Inspection on 05/07/06 for Lime House

This inspection was carried out on 5th July 2006.

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

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

Other inspections for this house

Lime House 24/02/06

Lime House 26/10/05

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 Kath Smethurst Key Unannounced Inspection 5th July 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lime House DS0000005746.V295587.R01.S.doc Version 5.2 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.V295587.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lime House Address Newton Road Lowton Nr Warrington Cheshire WA3 1HF 01942 674135 01942 678796 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 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.V295587.R01.S.doc Version 5.2 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. 24th February 2006 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. Fees range from £312.14 to £434 per week. Additional charges are made for hairdressing, toiletries and newspapers. Lime House DS0000005746.V295587.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection site visit took place over a period of eight hours. The home had not been told that the inspector would visit. The inspector looked around parts of the building, eat the food served at lunch and checked some paperwork about the running of the home and the care given. To get more information about the home six residents, the manager and three staff were spoken with. Care staff were also watched as they went about their work. Before the inspection comment cards were sent to residents, relatives and people such as social workers, district nurses and doctors. Six residents, four relatives and one district nurse returned comment cards. What the service does well: From speaking to residents and comments made by residents and relatives in comment cards it was clear all were very happy with the care provided. Staff were described as “very good”, “nice”, “very friendly” and “kind”. One resident wrote, “I like the home very much. I have no complaints”. One relative wrote, “ The care that Lime House gives is just first class in every area”, a second, “Lime House maintains excellent standards of care to all residents”, a third, “I am so glad my mother is a resident of Lime House because I know she is getting the best care she can possibly have. The staff are excellent and the home is run so very well. Long may Lime House continue the good work”. Before people come to live at the home staff visit residents, either at home or in hospital, to make sure the care needed can be provided. Residents and relatives are welcome to visit before they decide to come and live at the home. Each resident had a named carer, called a key worker, who would help them have a bath, go shopping for them or keep their clothes tidy. The records kept on residents (care plans), includes a lot of information about the things residents need support with and the things they like to do. This means staff have the information they need so they can make sure residents get the care and support they need. The home is good at making sure residents health was taken care of by seeing doctors and other health care workers. Lime House helps residents to lead active and interesting lives by arranging a lot of social activities in the home and regular trips out. Lime House DS0000005746.V295587.R01.S.doc Version 5.2 Page 6 Relatives who returned comment cards said they could visit at any time and staff always made them feel welcome. Residents were very satisfied with the food stating they got enough, that they were given choices at each meal and that it was good home cooking. If residents or relatives are unhappy about things staff are good at sorting things out. Staff have done a lot of training, which helps them look after people properly. For example understanding the special needs of people with dementia, how to move residents safely, first aid and what to do if a resident isn’t being treated properly. The home makes sure that before staff starts work they are properly checked to make sure they are suitable to care for people living in the home. What has improved since the last inspection? 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.V295587.R01.S.doc Version 5.2 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.V295587.R01.S.doc Version 5.2 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): 3 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. Residents are properly assessed prior to admission in order to ensure the home is able to meet any identified needs. EVIDENCE: Inspection of the records of two of the most recent admissions showed a full assessment of physical care needs had been completed and where applicable social work assessments had been taken note off. The assessment document was detailed and included information relating to physical and social care needs. The initial assessment is followed by an ‘on admission assessment’ which is completed 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. Discussion took place in respect of the assessment process undertaken. The acting manager advised that if possible prospective residents are visited prior to admission at home or hospital, whether they are paying for themselves or Lime House DS0000005746.V295587.R01.S.doc Version 5.2 Page 9 the local authority funds their care. This was felt important to ensure the home was able to meet needs. The acting manager advised that trial visits are available and seen as important in order residents can get to know residents and staff before coming to live at the home. Prospective residents are encouraged to visit a more than once and at different times where they can have a meal and spend some time in the home. If this is not possible relatives usually looked around the home prior to their relative’s admission. New residents are allocated a key worker. While it is not always possible for the key worker to be on duty when a new resident is admitted steps are taken to make sure a member of staff they