Inspection on 22/08/07 for Limetree Avenue Care Home

This inspection was carried out on 22nd August 2007.

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 found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Limetree Avenue Care Home 12/05/08

Limetree Avenue Care Home 30/05/06

Limetree Avenue Care Home 25/01/06

Limetree Avenue Care Home 30/11/05

Limetree Avenue Care Home 15/02/05

Limetree Avenue Care Home 15/07/04

Limetree Avenue Care Home 16/03/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

CARE HOME ADULTS 18-65 Limetree Avenue Care Home 23 Limetree Avenue Retford Nottinghamshire DN22 7BB Lead Inspector Jayne Hilton Key Unannounced Inspection 22nd August 2007 02:30 Limetree Avenue Care Home DS0000008709.V341078.R01.S.doc Version 5.2 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 Limetree Avenue Care Home DS0000008709.V341078.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Limetree Avenue Care Home DS0000008709.V341078.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Limetree Avenue Care Home Address 23 Limetree Avenue Retford Nottinghamshire DN22 7BB 01777 708 725 F/P 01777 708 725 sarah.hall@mencap.org.uk www.mencap.org.uk Royal Mencap Society 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) Acting manager Sarah Hall Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Limetree Avenue Care Home DS0000008709.V341078.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th May 2006 Brief Description of the Service: 23 Limetree Avenue is a 3-storey, semi-detached house in a quiet, residential street within quarter of a mile of Retford town centre, near shops, pubs, and cinema and leisure facilities. The home caters for six male and female residents with learning disabilities. It was established in 1991 and five of the residents have been there since that time. The latest addition arrived in 1996; no one has been admitted since. Five of the current residents attend local authority day care services for some part of the week. All residents have their own personalised decorated bedrooms, with a communal lounge, dining room and kitchen. There is a bathroom and a shower room; there are toilets on each floor. One ground floor bedroom is en-suite. There is a small well - maintained garden. On the second floor there is a sleepin room for staff and an office where records, documents, policies and procedures are kept. Information was provided about fees in the Service User Guide as £376.44 plus one to one fees, service users pay extra for hairdressing and meals taken outside of the home. A Statement of Purpose and Service user guide was on display in the home on the day of the inspection and a copy of the Inspection report was available on request. Limetree Avenue Care Home DS0000008709.V341078.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for service users and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. This inspection took place over 5 hours. The Registered Manager had provided some requested information to the Commission for Social Care Inspection in August 2007. The main method of inspection used was called ‘case tracking.’ This involves selecting two residents and looking at the quality of the care they receive by talking to them, examining their care files and discussing how support is offered to them by staff members. Many of the people who live at this home have a very limited ability to understand and communicate. Therefore many judgements in this report are from observation and reading residents’ records and documents. The residents who were “case tracked” were not able to help by giving an opinion about the care provided. Comments from all service users and three relatives were obtained from pre inspection surveys issued prior to the inspection. One member of staff and the acting manager, were spoken with as part of this inspection, documents were read and medication inspected to form an opinion about the quality of the care provided to residents. A review of the Registration Certificate was undertaken and it was agreed that the name of the registered manager on the certificate is now incorrect this will change once the new acting manager is registered. What the service does well: Service users and staff benefit from a well run home, with which service users and their representatives can be confident their views underpin all self monitoring, review and development of the home. Their needs are fully assessed and the care planning and risk assessment framework are well organised. Limetree Avenue Care Home DS0000008709.V341078.R01.S.doc Version 5.2 Page 6 Staff at Limetree Ave are well informed and aware of individual service users needs and plans, which promote and assist service users with choice and decision-making and are subject to robust recruitment systems and appropriate training. The system in place for medicine management was satisfactory. The home provides a range of daily internal and external activities, the homes management and staff are clearly committed to providing a stimulating environment. However service users social and recreational needs may be somewhat compromised by recent staffing shortages. Service users are supported to have appropriate personal family relationships and service users rights are clearly recognised and overall enjoy a healthy and nutritional diet. Service users receive personal support in the way they prefer and require and their specific, physical and emotional needs met. Service users said they would tell the manager, should they not be happy The home provides a clean and comfortable environment. Comments from the service user and relative surveys were 100 postive and include the following statements: “The staff are excellent nothing seems too much trouble for them” “They look after my son very well” What has improved since the last inspection? The requirement set at the previous inspection in respect of improving the medication policy has been addressed. Limetree Avenue Care Home DS0000008709.V341078.R01.S.doc Version 5.2 Page 7 The requirement set at the previous inspection in respect of the service users personal allowances has been addressed. The bedrooms and communal areas have been redecorated. One person has been supported to own a pet. 