residents in the main house have a choice of two lounge areas, the dining room has a sitting area. The lodge has a combined dining room and lounge. The inspector spent some time talking to residents in a lounge in the main house, one resident said she was ‘very satisfied’ with home life and her surroundings. The residents in the second lounge were all a sleep. The inspector spoke with a resident and a visitor in the lounge in the lodge. Both had good things to say about the home, as stated earlier in the report. A tour of the premises took place. The home is well-maintained, homely and comfortable. Since the last inspection, five bedrooms have been re-decorated and new beds and vanity units have been purchased. New carpets have been fitted and Lime House DS0000005746.V260266.R01.S.doc Version 5.0 Page 17 there are new chairs in the lounge. The lodge has been re-decorated and has had new windows fitted. The home has an annual rolling programme of redecoration and renewal. The home is set in landscaped gardens that are enclosed. This ensures residents can enjoy the garden in safety. The gardens can be seen from the lounge areas in the main house. Each bedroom door has a photograph of the resident, the residents name and the room number. This is particularly helpful for residents with dementia or who are forgetful. Residents are encouraged to personalise their own room, a resident said ‘my room is very nice’. To assist residents with dementia, the home is decorated in light coloured wallpaper. The toilets and bathrooms have soap dispensers and paper towels to ensure no cross infection takes place. The home was found to be clean and tidy and free from odour. Lime House DS0000005746.V260266.R01.S.doc Version 5.0 Page 18 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, 30, There are sufficient numbers of staff on duty, to meet the needs of the residents. Staff training at the home is good, which ensures residents receive good care. EVIDENCE: The resident’s needs are met by an experienced and well trained staff team. The home has a long-standing staff team, who are dedicated to providing a good quality service to the residents. The staff team consists of the manager, four supervisors, eighteen care staff, fourteen domestic staff including laundry and kitchen staff, a handyman and an activities co-ordinator. All staff receive mandatory training, for example, food hygiene, fire safety, moving and handling, infection control, protection of vulnerable adults. Other training includes; challenging behaviour, first aid, bereavement, medication training and managing depression. The home is registered to care for up to eight residents with dementia and therefore, all staff have received training in dementia care. Four members of staff have attended a two-day dementia mapping course, which gives a more in-depth understanding of the different types of dementia and how to communicate and understand people with dementia. Dementia training assists staff in providing a good service for and understanding the needs of eight residents at the home who have dementia. Lime House DS0000005746.V260266.R01.S.doc Version 5.0 Page 19 Ten staff have achieved NVQ level 2, whilst one member of staff is soon to complete this course. Two staff have achieved NVQ level 3 and two staff are working towards NVQ level 4. Staff spoken with, said they enjoyed working at the home. One senior member of staff has covered night duty for over ten years, has moved to day time duty, she said she was enjoying the change and the challenge and has always enjoyed working at Lime House. All the staff on duty were cheerful and friendly. A resident said, ‘the staff are good, I am very content’. There are four care staff and a supervisor on morning duty, sometimes there are five care staff, depending on the needs of the residents. Three staff and a supervisor are on duty throughout the day and the evening, whilst there is one carer and one senior carer on waking night duty. There is always a first aid trained member of staff on duty on each shift. Lime House DS0000005746.V260266.R01.S.doc Version 5.0 Page 20 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): The management and ethos of the home, ensures the home is run in the best interests of the residents. EVIDENCE: The manager has worked at Lime House for nineteen years and has been manager for approximately ten years. The manager is a state enrolled nurse and has many years experience of working with older people and has attended a training course in dementia care mapping, along with three of the homes supervisors. The home is run in the best interests of the residents, this is demonstrated in the records of a resident’s meeting, the issues discussed included; welcoming a new resident, staff changes, complaints procedure, menus, asking if residents were happy with them and activities and trips. Lime House DS0000005746.V260266.R01.S.doc Version 5.0 Page 21 Resident’s preferences and opinions are also sought from one to one conversations with the key worker, or the activities co-ordinator. The manager said that ‘having good relationships with residents families and representatives’ was another way of ensuring the home was run in the best interests of the residents. Also staff training ensures the home is run in the best interests of the residents. Training courses such as dementia care, challenging behaviour and managing depression, are specific to the needs of the current resident group. The manager was observed as having a good rapport with staff and residents. At the last inspection, a recommendation was made that, the manager should commence the Registered Managers Award and NVQ level 4, this recommendation remains unmet. Lime House DS0000005746.V260266.R01.S.doc Version 5.0 Page 22 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 2 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x 3 3 x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x x x x x Lime House DS0000005746.V260266.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 5 Requirement The service user guide should include information on the homes complaints procedure, the guide needs updating to include the name of the new Business Relationship Manager at the Commission for Social Care Inspection.. Timescale for action 30/11/05 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 Refer to Standard OP33 Good Practice Recommendations The registered manager must undertake the Registered Managers Award and NVQ level 4. Lime House DS0000005746.V260266.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG 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 Lime House DS0000005746.V260266.R01.S.doc Version 5.0 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. 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