have met is on duty. Feedback in returned resident comment cards indicated they were provided with sufficient information prior to coming to live in the home. Two residents spoken with confirmed they had been able to visit Lime House before they were admitted. These residents also said staff had asked them about the things they needed help as well as their preferences. Lime House DS0000005746.V295587.R01.S.doc Version 5.2 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): Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. Care plans were detailed, up to date and provide staff with the information they need when delivering care. Health care needs were well met with evidence of good multi disciplinary working taking place on a regular basis. The management of medication in the home is satisfactory as a result any potential risks to resident’s health have been reduced. Personal support is offered in such a way as to promote resident’s privacy and dignity. EVIDENCE: Three care plans were examined. All contained comprehensive information relating to residents personal, social and health care needs. Each are of risk has a separate record. Supplementary information includes personal care record and weight. Daily entries in care notes were completed in all the plans Lime House DS0000005746.V295587.R01.S.doc Version 5.2 Page 11 examined and gave a good indication of the care provided and residents well being. The plans were easy to read, had been regularly reviewed and set out clear guidance for staff to take when providing care. There was written evidence that the plans had been signed and agreed by either the residents or their representatives. The care plans examined contained some very good information in respect to residents past lives, needs, likes/dislikes and chosen lifestyle. For example one plan read, “Likes to get up early”, a second “No religious beliefs”. A full range of risk assessments was in place covering areas such as nutrition, moving and handling and mental health. All had been reviewed and updated on a regular basis. In addition to internal monthly reviews there was evidence of external Social Services reviews having taken place. Feedback from residents and relatives was very complimentary about staff and the care provided. One relative wrote, “Lime House maintains an excellent standard of care to all residents”, a second, “I am so glad my mother is a resident of Lime House because I know she is getting the best care she can possibly have”. Residents spoken with also indicated they always received the support and care they need. The health care needs of residents were well met. Individual care records inspected showed evidence of visits from general practitioners, chiropodist, optician, district nurses and community psychiatric nurse. Residents who returned comment cards confirmed they received the medical support they needed. Prior to the inspection comment cards were sent to health care professionals in order to ascertain their views. A visiting district nurse returned a card and she had no concerns in respect to the way residents were cared for. The district nurse wrote, “I have visited Lime House since it opened, all staff very accommodating and helpful. A very pleasant home to visit and standards are maintained at all times. A detailed medication policy and procedure is in place covering all relevant areas including controlled drugs, self-medication and homely remedies. The home uses a monitored dosage system supplied by a local pharmacy. Accurate records were in place for the receipt and disposal of medication. All staff involved with medication at Lime House has received relevant training. Training is organised and funded by Nugent Care and is updated at least twoyearly. It was positive to note that only a small number of designated staff are allowed to handle medication. Each person has provided a sample of their signature and initials so that medication records can be monitored and verified. Lime House DS0000005746.V295587.R01.S.doc Version 5.2 Page 12 Lime House has regular contact with the local pharmacist for advice, information and medication checks. Nugent Care Quality Assurance Team also carries out medication checks and audits. The last audit was undertaken on the 27/6/06. The audit identified that on occasions the MAR (Medication Administration Records) noted that columns had not always been dated and the codes indicating why a medicine had not been administered had not always been detailed. Both these issues have now been addressed. A sample of MAR was examined and were found to be up to date and accurate. Most of the Medication Administration records were printed by the pharmacy for staff to fill in when medications were given. But, some records were handwritten. The handwritten entries were not checked and signed by a second member of staff. This is recommended to reduce the risk of mistakes in handwritten instructions. Medication storage was secure and orderly with no evidence of overstocking. Separate safe storage and recording systems are provided for Controlled Drugs. A lockable drug trolley is provided which when not in use is secured to the wall. A lockable medication fridge is also available which is used to store eye drops, antibiotics etc. It was however noted that the temperature of the fridge had not been checked. The temperature of the fridge should be checked daily and recorded in order to ensure the appliance is working efficiently. Most residents hand over the management of their medication to the homes staff. At the time of the inspection two residents were looking after their own medication. An assessment is carried out with them to identify any risk factors that may be apparent. A lockable facility is provided in resident’s bedrooms in which to store their medicines safely. They are given a week’s supply of medicines in a ‘blister pack’ that they return at the end of the week. During the inspection staff were observed to treat residents with respect and consideration, were attentive to individual needs and were discreet. Residents were seen to be dressed in