CARE HOMES FOR OLDER PEOPLE
Limegrove St Martins Close East Horsley Surrey KT24 6SU
Lead Inspector Megan McHugh Unannounced 19 April 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Limegrove Version 1.10 Page 3 SERVICE INFORMATION
Name of service Limegrove Address St. Martins Close East Horsley Surrey KT24 6SU 01483 280690 01483 280834 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Anchor Trust Mrs Christine Maureen Conroy CRH (PC) 54 Category(ies) of Dementia - over 65 years of age (DE(E)) 14. registration, with number of places Physical disability over 65 years of age (PD(E)) 13. Old age, not falling within any other category (OP) 27. Limegrove Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 12 October 2004 Brief Description of the Service: Limegrove is a large purpose built home for older people located in the village of East Horsley. The home is registered to provide personal care for 54 service users. The home is didvided into five (5) self contained units comprising of a lounge, dining room, kitchenette, toilets and assisted bathrooms. All residents bedrooms are for single occupancy with an en-suite facility. The conference room is used for some activities and others are held on individual units. Theer are laundry facilities offered and the home has a residents laundry too. The home has spacious, well-maintained gardens and is located close to the local village. There is parking to the front and rear of the property. Limegrove Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over seven and a half hours and was done in conjunction with a follow-up pharmacy visit by the CSCI pharmacy inspector. A pharmacy inspection was carried out by the CSCI Pharmacy inspector in January 2005 and a monitoring visit was carried out in March 2005, by the regulation inspector following meetings held under the local authority multi-agency procedures. Letters sent to the registered person following those visits can be obtained from the CSCI Surrey Local office on request. A tour of the premises was undertaken and care records were sampled during the day. Staff were spoken with during the course of their duties and ten of the fifty residents and two visitors were spoken to in depth and ten residents were spoken to in a group situation. What the service does well:
Residents stated that staff are kind, that they are given choice and independence and that there is a good continuity of care. Residents were happy with the activities offered and were complimentary about the activities co-ordinator. Residents talked about outings that they had been on and what they were looking forward to in the coming weeks. The choice of meals offered and the good quality of meals was commented on by many and a resident was very happy that her special dietary needs were well catered for. The menus over a four-week period offered a variety of food and choices for the mealtimes. Many residents stated that if they did not like the options for the day, they requested what the wanted and it was usually provided to them, but that if the home could not do so, the chef would visit them to discuss it further. This was seen as positive communication and confirmed that residents are given choice. It was pleasing to note and to hear that resident’s medical needs were dealt with promptly when a problem arose. A resident stated that she informed staff that her dentures were loose and the next day the dentist visited her. This was confirmed by staff. Limegrove Version 1.10 Page 6 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or
Limegrove Version 1.10 Page 7 by contacting your local CSCI office. Limegrove Version 1.10 Page 8 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 Standards Statutory Requirements Identified During the Inspection Limegrove Version 1.10 Page 9 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 standard(s) 1, 3, 4 and 5. Residents have access to information about the home to enable them to make an informed choice about the service. People are invited to visit the home prior to making a decision. EVIDENCE: The statement of purpose was found on each unit on the notice board and information about the home was found in resident’s bedrooms with their ILAs (Independent Lifestyle Agreements). These contained information about the level of needs the home can cater for and any specialist equipment available. Residents and family members stated that they had been visited by some one from the home or they came into the home for a day prior to admission. During this time they were asked questions about the care they needed and what their expectations of the home were. This information was held in the resident’s files and there was evidence of a review on at least one of the files sampled. Limegrove Version 1.10 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 standard(s) 7, 8, 9 and 10 The resident’s health, personal and social needs were documented in an ILA and their health care needs were being met and promptly. However, the recording practices are still poor. There was no progress in relation to the systems for the administration of medication, which is poor, and this potentially places service users at risk. EVIDENCE: The Individual Lifestyle Agreements (ILA) or care plans were regularly monitored and reviewed on a monthly basis. There was evidence of reviews being held and a resident confirmed that they had had a review recently and that they and their family were involved. The resident stated that staff must read the plans as there had always been a continuity of care that is provided to them. However, staff could not find the ILA for a resident on respite care and the staff member on duty was not aware of any care this person should be receiving. This had not been