Inspection on 09/05/06 for Limetree Care Centre

This inspection was carried out on 9th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Limetree Care Centre 26/11/07

Limetree Care Centre 05/12/06

Limetree Care Centre 08/08/06

Limetree Care Centre 16/11/05

Limetree Care Centre 01/06/05

Limetree Care Centre 25/01/05

Limetree Care Centre 03/06/04

Limetree Care Centre 01/03/04

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

CARE HOMES FOR OLDER PEOPLE Limetree Care Centre 8 Limetree Close London SW2 3EN Lead Inspector Lynne Field, Mary Magee & Vashti Maharaj Unannounced Inspection 9th,13th,23rd & 31st May 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Limetree Care Centre DS0000043119.V290330.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. Limetree Care Centre DS0000043119.V290330.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Limetree Care Centre Address 8 Limetree Close London SW2 3EN 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) 0208 674 3437 0208 674 3949 mohamed.madarbux@excelcareholdings.com Limetree Healthcare Ltd Care Home 92 Category(ies) of Dementia - over 65 years of age (28), Mental registration, with number disorder, excluding learning disability or of places dementia (6), Old age, not falling within any other category (64) Limetree Care Centre DS0000043119.V290330.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th November 2005 Brief Description of the Service: Limetree Care Centre is a modern, purpose built home. It is located just off the South Circular Road between Tulse Hill and Streatham Hill. It is owned and managed by Excelcare Holdings. Limetree offers residential and nursing care for older people suffering from dementia; there is one residential floor and two nursing floors. There are 92 service users all with their own bedroom with full en suite facilities. On the day of inspection there were 6 vacancies. The registered person informed CSCI that information about the service is available in documents called the “statement of purpose” and the “service user guide”. These documents are available in the entrance hall along with the recent CSCI inspection report. Copies of the statement of purpose” and the service user guide are available on request and are given to people considering living at the home, their relatives and current service users. The registered person said the current range of fees is charged from £350-00 per week. Additional charges are made for things such as hairdressing and newspapers. Limetree Care Centre DS0000043119.V290330.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection consisted of three visits during May 2006 as well as a pharmacy inspection. During the early part of 2006 CSCI inspection visits to the home had identified a failure to meet some of the national minimum standards and The Care Homes Regulations 2001. The failure included the need for the service to have a registered manager. The failings were such that CSCI served a notice on the home of the intention to impose a condition of registration. The proposed condition is not to allow the admission of new service users to the home until such time as the acting manager is registered by CSCI. And there have been improvements to the quality of care. A separate enforcement notice was also served relating to the need for care plans to be drawn up with the involvement of service users and relatives or representatives. Since the enforcement action taken by CSCI the provider has responded by appointing a senior manager to provide a dedicated management presence at the home. The provider has also provided CSCI with information about the actions they are taking to improve the service as well as comply with the enforcement notice. This inspection focussed on the assessment of the key national minimum standards as well as assessment of outstanding requirements given in previous reports. On the first day two inspectors spent nine hours inspecting all floors of the home, including speaking to twenty staff, from senior managers through to domestic staff, service users, relatives and two visiting professionals. Documents and records the home is required to keep were also inspected. The second visit involved one inspector visiting three relatives and speaking to the relatives of ten service users and five staff. The third visit was to see how work was progressing and to look at the environment. Some of the information in this report was gathered from other professionals and relatives before and during visits to the home. The CSCI pharmacy inspector spent one afternoon inspecting the medication of the home. The findings are incorporated into the report. What the service does well: The environment and Health and Safety within the building is well maintained. Staff training for care staff in NVQs is ongoing. Management deal with complaints quickly. Limetree Care Centre DS0000043119.V290330.R01.S.doc Version 5.2 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 report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Limetree Care Centre DS0000043119.V290330.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 Limetree Care Centre DS0000043119.V290330.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): 3,4 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Improvements are needed to the assessment information obtained about service users and their needs. This is particularly important in terms of those service users who have dementia. EVIDENCE: The inspectors viewed seventeen needs assessments that had been completed for service users. They found that not all were reflecting their full individual needs. Pre-admission assessments are completed for all service users prior to admission. Not all service users have information on lifestyle preferences or life reviews. There were examples of assessments for service users that lacked essential information such as the need for staff to explore fully with individuals and / or their families about service users preferred lifestyle. One statement had the following comment recorded in history and interests section on the assessment “ as no interests”. As a result care plans for activities of daily living are not Limetree Care Centre DS0000043119.V290330.R01.S.doc Version 5.2 Page 9 developed to meet individuals care needs. Service users specific needs relating to dementia also need to be recorded and provided for. Requirements are given about both these matters. This was confirmed at a relatives meeting the inspector attended where a number of relatives said they had not been asked to be involved with the care planning or been asked for any information. The senior management team, who were at the relatives meeting, suggested that after the meeting the relatives speak to them and the team leaders to discuss this and arrange to meet to help complete the care plan. Since that meeting, the inspector has met with one relative who has done this. They said they knew the team leader writing the care plan “meant well” but they expressed a concern that the care plan of their relative was written in “a muddled way” that did not clearly express their relatives wishes and needs. Limetree Care Centre DS0000043119.V290330.