clean well maintained clothing. Staff were observed knocking on doors before entering rooms and toilets. There is also written evidence in care plans that resident’s needs in respect to privacy and dignity were considered important. Residents who were able to comment were very positive about how staff assisted them with personal tasks. For example staff did not make them feel embarrassed when assisting with intimate care tasks, made sure they wore their own clothing and knocked on doors before entering. One resident spoken with liked the staff and described them as being “very good”. Lime House DS0000005746.V295587.R01.S.doc Version 5.2 Page 13 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 Quality in this area is good. This judgement has been made from the evidence gathered both during and before the visit to the service. Lime House supports its residents to lead active and interesting lives by providing a range of varied social and leisure opportunities both within the home and the community. Visiting arrangements in the home are good ensuring links between residents and their relatives and friends are maintained. Personal support is offered in such a way as to enable residents to exercise choice and control over their lives. Meals are good and the needs of residents are well catered for with a balanced and varied selection of food provided. EVIDENCE: An activity co-ordinator is employed for twenty hours per week. Activities take place both inside and outside the home and on a regular basis. Written records of the activities individual residents take part in are recorded. Details of the activities arranged for each week are displayed on the notice board. For Lime House DS0000005746.V295587.R01.S.doc Version 5.2 Page 14 example during the week of the inspection the following activities had been arranged, bingo, quiz, manicures, birthday party, plane spotting (Manchester Airport) followed by a pub lunch. Other recent activities included, gentle exercise, musical entertainment, cinema, bowling, baking, clothes party, reminiscence. Good practice was noted in that regular trips out are arranged. Recent outings included a canal boat trip, social evening at Lowton labour Club and pub lunches. Residents wishing to maintain their religious links are enabled to do so. Care plans take note of resident’s religious preferences. 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. Good practice was noted in that the home recognised not all residents had religious beliefs and this was indicated in care plans. Some of the residents living in the home have communication and memory difficulties. These residents are able to take part in most of the activities arranged. Nevertheless staff have recognised that this group of residents need for more specialised activities. For example reminiscence and sensory activities such as baking nail care and hand care. During the visit staff were observed spending time socialising with residents when their duties allowed. Staff were seen taking time to sit and chat. A friendly but respectful banter was seen. Care notes also contain details of the activities residents take part in as well as details of interests and hobbies. The inspector was impressed with the activities programme and the value placed on this by the staff and residents. Regular residents meetings are held regularly. The minutes of the last meeting were examined and indicated residents were satisfied with the range and frequency of activities available. While social inclusion is encouraged, individual choices and preferences are taken into account. Those who choose not to participate in group activities are not pressurised to do so. Residents spoken with and those who returned comment cards had no complaints about the activities provided. The home has an open visiting policy. There are no restrictions on the time people visit evidence of which was highlighted in the visitor’s book, where entries showed residents friends and relatives visiting at different times during the day and the evening. The only time restrictions would be imposed is when requested by residents. Anecdotal evidence from residents indicated staff encouraged links with families to be maintained. Feedback in returned relative comment cards indicated they were always made welcome when visiting. Lime House DS0000005746.V295587.R01.S.doc Version 5.2 Page 15 The routines of daily living were observed to be flexible. Residents were observed getting up in the morning at times that suited them and to choose where they spent their day. For example one resident has a car and goes out most days. Two residents spoken with confirmed they were able to get up and go to bed when they wished and a choice of menu was available. One resident described how she liked to spend most of her time in her room and said, “I please myself what I do”. Another resident said he preferred not to take part in activities and appreciated that staff respected this. It should be noted a number of residents have memory and communication difficulties so were unable to confirm they were able to exercise choice. Nevertheless observation of care practice indicated residents could make choices. For example some residents were seen to choose the privacy of their own rooms. Staff were observed asking residents which meal option they preferred. Resident’s rooms are personalised and residents are able to bring personal items in the home. Care plans take note of personal preferences and chosen lifestyle for example one plan read, “X is an atheist and does not wish to attend church” a second “likes to go to bed around 11pm”. The menus were seen, these offer choice and a balanced diet. Meat or fish was offered on a daily basis, as well as a good assortment of vegetables. Milk puddings, custard, tinned fruit and fruit crumbles are also offered. Menus have recently been reviewed and a summer and winter menu compiled. Residents were involved in this process. Breakfast is served on a flexible basis, the main meal being served from 12.30, and a lighter tea being served from 5.15 p.m. Drinks and snacks are