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. The summary of this inspection report can be made available in other formats on request. Limetree Avenue Care Home DS0000008709.V341078.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Limetree Avenue Care Home DS0000008709.V341078.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have the information they need about the home and have their needs assessed. EVIDENCE: A statement of purpose and service user guide was avialable in the home and contained picture and symbol formats to assist people with learning disabilities to access them. Terms and conditions are issued but the two, viewed through case tracking, were not however signed by the individual or their representative. Assessment documentation was in place for the two people ‘case tracked’ and person centred plans were devised from these and any ongoing assessments and reviews. One person has additional specialised needs and there was evidence that the home utilises and provides specialised services to enable the person to continue to be supported at the home. Staff, were observed to communicate effectively with the service users during the inspection and were able to demonstrate verbally and through person Limetree Avenue Care Home DS0000008709.V341078.R01.S.doc Version 5.2 Page 10 centred planning that any cultural or religious needs of individuals were catered for. When service users reach 65 years of age care plans need to be implemented in respect of the care needs of older people, with regular review including consideration of the environmental standards. Limetree Avenue Care Home DS0000008709.V341078.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported to make decisions about their lifestyle and are enabled to take responsible risks. EVIDENCE: Each service user has a comprehensive person centred plan (PCP). Each plan contained specific details of personal social and health support needs and ‘how’ staff provide services to individual service users. Observation of practice on the day of inspection provided evidence that staff followed the care plans and promoted choice. Appropriate risk assessments were in place and where service users presented challenges to staff this was well recorded and evaluated. Limetree Avenue Care Home DS0000008709.V341078.R01.S.doc Version 5.2 Page 12 There was evidence of service user involvement within their plans and signatures where appropriate and a key-worker system in place. Service users are unable to manage their own finances. Records are kept of all incoming and outgoing payments and independently audited and monitored. There was a range of information available to service users in accessible formats and they said they are able to participate in household tasks and in meetings about the home and that are they are consulted about choices and wishes on a day to day basis. Limetree Avenue Care Home DS0000008709.V341078.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are supported to live an ordinary and meaningful life and enjoy a healthy diet and mealtimes. However service users social and recreational needs may be compromised by recent staffing shortages. EVIDENCE: All, but one service users attend day centres and their other social and recreational needs are documented and a record is kept of their participation. Staff spoken with said that although going out may be limited some times due to staffing levels they do try to ensure that in house games and activities are provided. Limetree Avenue Care Home DS0000008709.V341078.R01.S.doc Version 5.2 Page 14 One service user said she had a pet rabbit and enjoyed shopping for pet food and looking after him. Another said he enjoyed his music and liked being a DJ. Other service users said they enjoyed going out for meals, shopping and horse riding. Service users confirmed holidays are provided and Skegness was a favourite destination and that they enjoy a pint of beer or lager when they go to the pub. Other holidays have been arranged for Centre Parks and London. Three relatives confirmed that the home supports service users to maintain contact with them. Service users confirmed that staff, always knock before entering their rooms and that staff respect their privacy and dignity. Service users are supported to create a weekly menu, and are encouraged to eat a healthy diet, alternatives can be provided should they decide they want the item on offer. Service users confirmed this and records kept. There was however some gaps in meal records which needs to be addressed. The meal served on the day of the inspection was curry and rice and all said they had enjoyed it. The evening meal was not rushed and a relaxed atmosphere noted and good interaction between service users and staff observed. Limetree Avenue Care Home DS0000008709.V341078.