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): 7,8,9,10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users are not having all their health care needs fully assessed or recorded. For example, in the areas of weight loss recording and the recording of routine daily care. This lack of assessment and recorded information means essential health care needs and social needs of the service users are at times not met. There is a medication policy which is accessible to staff. Medication records are generally up to date for each service users and medicines received, administered and disposed of are recorded. There is evidence of one service user administering their own medication safely. The home understands the need to comply with the administration, safekeeping and disposal of controlled drugs. Where medication systems are in need of action the registered person is working towards improvement. EVIDENCE: A total of seventeen service users’ daily records from all three floors were viewed during the inspection. These varied in terms of consistency and Limetree Care Centre DS0000043119.V290330.R01.S.doc Version 5.2 Page 11 accuracy. Some contained evidence of the care provided it was in agreement with care plans. This was a requirement from the previous inspection that care plans are kept up-to-date and contain clear guidance to staff on the actions to be taken to meet their health care needs. Professional guidance must be incorporated into care plans and followed. All changes must be documented and reflected in the care plans. The home has put a lot of effort to develop these but at the time of this inspection it was identified that further work was needed. In agreement with the provider the timescale for this work has been extended. (See requirement 9) The inspector observed staff knocking on service users bedroom doors before entering and making sure bedroom and bathroom doors were shut before helping service users with personal care. During the relatives meeting there was a discussion about who could view the care plans because there could be information in them the service user would not want their families to know about. The consensus of opinion was that only the next of kin should see these unless the service user gave their permission. There were examples seen by the inspector of occasions when staff did not always follow agreed care plans. An example was seen where a service user’s care plan advised staff to support her to get out of bed and to sit in her chair to relieve unnecessary pressure that might lead to a breakdown in her skin. Daily records when examined showed that this was not always followed. Other records seen had numerous inconsistencies. These included waterlow and bowel charts that were completed sporadically. As a result these records are of little assistance in monitoring individuals health needs. The inspector noted from the records that the guidance on the monitoring of service users with a history of poor eating habits and weight loss, such as recording what was eaten by the service user and being weighed weekly, was not always followed. This has resulted in substantial weight lose, going unnoticed. There were some record of falls and accidents that were not linked into care plans. Although there were risk assessments present, some of these were not updated to reflect of changes in risk management. Examples were seen on records of service users that experienced frequent falls and not appropriate follow-ups on risk assessments. A number of records checked by the inspector showed that when a service user had had a fall that individual should be monitored regularly over a short period of time to observe any changes to the service user. Diary and daily records indicated that this was not always done. This applied particularly at night. For one service user who had fallen, there was written guidance recorded for staff that stated the service user should be observed every half hour and that the service user was unable to use the call bell. The records of the actions taken by night staff was not in accordance written guidance laid down in the care plans. It was recorded that they were observed hourly or less frequently. Limetree Care Centre DS0000043119.V290330.R01.S.doc Version 5.2 Page 12 The inspector noted that copies of accident and incident records are not kept in service user files and records of actions taken following the falls are not being recorded correctly, either. This could mean any carer looking at a service user’s file would not be aware of previous accidents or incidents. One service user attended hospital to be checked over following a fall. The accident report and daily record differed on the follow up action. When the inspector spoke to staff about this they did not know whether the service user had attended the hospital or not. As referred to earlier regarding needs assessments these must be completed more fully so that a plan of care is drawn up with each service user and provides the basis for the care to be delivered. Service users experiencing dementia had little in the way of stimulation. There were adequate numbers of staff were on duty but their times were not always used appropriately. One carer was observed sitting in the lounge to ensure the service users safety but did not take the opportunity to or was unaware of using this time to interact with the service users. The inspectors noticed through out the inspection there was very little in the way of stimulation apart from a group sing along in the afternoon. The inspector spoke to the staff about how they could engage with service users by offering them drinks and by just speaking to them for short periods of