provided throughout the day. For example the inspection took place on a very hot day. A selection of cold drinks were provided in each lounge and staff encouraged residents to drink regularly. Meals are home cooked and the use of convenience foods is limited. A choice is offered at every meal. Details of the menu are displayed in the dining room. Take away meals are sometimes organised to ensure that variety is available and that interest in food is maintained. For example recently some residents had an Indian take away meal. Details of the menu are displayed in the dining room. Breakfast consists of an assortment of cereals, fruit juice, and a cooked breakfast to order, toast, tea and coffee. The lunchtime meal was observed. The dining area was clean and tables were nicely set. A choice of seating options are available - some people were sharing a dining table with two or three other people, others were eating their lunch in their bedroom. The cook served the meal. On the day the meal consisted of steak pie, carrots and potatoes or turkey salad followed by fresh fruit. The inspector sampled the food and it was found to be very tasty. Residents were given time to enjoy their meal and support was given in a discreet and individual manner. For example when a resident Lime House DS0000005746.V295587.R01.S.doc Version 5.2 Page 16 required assistance staff carried on a conversation with the resident, and maintained good eye contact. The meal was taken at a leisurely pace and no one was rushed. Portion sizes were good. All residents spoken with and who returned comment cards were very complimentary about the food served. One resident spoken with said the food was “Very good” while a resident who returned a comment card wrote, “The meals are very good-ten out of ten”. Lime House DS0000005746.V295587.R01.S.doc Version 5.2 Page 17 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): Quality in this area is good. This judgement has been made from the evidence gathered both during and before the visit to the service. There is a well publicised and accessible Complaints Procedure with evidence resident’s concerns are listened to and acted upon. Policies, procedures and training were in place to safeguard residents from abuse or harm, and for taking any concerns seriously. EVIDENCE: A detailed complaints procedure is in place. Good practice was noted in that the procedure is available in different formats, for example, in large print using easy words and on DVD. Various notices around the home remind people of their right to express dissatisfaction or to make complaints about the care that they receive. The contact details of a member of the Head Office staff are provided on the notices so that residents can to complain to somebody outside of Lime House. One of the Care Supervisors is designated as the home’s Complaints Co-ordinator. The Co-ordinator reminds residents of the Complaints Procedure at the regular Resident’s Meetings. Notes of the last meeting confirmed this. No formal complaints have been received by the CSCI (Commission for Social Care Inspection). One formal complaint has been made directly to the home. This related to procedures for contacting relatives at night. Nugent Care Lime House DS0000005746.V295587.R01.S.doc Version 5.2 Page 18 undertook an investigation and upheld the complaint. Good practice was noted in that as a result of the findings of the investigation the home has reviewed and amended procedures for contacting relatives. The acting manager advised that she was also planning to arrange “complaint” training for staff. She felt this would prove beneficial in ensuring staff are better equipped to deal with concerns and complaints that may arise. Those residents able to comment had not made a complaint but all indicated they felt able to approach staff with any concerns. None of the residents or relatives who returned comment cards had made a complaint but all confirmed they knew whom to approach if the need arose. An Adult Protection and Prevention of Abuse policy is in place, which incorporates, whistle blowing. The home ensures all staff completes a POVA and CRB (Protection of Vulnerable Adults Register/Criminal Records Bureau) check before they commence work. No recent POVA (Protection of Vulnerable Adults) investigations have taken place. Staff spoken with understood the importance of reporting any allegations or suspicion of abuse. Training in the signs and recognition of abuse is covered during induction and in NVQ training. Good practice was noted in that staff have routinely complete updated protection of vulnerable adults training. Lime House DS0000005746.V295587.R01.S.doc Version 5.2 Page 19 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 & 26 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. The home is clean, pleasant, safe and comfortable and offers people a range of communal and private areas in which to spend their time. EVIDENCE: The home is situated in Lowton a few miles from Leigh town centre. It is in a residential area, on a main road with local shops and public transport nearby. Lime House is a large converted detached property set in extensive grounds. The garden areas well maintained, attractively landscaped and enclosed. This ensures residents can enjoy the garden in safety. Garden furniture is also provided for residents. Care parking facilities are available at the front of the building. Lime House is well maintained internally and externally. Ample communal facilities are available providing residents with a choice of seating areas. In the Lime House DS0000005746.V295587.R01.S.doc Version 5.2 Page 20 main house residents have a choice of two large lounges (one quite lounge and one TV lounge) both overlook the garden. There is a separate dining room with an additional seating area. The “lodge” has a combined lounge/dining area. A separate hairdressing facility is provided. The home is furnished with good quality items. Pictures, flowers and ornaments enhance the homeliness of the communal areas. Throughout the home signs and symbols are used to remind people where