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users physical and emotional health needs are met. EVIDENCE: The person centred plans reflect the needs and wishes of the residents to meet their physical and emotional heath needs. Annual well person checks are recorded and plans would be improved further by holding records about decisions made by GPs about other routine screening, such as breast care etc. Relevent specialist profesional input is accessed and records kept. Where bedrails are used, information about potential risks and consent/agreement for their use should be included with the care plan. It is also recommended that tissue viability risk assesment tools are implemented, also the introduction of nutritional screening tools, running Limetree Avenue Care Home DS0000008709.V341078.R01.S.doc Version 5.2 Page 16 history records for medication reviews and changes would be beneficial to both service users and staff. Continence issues were well managed, however the manager stated in the Annual Quality Assurance Assessment that there was no policy in place for continence promotion, which needs to be addressed. Medication management was assessed. Pen pictures are used in pictures and symbol formats to assist service users understanding and needs. Medication policies have been reviewed to ensure they reflect the practice in the home. All medication practices in the home were assessed as satisfcatory. Service users needs with detriorating conditions or dementia have their changing needs promptly reviewed. Training for staff is to be provided in Palliative Care to enable service users, wherever possible to remain in the home to the end of life, should they wish to do so. Limetree Avenue Care Home DS0000008709.V341078.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users said they would tell the manager, should they not be happy, however service users safety may be compromised by the current staffing level situation. EVIDENCE: The residents spoken with said they feel able to talk to the staff and say if they are not happy. No records of complaints have been recorded since the last inspection. The home uses the Mencap policies and procedures for responding to allegations/suspicions of abuse and neglect. Staff’s spoken with were aware of action to be taken in the event of an allegation or suspicion of abuse and that training is provided. There have been three incidents referred under Safeguarding Protocols which appropriate action has been taken. However because of the current staffing levels for afternoons and weekends, service users are left unsupervised for periods which, could potentially leave service users vulnerable. A security review is also recommended, particularly respect of the garden gates and laundry window Limetree Avenue Care Home DS0000008709.V341078.R01.S.doc Version 5.2 Page 18 Individual finance records are maintained. Limetree Avenue Care Home DS0000008709.V341078.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users live a comfortable and clean home. Remedial work to the garden pathing is needed to minimise any risk of trips or falls. EVIDENCE: All residents bedrooms were seen on the day of inspection. The rooms were well-personalised and met individual needs and tastes. The ground floor bedroom has an ensuite toilet and walk in shower to accommodate with wheelchair access. Ramps are in place for access to the garden and front door. Furnishings and fittings are of good quality. The home provides sufficient light and ventilation. Limetree Avenue Care Home DS0000008709.V341078.R01.S.doc Version 5.2 Page 20 The home has sufficient bathing and toilet facilities for the number of residents accommodated. One service user has provided her own hoist facility. It is reccomended that this situation be reviewed under Standard 29, Regulation 13 and 23. The home was clean and well maintained on the day of inspection. Attention is needed to esure staff wear personal protective clothing and for food handling/safety. The paving slabs in the garden seating areas were observed to be uneven and a potential trip hazard. The manager reported that this has been reported and action agreed to rectify this. The area is accessed daily and therefore the remedial work must be undertaken without delay to ensure safe access for service users, staff and any visitors to the home. Limetree Avenue Care Home DS0000008709.V341078.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33,34, 35 and 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users are supported by staff who are supervised and trained and they are protected by the homes recruitment practices, however service users safety and lifestyle choices may be compromised because of the low staffing levels currently provided. EVIDENCE: Only two staff were on duty on the afternoon of inspection and upon review of the rota, speaking with staff and the acting manager it was confirmed that the home had a staffing crisis and they were trying to recruit new staff, particularly relief workers for the home. The manager is covering shifts herself and there is no other senior staff employed. Support staff; also undertake laundry, domestic and catering duties within their roles also. Rotas showed that evening and weekends were not sufficiently covered, as one person requires two staff to assist with personal care. There is also a conflict issue between two particular service users, one of who has other complex Limetree Avenue Care Home DS0000008709.V341078.R01.S.doc Version 5.2 Page 22 needs. There are clearly times that service users are left unsupervised when staff, are busy elsewhere and this potentially leaves service users vulnerable. The manager stated that agency staff hade been used in the past but that this had been problematic. The manager agreed to reintroduce agency staff/seek assistance from other services as an interim until a bank of relief staff are recruited. Training records and staff spoken with evidenced a good level of training, including Equality and Diversity. It is recommended that staff undertake training in the needs of older people and tissue viability. Two staff personal files were examined and recruitment practices satisfactory and 22 of staff hold NVQ 2 or above. Staff spoken with confirmed that they had regular supervision and records supported this. Limetree Avenue Care Home DS0000008709.V341078.