time about something they knew they liked. During this period apart from meal times there was not appropriate stimulation taking place. Even at meal times some service users had their meals brought to them where they were sitting, so did not even have the stimulation and interaction of being moved. The pharmacy inspector conducted a visit to inspect the medication and issues regarding medication within the home. The findings are as follows: Medication handling has improved since the last inspection by the CSCI Pharmacist. There were no out of stock medicines, the GP and supplying Pharmacy are providing a reliable service, service users have had medication reviews, storage facilities are acceptable and the home is conducting regular audits on each unit to pick up and address issues with medication handling and recording. Only one service user is self-administering medication. Although this is low for such a large home the home is now going to assume that service users will self-administer their medication unless they have been risk assessed as not being able to. Limetree Care Centre DS0000043119.V290330.R01.S.doc Version 5.2 Page 13 Covert administration of medication has been discussed and agreed for some service users. Although the home is working to the NMC Guidelines on covert administration there should be an individualised procedure on covert administration including the steps to take to improve compliance before resorting to covert administration. For example, the use of liquid medicines, different strengths and formulations to decrease the number of doses needed daily. Some instructions on medication administration records (MAR) charts are written in Latin. If the GP writes any Latin instructions on a chart, for example,po od, the home must write the full English instructions. For example, one tablet once a day. Not all staff will be able to interpret Latin instructions. A system to ensure medicines refusals are notified to the GP in time should have been implemented in February 2006. However, this has not happened. The list of staff authorised to administer medicines is out of date, as it does not contain the names of all staff who have been administering medicines. And it has been authorised by a previous manager. The control of external products has improved. However, one unit was not recording when externals are applied. One service user has been refusing blood glucose monitoring for several months. This service user is on diet control, so the readings are not as critical as if they were on oral anti-diabetics or insulin. It would be good practise to indicate the frequency of testing on the blood glucose monitoring sheet e.g. daily, weekly, and also to state what action has been taken by the home for high/low readings or if a service user does refuse monitoring. The Homely Remedies list was authorised by the GP in 2003. It is good practise to request an annual review of this list, as service users who cannot have homely remedies must be identified and ideally added to this list, or a note made in their care plans that they cannot take certain homely remedies. Administering medicines, and it has been authorised by a previous manager. Limetree Care Centre DS0000043119.V290330.R01.S.doc Version 5.2 Page 14 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 outcome area is adequate. This judgment has been made using available evidence including a visit to this service. Service users are able to exercise a limited choice. There is insufficient information recorded of service users interests and there is very limited activity to choose from. Food provision and service was seen to be good. EVIDENCE: The inspector found the routines adopted by the home are not flexible or varied and give an institutional feel to the lifestyles experienced. As stated previously a member of staff sat in the lounge with service users during the afternoon to ensure their safety. During this period the inspector observed that they did not engage with service users throughout this time and showed little empathy with them. Information is posted in the building of availability of representatives from various denominations attending the home for regular spiritual observance. Of the twelve service users files were inspected during the course of the inspection it was found four service users files did not have sufficient Limetree Care Centre DS0000043119.V290330.R01.S.doc Version 5.2 Page 15 information recorded in their assessments of their interests or the way they would like to spend their day. One service users husband told the inspector the staff had tried very hard but he said “for some reason it still was not right”. Activities are arranged for groups with no consideration given to individualising leisure or recreational activities. The home accepts a large number of service users that experience dementia. There is a lack of provision for these people or for those that are cognitively impaired. The regional area manager told the inspectors that the organisation had reviewed the needs of the service users and how the activities service was delivered. This is in the process of being restructured and the organisation has employed a regional activities manager to develop the activities service within the care homes it owns across London. The inspector spoke to the regional activities manager who explained how she was working with the home’s activities coordinators to assess each service user and develop a program to suit their individual needs but this was still in an early stage of development. Part of the redevelopment program is to make care staff aware that part of their role as a carer, they need to interact with the service users when they are giving personal care and support and to think of activities as part of every day living. A requirement has been given about service users being consulted about activities they would like to do. On the day of the inspection, the inspectors noted that many service users needed assistance with eating. The home is adopting the protected time for meal times. This means no other activities such as administering medication takes place during this time. Staff on duty are not expected to take their break at this time and all staff are expected to assist service users eat. Staff told the inspectors that this is working well and as the medication is not being dispensed at meal times, team leaders are able to assist service users to eat their meals. At mealtimes there were appropriate numbers of staff present to assist the service users to eat their meals. During this time the inspector observed some good interaction between staff and service users, for instance one member of staff was gently holding a service users’ hand as she was being helped to eat. At breakfast service users were not given the choice of having breakfast in their rooms or at a time that they preferred. At lunch and supper times meals were served in dining rooms at set times. The inspector was pleased to see that the meals served had improved since the previous inspection in February 2006 and appeared appetising and nutritious. The inspectors met and spoke to five sets of relatives on the day of the inspection. One service users’ wife told the inspector the staff always made her feel welcome when she came in to see her husband. Limetree Care Centre DS0000043119.V290330.