reported to anyone and none of the staff were aware for how long this had been missing. The senior care officer stated that they had seen the file since the resident had been admitted two days previously but not on the day of the visit. Limegrove Version 1.10 Page 11 There were records of medical professional visits and a resident stated that after staff were informed about their dentures being loose, the dentist was in to see the resident the next day. Another example was given in relation to the chiropodist and the GP visits being prompt following on from the resident informing staff of a problem. This was very positive to hear. There was negative information given to the inspector in relation to the length of time it took for the GP to visit and tests to be carried out. Evidence showed that staff had contacted the correct people at the time however it was circumstances outside of their control that caused the delays. Staff stated that they had kept the resident informed of these delays. There were no issues noted around privacy and dignity of residents and residents spoken with said that staff treated them well. The pharmacy inspector carried out the pharmacy inspection and found that staff did not have detailed medication handling procedures to work to. Medication stocks and records were sampled and failed to show that service users were receiving their medication as intended by their doctors. There were frequent omissions in completing the medication administration records, resulting in no record being kept of whether medication had been administered or not. A small number of service users were administering their own medications but not all had risk assessments completed. Medication was not being stored securely for the protection of service users as the keys were left unattended. Controlled Drugs were stored in a cupboard that was not fixed correctly to the wall. Audit records were not being completed for all medications. On the day of the visit the regulation inspector also found tablets in a medicine cup on the bookcase in the communal lounge on a unit. The staff were unaware of how this had happened or who was responsible for this. The senior care officer was informed and they removed the tablets and went through the records to find out to whom the tablets belonged so that the record could be amended. CSCI has required the home to take action in respect of these matters. Please see page 22. Limegrove Version 1.10 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 standard(s) 12, 13, 14 and 15 Social activities were well managed and provided a choice, daily variation and social contact for residents. Residents had a right to make choices and exercised some control over all aspects of daily living. Mealtimes were well managed and provided a choice and variety of meals. EVIDENCE: The home has employed an activities co-ordinator who takes residents out shopping, arranges trips, provides activities and spends one to one time with residents in their bedrooms if that is what they prefer. Residents spoken with commented on the range of activities provided and emphasis was put on their choice to attend activities or not. Religious needs are met with the local ministers coming into the home or residents being accompanied out to church services. The activities lady works flexible hours so that she can be in the home according to residents wishes for activities and this includes evenings and weekends. Many residents stated that they had had visitors or were expecting visitors during the day. Visitors were noted in the home throughout the day. Some residents are able to go into the village for shopping and trips out and are accompanied by the activities lady.
Limegrove Version 1.10 Page 13 Dining rooms on the units were bright and nicely decorated, with tables laid with cloths and flowers. Residents are asked to choose their meal for the following day and alternatives are provided wherever possible. Most residents stated that the food was good and choices offered were satisfactory. Tea times provided residents with snacks and cakes as well as refreshments. A resident was not satisfied with the quality of the food offered in the home and did not feel the food was cooked to a decent standard. The chef was asked to visit with the resident to identify any ways to improve the food provided to them. The chef stated that he visits all residents when they have moved into the home and if anyone has a complaint about the food he visits them again. Records were shown of the menus indicating choices residents have made and when they have requested an alternative to what is offered on the menu for the day. It was suggested that the chef sign or have some way of showing that the alternative was provided to the resident, as requested. Limegrove Version 1.10 Page 14 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 standard(s) 18 Procedures were in place in respect of the protection of vulnerable adults and training and induction was available for staff. EVIDENCE: Staff receive training in their induction and full abuse training that teaches them how to recognise signs of abuse and what to do if the witness or suspect that a resident is being abused. Residents spoken to stated that staff were caring and kind. Limegrove Version 1.10 Page 15 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 standard(s) 19, 20, 21, 22, 23, 24, 25 and 26 The home is clean, pleasant and safe to live in. It was well maintained, bedrooms were personalised and there was sufficient facilities and equipment to meet residents needs. EVIDENCE: Each unit is painted and decorated in different colours to assist to differentiate between them. All areas appeared to be well maintained and provided residents with safe and accessible communal areas. Three of the five units have access to the gardens. The two ground floor units have doors leading to the enclosed courtyard area so residents are able to access this at any time. Each unit has as an assisted bathroom, a walk-in shower room and lavatories, as well as each bedroom having en-suite facilities of a hand basin and toilet. Specialist equipment was noted around the home and one resident informed the inspector that she had a special piece of equipment that staff use to get her up and into her wheelchair. The resident was very pleased with the