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users benefit from living in a home that is well managed and which seeks their views, however there are some health and safety issues to address to ensure service users and staff are fully protected. EVIDENCE: The new acting manager has been in post for twelve months but has not yet applied to be registered by the Commission for Social Care Inspection. She reported that an application would be submitted for consideration shortly. She also reported that she has not yet fully completed the Registered Manager’s Qualification due to some unforseen circumstances with the training provider. Limetree Avenue Care Home DS0000008709.V341078.R01.S.doc Version 5.2 Page 24 A staff member spoken with reported that the team worked well together and that the manager was approachable, firm but fair. Mencap’s quality assurance and monitoring systems are used in the home including service user surveys. Evidence of this was seen and for provider visits under Regulation 26. Records were well organised and were seen for hoist servicing, gas safety checks and the fire risk assessment, but the electric circuit safety check was noted to be overdue by 6 months. Some windows have been replaced but some restrictors have not been adjusted to the safe opening limit. The manager said she would review this and ensure remedial work will be undertaken to rectify the matter. A health and safety policy was in place and generic risk assessments were seen. Work is needed to make the garden paving safe and a security review recommended [see Standard 24] Limetree Avenue Care Home DS0000008709.V341078.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 2 30 2 STAFFING Standard No Score 31 X 32 2 33 1 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 2 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 2 3 3 X X 2 X Limetree Avenue Care Home DS0000008709.V341078.R01.S.doc Version 5.2 Page 26 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA24 Regulation Requirement Timescale for action 30/09/07 13[4][a][c] The paving slabs in the garden seating areas were observed to be uneven and a potential trip hazard. The area is accessed daily and therefore the remedial work must be undertaken without delay to ensure safe access for service users, staff and any visitors to the home. Rotas showed that evening and weekends were not sufficiently covered, as one person requires two staff to assist with personal care. There is also a conflict issue between two particular service users, one of who has other complex needs. There are clearly times that service users are left unsupervised when staff are busy elsewhere and this potentially leaves service users vulnerable. Sufficient staffing levels must be provided to ensure service users are safely supervised. 2 YA33 18[1][a] 30/09/07 Limetree Avenue Care Home DS0000008709.V341078.R01.S.doc Version 5.2 Page 27 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 YA1 Good Practice Recommendations Allthough a copy of the last inspection report was avialable, there was no information informing service users and visitors to the home how to access the report.[Including Internet Access] It is recommended that information is posted close to the visitors book about this. When service users reach 65 years of age care plans need to be implemented in respect of the care needs of older people, with regular review including consideration of the environmental standards. Where service users do not have representatives it is recommended that an advocate be used. It is also recommended that care plans contain medical evidence that the person does not have capacity for consent in line with The Mental Capacity Act 2005 It is recommended that some care plans be revised in respect of appropriate terminology for personal care aspects, as was discussed at the inspection with the acting manager. Where bedrails are used, information about potential risks and consent/agreement for their use should be included with the care plan. It is also recommended that tissue viability risk assesment tools are implemented, also the introduction of nutritional screening tools,running history records for medication reviews and changes would be beneficial to both service users and staff. There is no policy in place for continence promotion, which needs to be addressed. A security review is recommended, particularly respect of the garden gates and laundry window One service user has provided her own hoist facility. It is reccomended that this situation be reviewed under Standard 29, Regulation 13 and 23. Attention is needed to esure staff wear personal protective clothing and for food handling/safety. Consideration is given to providing the manager with more hours for administrative and managerial tasks and duties DS0000008709.V341078.R01.S.doc Version 5.2 Page 28 2 YA3 3 YA5 4 YA6 5 6 YA19 YA19 7 8 9 10 11 YA19 YA23 YA29 YA30 YA33 Limetree Avenue Care Home 12 13 14 YA35 YA42 YA42 It is recommended that staff undertake training in the needs of older people and tissue viability. The electric circuit safety check was noted to be overdue by 6 months. Some windows have been replaced but some restrictors have not been adjusted to the safe opening limit. The manager said she would review this and ensure remedial work will be undertaken to rectify the matter. Prompt action is necessary. Limetree Avenue Care Home DS0000008709.V341078.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Limetree Avenue Care Home DS0000008709.V341078.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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