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaints are taken seriously and investigated properly. Service users and their families know their complaints will be listened to and acted upon. At times service users are at risk because of a lack of staff knowledge about service users needs and lack of information in the care plans as well as through lack of accurate record keeping. The management team are collating information to enable a preventative strategy to be developed. EVIDENCE: Complaints are now responded to in a more positive way although there are number of outstanding complaints that are still being investigated and being dealt with. The inspector attended the relatives meetings. Although the relatives who attended were very positive, out of a home of ninety-two service users, only eleven service users families attended. These were held floor by floor to allow relatives to discuss issues in smaller groups that were relative to that floor. The home has also set up monthly surgeries where relatives can come in without an appointment and discuss any concerns with the senior management team. The home is planning to canvas service users families to try to discover what would encourage them to attend relatives meetings. The regional manager and Lambeth’s adult protection coordinator told the inspector most staff has received training in the protection of vulnerable adults over recent months. The home manager showed the inspector a copy of the Limetree Care Centre DS0000043119.V290330.R01.S.doc Version 5.2 Page 17 homes training matrix. Copies of certificates of the courses staff had attended were kept in individual staff files There is evidence on file and through complaints received by the home and made to Lambeth’s adult protection coordinator that staff are not always robust in responding appropriately when a change is identified in a service user’s condition. In several instances service users have had small bruises or cuts noticed by members of staff, and at times by relatives, yet some time had lapsed before these were responded to appropriately by staff. Although staff have had training in Adult protection, from the incidents recorded demonstrate that not all staff are competent at protecting service users from harm and abuse. For insistence there have been a number of instances where there have been unobserved falls. The regional area manager told the inspector the home was collating all incident / accidents to see if a pattern can be identified to enable a preventive strategy to be put in place. Limetree Care Centre DS0000043119.V290330.R01.S.doc Version 5.2 Page 18 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): 19,24,25,26 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The home is comfortable, accessible and suitable for its purpose. It was seen to be clean and well maintained. EVIDENCE: The home is modern and comfortable, accessible for all service users and well maintained. All service users have comfortable single bedrooms, which are well furnished and meet the needs of service users. There is a variety of communal space on each floor, which caters well for the needs of service users. The small kitchenette door from the dining area has had the smoking room sign taken off the door, as they are not smoking areas. The inspector was told that although there was a sign on the door stating “Smoking Room” these have never been used as such. Limetree Care Centre DS0000043119.V290330.R01.S.doc Version 5.2 Page 19 All bedrooms have an en-suite shower and there are other assisted bathing facilities. This provision is more than adequate and at the relatives meeting, it was confirmed by relatives and the management team there were adequate shower chairs to meet the service users needs within the home. The inspector was told and shown how the home was addressing the problem of the home being excessively hot. The solid doors at each end of the corridors leading onto the stair well were being replaced with louvered doors. This would provide through ventilation. The heating system had been serviced and faulty valves had been replaced. The regional area manager showed the inspector how the lounges had been rearranged to make them more homely. He told the inspector of the plans to utilise more of the space and try to divide the service users into smaller groups. Rather than have a lounge and dinning room, each room will have a dinning area and a sitting area with groups of service users sitting in each. Some of the nurses’ stations had been moved so staff working at these could observe the service users. Limetree Care Centre DS0000043119.V290330.