Limegrove Version 1.10 Page 16 specialist care the home offered to her. Many residents were seen to be using pressure relieving equipment on their chairs and beds. Some residents had pieces of their furniture brought in from their previous house, in their bedrooms. A number of residents stated that they liked having their memories around them and that staff were helpful in hanging pictures and getting frames for their photographs. Limegrove Version 1.10 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The staffing levels in the home are satisfactory to meet the needs of the current residents. EVIDENCE: The staffing rota showed that for the morning shift there were nine care staff plus a senior on duty, this was reduced to seven carers for the afternoon shift and night time levels were less. Many residents stated that they felt the staffing levels were adequate, although things can get tight if some one calls in sick. One resident commented that some times she felt rushed by staff but it was usually if they were short staffed. Staff spoken to said they felt there were enough staff on duty and that the float system worked well in getting additional help or for relieving them for breaks. The manager is still working on a system of having a carer come in an hour early to assist night staff with residents who like to get up early. The manager stated that most mornings are covered. The senior care staff are working more out in the units now as a part time receptionist has been employed and the home has purchased a two way radio system to contact the seniors if required at the front desk. Limegrove Version 1.10 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32 and 38 The home is run and managed by a person fit to be in charge. Residents benefit from the ethos and management approach in the home and their safety and welfare is promoted. EVIDENCE: The manager has implemented a number of new systems in the home to try to identify weaknesses and to pick up any omissions in paper work. This is to be checked by the senior care officers who deal with or report any issues to the manager. Gaps and omissions were noted on the day of the visit and the manager dealt with these issues immediately by calling a meeting with the senior care officers to discuss the problems. Records of staff meetings and senior staff meetings were seen. There were other issues that were identified at separate meetings held under the local authority multi-agency procedures and these have been dealt with accordingly and with good results. Limegrove Version 1.10 Page 19 There were some issues of health and safety identified in other areas of the report. For example in medication administration, record keeping and safe keeping of medication keys. Limegrove Version 1.10 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 3 3 x x x x x 2 Limegrove Version 1.10 Page 21 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 OP 9 Regulation 13(2) Requirement The keys to the medication cupboards must be kept on the person of the designated carer at all times and never left unattended. A complete record must be kept of ALL medication received into the home from whatever source. Previous timescale of 24.1.05 not met A documented risk assessment must be in place for all service users who undertake to selfadminister their own medication Clear and comprehensive procedures for the receipt, recording, storage, safe handling, administration, selfadministration and disposal of medicines, specific to the home, must be available in the home and accessible to staff at all times.Previous timescale of 28.2.05 not met. Complete and accurate records must be kept of all medication administered or not administered, together with the reasons for the nonadministration to service users. Previous timescale of 24.1.05
Version 1.10 Timescale for action 19/04/05 2. OP 9 17(1)(a) 20/04/05 3. OP 9 13(4)(b) 03/05/05 4. OP 9 13(2) 31/05/05 5. OP 9 17(1)(a) 19/04/05 Limegrove Page 22 not met 6. OP 9 12(1)(a) Service users must not be left without access to medication prescribed for them by their General Practitioner.Previous timescale of 24.1.05 not met The Controlled Drugs cupboard must be correctly secured to a solid wall in order to comply with the Misuse of Drugs (Safe Custody) Regulations 1973.Previous timescale of 28.2.05 not met All residents must have a care plan in place and available at all times 19/04/05 7. OP 9 12(1)(a) 31/05/05 8. OP 7 15 30/04/05 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 OP 9 Good Practice Recommendations It is recommended as good practice that when it is necessary to handwrite a medication administration record chart in the home that the member of staff writing the chart signs the chart and that a second carer checks the entry for accuracy and then initials the chart. Daily records must be expanded to include information about care given to the residents and must include any checks made on self caring residents. 2. OP 7 Limegrove Version 1.10 Page 23 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey. GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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