toilets and bathrooms are located and bedroom doors have a photograph of the occupant on them. Notices are represented in colourful pictures to make them interesting and accessible to people. This is good practice and particularly important in a service where some people have signs of dementia. Sufficient toilet and bathroom facilities are provided. Assisted bathing facilities are provided. Toilets are situated close to communal areas. A sample of bedrooms was examined. Bedrooms were personalised with photographs and personal mementoes on display. Doors are fitted with locks that can be opened by staff in an emergency. Lockable storage space is also provided for residents to store items for safekeeping. Some residents have chose to have a doorbell fitted to their bedrooms. Some residents were seen to choose to spend most of their time in private in their own rooms. Residents spoken with and feedback in returned resident/relative comment cards indicated they were satisfied with the standard of the environment and cleanliness at Lime House. One resident described the home as being “very clean”. On the day of the inspection the home was clean and odour control was good. Policies and procedures were in place with regard to infection control. Staff were provided with protective aprons and disposable gloves. Liquid soap and paper towels were provided near to hand washing facilities. Staff were observed to be maintaining good hygienic practices. All residents personal laundry is undertaken on site and residents spoken to had no complaints about the standard of laundry service provided. Lime House DS0000005746.V295587.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. Staffing levels are satisfactory ensuring consistency of care and recruitment procedures for staff are robust which ensures people living in the home are protected. A comprehensive training programme is in place, which equips staff with the skills, and knowledge to meet residents assessed needs. EVIDENCE: Staff turnover at Lime House is very low with a number of staff having worked at the home for some considerable time. This would indicate staff are well supported and happy in their role. Further evidence of this was highlighted in discussions with staff. All staff spoken with indicated they enjoyed working at Lime House. A written rota is maintained. The acting manager works on a supernumery basis. An administrator, activity co-ordinator, and handyman are also employed. Domestic and catering support care staff seven days a week. Staff spoken with indicated that staffing levels were sufficient to meet resident’s needs. Lime House DS0000005746.V295587.R01.S.doc Version 5.2 Page 22 The atmosphere in the home was very relaxed and friendly. Interactions between staff and residents were frequent, natural and warm. During the visit staff were observed to respond speedily to requests for assistance made by residents and also spent time socialising with them. For example one resident wasn’t feeling very well. A member of staff spent a great deal of time with this resident offering reassurance and care. Another resident who had some memory difficulties became very anxious as to where she was and where her family were. A member of staff took the time to occupy and divert her. This strategy proved successful as a short time later the resident showed no signs of anxiety. Feedback from residents spoken with and in returned resident/relative comment cards was positive about the care provided. All indicated staff looked after residents very well. Good practice was noted in that shift patterns allow time for a staff handover. The afternoon handover was observed. It was evident that staff knew a great deal about residents. Staff exchanged information and contributed fully to discussions. Staff recruitment records are held centrally at Nugent Care head office in Liverpool. The inspector arranged for a sample of staff recruitment records to be brought to the home to be examined. The files of four staff employed looked at showed all necessary recruitment checks had been undertaken. All contained: written application forms, 3 references, Criminal Records Bureau (CRB) check and verification of identification. Good practice was noted in that any gaps of employment and the reasons for leaving previous jobs had been explored. All prospective staff attend an interview. The acting manager and another senior member of staff conduct interviews. If the position is at a more senior level the acting managers line manager is also involved in the interview process. Interview notes are also maintained. All staff are issued with a statement of terms and conditions of employment. A comprehensive staff development programme is in place and records of training are maintained. There was evidence that new staff undertake induction training that meets the National Training Organisation (NTO) specifications following which foundation training is undertaken. Staff spoken with confirmed they had undertaken induction training. Samples of training records were examined. The records confirmed the wide range of courses that staff had attended and that ongoing training is available. Staff spoken with were happy with the range of training provided by the home. One member of staff described training opportunities as being “Good”. Mandatory training needs are well met. Recent courses undertaken include, food hygiene, fire safety, moving and handling, health and safety, protection of Lime House DS0000005746.V295587.R01.S.doc Version 5.2 Page 23 vulnerable adults. Good practice was noted in that training records highlight updates are required. Of the twenty-one care staff employed eleven staff are in receipt of NVQ (National Vocational Qualification) level 2 with one member of staff working towards achieving the award. One member of staff is in receipt of NVQ level 2 and 3 and is working towards NVQ level 4. The acting manager has attained NVQ level 4. Training records also show staff have undertaken a range of more specialised training, including continence care, gender awareness, prevention of pressure sores, communication, counselling, care planning, rights and risk taking and challenging behaviour. The home provides a service for a group of residents living with dementia. 