CARE HOME ADULTS 18-65
Limetree Avenue Care Home 23 Limetree Avenue Retford Nottingham DN22 7BB Lead Inspector
Judith Avill Unannounced Inspection 30th November 2005 14:50 Limetree Avenue Care Home DS0000008709.V271463.R01.S.doc Version 5.0 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.V271463.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V271463.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Limetree Avenue Care Home Address 23 Limetree Avenue Retford Nottingham DN22 7BB 01777 708 725 01777 708 725 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.mencap.org.uk Royal Mencap Society Miss Kathleen Markham Antcliffe Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Limetree Avenue Care Home DS0000008709.V271463.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 15/02/05 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, 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 ensuite. 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. Limetree Avenue Care Home DS0000008709.V271463.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. There have been no new admissions since 1996 and the home has full occupancy. Involvement of healthcare professionals is evident in the support plans. During the inspection it was identified that the 24-hour needs of one resident were not being met. An immediate requirement was issued during the inspection. Since the inspection the service manager has confirmed that this has been addressed. What the service does well: What has improved since the last inspection?
The home has continued to enable residents to enjoy their chosen lifestyle and retain their independence as far as possible. Staff spoke with stated that some staff have completed or are currently working towards NVQ level 2 and 3. Limetree Avenue Care Home DS0000008709.V271463.R01.S.doc Version 5.0 Page 6 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. Limetree Avenue Care Home DS0000008709.V271463.R01.S.doc Version 5.0 Page 7 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.V271463.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 The residents have their needs fully assessed prior to admission and by an ongoing review process. EVIDENCE: Extended community Care assessments were seen on the files viewed. Staff spoken with stated that Person Centred plans would be developed from the commencement of the resident’s admission to the home. No residents have been admitted to the home since 1996. Limetree Avenue Care Home DS0000008709.V271463.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 &9 One support plan viewed that a residents 24-hour needs were not being met. The homes routine is flexible to meet resident’s needs. Risk assessments do not reflect action to be taken by staff. EVIDENCE: From the monitoring of a resident 24-hour needs the inspector identified and staff confirmed that a residents Support plans viewed needs were not being met by the home. Risk assessments viewed did not include specific details of action to be taken by staff for behaviour, medical conditions or medication. An immediate requirement was issued. Two other support plans seen included details of how assistance with independence was encouraged. Resident’s signatures were evident and residents spoken with were aware of their notes. Residents observed were supported in making decisions about their life styles and participate in the running of the home wherever able. Limetree Avenue Care Home DS0000008709.V271463.R01.S.doc Version 5.0 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13,15, 16 &17 Support plans viewed evidenced residents attendance at centres and social activities and maintaining links with family and friends and agreements within support plans. Staff and service users are involved in healthy eating programmes in the home EVIDENCE: Residents spoken with confirmed their attendance at day centres, involvement in domestic tasks within the home and how decisions are made at the home. Records of social activities were well maintained. Interaction was observed between residents and staff in the preparation of food. The menu viewed was varied and nutritious and residents commented on how they enjoyed the meals and being involved in planning and making decisions. Limetree Avenue Care Home DS0000008709.V271463.R01.S.doc Version 5.0 Page 11 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 &20 Residents receive personal support in a way they prefer and require and which meets their physical needs. Medication records were comprehensive and well maintained EVIDENCE: Residents spoken with commented that the staff helped them according to their wishes and enabled them to retain their privacy. Staffs were observed requesting permission to enter resident’s rooms and offering choices. The storage of medication keys was not maintained on the staff in charge of the shift. (An immediate requirement was issued on the day of the inspection.) Records of medication were well maintained. Limetree Avenue Care Home DS0000008709.V271463.R01.S.doc Version 5.0 Page 12 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22&23 Service users know how to make complaints and feel safe in the home. Recruitment practices ensure service users are protected. EVIDENCE: There have been no complaints in the past year. Service users interviewed were aware of their right to complain and said they would raise concerns with staff or the manager. Staff spoken with confirmed the recruitment practices were followed. Limetree Avenue Care Home DS0000008709.V271463.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 &30 The home meets the environmental requirements for the accommodated residents. A risk assessment needs to be completed for the wedging open of a resident’s bedroom. The home was clean and well maintained. EVIDENCE: The decor, furniture and fittings are of a good standard and the home is well maintained. All residents have single rooms. The first floor bedroom has ensuite facilities. A bedroom door was observed to be wedged open; staff reported that this was the resident’s wish. Health and safety tests are regularly carried out and records maintained up to date. Limetree Avenue Care Home DS0000008709.V271463.R01.S.doc Version 5.0 Page 14 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32, 33, 34 &35 Staffs were seen to be approachable and comfortable with the residents. The staffing levels at the time of inspection did not meet residents assessed needs. Staff training and supervision is up to date. EVIDENCE: Staff observed with residents appeared interested in and communicated well with residents. Service users confirmed that staffs treat them with respect. At the time of inspection the home was not sufficiently staffed to meet all the residents 24 hour needs. (An immediate requirement was issued on the day of the inspection) See standard. Staff spoken with reported that the organisation follows the recruitment policies and [procedures and checks are completed on prospective staff before commencement of work at the home. Supervision records were not seen but staff stated they were well supported by the manager. Staff training records viewed evidenced training attended. Staff spoken with confirmed that training is available and arranged to meet the changing needs of residents. Limetree Avenue Care Home DS0000008709.V271463.R01.S.doc Version 5.0 Page 15 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 &42 The health, safety and welfare of service users are promoted and protected and supported by a competent and accountable management of the service. EVIDENCE: The staff spoken with stated that the registered manager works shifts at the home and residents and staff said she and the senior staff provide good support and are well aware of individual residents needs. Fire safety and accident documentation are maintained up to date. Health and safety documents seen were maintained up to date. Staff reported that the service manager visits the home on a regular basis. No records of the visits were seen on this inspection. Limetree Avenue Care Home DS0000008709.V271463.R01.S.doc Version 5.0 Page 16 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X 3 X X X Standard No 24 25 26 27 28 29 30
STAFFING Score 2 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 Standard No 31 Score 3 2 3 3 X 3 3 2 3 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Limetree Avenue Care Home Score 3 3 2 X Standard No 37 38 39 40 41 42 43 Score 3 X 3 X X 3 X DS0000008709.V271463.R01.S.doc Version 5.0 Page 17 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 YA6 Regulation 18 Requirement The registered person must ensure that at all times suitably qualified, competent and experienced persons are working at the care home to meet the residents needs (Immediate requirement issued) Risk assessments must include details of action to be taken by staff (Immediate requirement issued ) The registered person must ensure that the medication keys are stored on the person in charge. (Immediate requirement issued ) The registered person must ensure that all adequate precautions are taken against the risk of fire Timescale for action 30/11/05 2 YA9 13 30/11/05 3 YA20ya 13 30/11/05 4 YA24 23 18/01/06 Limetree Avenue Care Home DS0000008709.V271463.R01.S.doc Version 5.0 Page 18 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 6 24 Good Practice Recommendations Include more specific detail of how care and support is provided in support plans Consider alternative method of wedging residents bedroom doors open Limetree Avenue Care Home DS0000008709.V271463.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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