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. Lime House DS0000005746.V295587.R01.S.doc Version 5.2 Page 24 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): Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. Leadership in the home is changing. However, this was being well managed, with clarity and stability being maintained and morale remaining good. Systems for monitoring the quality of the service provided at Lime House were in place, enabling a regular review of the service received by residents. Money kept on behalf of residents is managed properly, which ensures the residents financial interests are protected. The health, safety and welfare of residents and staff are promoted and protected. EVIDENCE: Lime House DS0000005746.V295587.R01.S.doc Version 5.2 Page 25 The Registered Manager retired on 23 March 2006. An experienced Care Supervisor was appointed as ‘Acting Manager. The Acting Manager has worked at Lime House for several years and has NVQ Level 4 in Care. Support is provided from Head Office through regular visits and telephone contact. Despite the changes there remains a clear line of accountability in the home which both residents and staff are aware of. Record keeping remains good and residents indicated they continue to be satisfied with the care and organisation of life in the home. During the last inspection a requirement was made for an application to be made to the CSCI (Commission for Social Care Inspection). This has not been addressed in the timescale indicated. Steps need to be taken to resolve this situation and a permanent manager appointed. The responsible individual needs to be mindful that it is a condition of registration that “The service should employ a suitably qualified and experienced Manager who is registered with the CSCI”. While management arrangements are satisfactory, the current situation should not continue for an indefinite period. The person responsible must keep the CSCI informed of progress in this matter. Internal and external quality assurance systems are in place. Regular resident and staff meetings take place and are minuted. The last residents’ meeting took place on the 9/3/06 and was well attended. Agenda items for this meeting included staff changes, menu, household, complaint procedure and activities. Nugent Care representatives visit the home on a monthly basis to audit records and speak to residents and staff. A written report is then produced of the findings, which is then forwarded to the CSCI. In addition Nugent Care Quality Assurance Team also carries out medication checks and audits. The Contracts Section of Wigan Social Services Department, in conjunction with a company called RDB Limited, has undertaken a voluntary star rating of homes in Wigan. As part of the rating process an annual audit of quality is undertaken. This includes consultation with service users and staff. Lime House has been awarded 5 stars, which is the highest rating. The home has a system for recording the complaints of those who don’t wish to complain formally. Residents are informed of CSCI inspections and inspection reports are available for visitors and residents to read. The manager undertakes regular quality audits of records for example accidents, medication and care plans. Feedback from residents spoken with and in returned resident/relative comment cards indicated staff listened to and acted on what they said. Lime House DS0000005746.V295587.R01.S.doc Version 5.2 Page 26 Lime House encourages residents to manage their own finances with help from a representative if needed. A lockable facility is provided in all bedrooms for safe keeping of money and other valuables. The home’s policy is for staff to avoid becoming involved if possible and to discourage residents from keeping large amounts of money or valuables at the home. If help from staff is needed then appropriate records are maintained and receipts are kept. Rather than holding money for residents, staff purchase items on their behalf and provide an invoice for the full amount. With the pre-inspection materials, the manager provided a list of maintenance and associated records. A number were checked on the site visit on the 5th July, including the gas and lift servicing. All were up to date. Fire safety records showed that that all fire tests and maintenance procedures had been undertaken regularly. Records also indicated that fire drills and instruction had taken place at frequent intervals. Training records indicated that training and regular updates are provided to staff in key areas such as moving and handling, fire safety, first aid, infection control, fire safety awareness etc. There were satisfactory policies and procedures in place relating to the recording and reporting of accidents to residents and staff. Samples of accident records were examined and were found to be appropriately maintained. Lime House DS0000005746.V295587.R01.S.doc Version 5.2 Page 27 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Lime House DS0000005746.V295587.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 8&9 Requirement An application for a suitably qualified, competent and experienced manager to be registered with CSCI must be submitted. Timescale 28/04/06 not met. The responsible individual must keep the CSCI (Commission for social care inspection) informed of progress in meeting this requirement. Timescale for action 01/09/06 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. Refer to Standard OP9 OP9 Good Practice Recommendations Handwritten MAR entries should be signed, checked and countersigned. The temperature of the medicines fridge should be monitored and recorded. Lime House DS0000005746.V295587.R01.S.doc Version 5.2 Page 29 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.V295587.R01.S.doc Version 5.2 Page 30 - 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. 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