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. The skills and competency of a number of the staff team still need to be developed in areas such as dementia and moving and handling training. Files viewed show that recruitment procedures are robust and that all the necessary information is sought before staff are appointed. EVIDENCE: On the day of the inspection there were adequate numbers of staff on duty. However, staff deployment to enable positive interaction with service users, particularly those with dementia, was not always appropriate in making provision for service users. Not all service users have their needs met fully. Service users experiencing dementia had little in the way of stimulation. There are a number of staff that demonstrate good working practices in a kindly way and share an empathy with older people. The inspectors observed staff assisting service users to move using the hoist and it was evident to the inspector through how they assisted the service user and handled the lifting equipment as well as the distress of the service user that this was not how they usually moved the service user. The requirement given at the most recent inspection, for staff to have their manual handling Limetree Care Centre DS0000043119.V290330.R01.S.doc Version 5.2 Page 21 needs assessed, is reinstated in this report. Ongoing training is needed to reinforce good manual handling practices within the staff team. Ten staff files were inspected and there was evidence that all necessary measures are taken during recruiting to safeguard service users. Each file inspected had copies of the application forms, two references from their last employer and copies of the member of staff’s identification. The manager told the inspector they had gone through all the staff files and all staff had enhanced CRB checks. The inspectors were shown copies of the CRB and POVA checks that were on file. All were being properly undertaken and recorded. Team leaders and senior staff told the inspector they did not feel supported by the senior managers of the home. They said senior management within the home were not listening to staff when they were informed about poor practices and so poor practice was not being dealt with appropriately. The inspector spoke to one senior member of staff who told her although they were a trained nurse they felt they needed help managing the staff team. Senior staff have not had management training and may not therefore have the management skills to manage and supervise the number of staff in the home. Senior managers will need to develop their management and supervisory skills to assist senior staff and care staff develop into an effective, competent team that consistently meets the needs of the service users. Team meetings were happening but staff did not find these a positive experience. Limetree Care Centre DS0000043119.V290330.R01.S.doc Version 5.2 Page 22 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): 31,32,33,35,36,37,38 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. Some progress has been made by the management team and the provider to improve the service provided. However, there are still areas to address and the acting manager must complete the registration process with CSCI. Feedback from staff suggests that there are still staff development and teamwork issues to be addressed. EVIDENCE: The manager has been in post for about seven months and has applied to be the registered manager. Team leaders told the inspector they did not feel supported by the management team. One relative told the inspector that they thought the lack Limetree Care Centre DS0000043119.V290330.R01.S.doc Version 5.2 Page 23 of experience in the team leaders has lead to staff managing themselves. They said they observed that when something was done and the member of staff questioned as to why they had done it that particular way, staff have reacted in an undisciplined way, which in turn has lead to service users not receiving a service that meets their needs. This, they felt, indicates that the home is not run in the best interests of service users. The home is not an appointee for any of the service users. The inspector was told that when service users come to live at the home, service users families are encouraged to take on the appointeeship. For those service users who do not have anyone who can or is willing to be their appointee, the home asks the local authority to be their appointee. The inspector was shown supervision records for two of the senior staff but these were not kept on the staff files. Some staff told the inspector they are having supervision, but when questioned about it, it was clear they did not understand what was meant by supervision. Customer satisfaction surveys have been conducted to seek the views of service users, relatives and visiting professionals but on the day of the inspection these still need to be collated and the summarised results are fed back at meetings for staff and relatives. Since the inspection the inspector has been informed these have been collated and are on public display throughout the home. Service user meetings are rarely held, as most of the service users are unable to take part. Relatives meetings have been held recently but as stated previously were poorly attended. Limetree Care Centre DS0000043119.V290330.R01.S.doc Version 5.2 Page 24 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 2 2 X x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 X X X X 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 3 2 2 Limetree Care Centre DS0000043119.V290330.R01.S.doc Version 5.2 Page 25 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 OP3 Regulation 14 (1) a,b,c,d Requirement The registered person must ensure that service users have a comprehensive needs assessment completed in consultation with them and /or their representative, having regard to the service user’s needs in respect of health and welfare. This assessment must be kept under review. The registered person must ensure that the home meets the special needs of service users suffering from dementia. Previous requirement of 31/03/06 not met. The registered person must ensure that the information in care plans relating to the recording of weight loss is followed by the staff at all times. The registered person must ensure that the information in care plans relating to the following and recording of bowel charts is followed by the staff at all times. The registered person must ensure that the information in DS0000043119.V290330.R01.S.doc Timescale for action 01/08/06 2 OP4 12(1) (a) 18(1)(a) 01/08/06 3 OP8 12 (1) (a)(b) 01/08/06 4 OP8 12 (1) (a)(b) 01/08/06 5 OP8 12 (1) (a)(b) 01/08/06 Limetree Care Centre Version 5.2 Page 26 6 OP8 12 (1) (a)(b) 7 OP8 13(4)(c ) 8 OP8 Sch3 3 (j) 9 OP7 15(1)2(c) 10 OP8 OP7 12 (1) (a)(b) 11 OP9 12(2) 12 OP9 13(2) care plans relating to the following and recording of waterlow scores is followed by the staff at all times. The responsible person must ensure that night staff follow the written guidance in the care plans and record the actions taken. The registered person must ensure that risk assessments are reviewed to reflect any changes in the risk management of the service user. The registered person must ensure that copies of accidents and incidents relating to the service user are kept in their files. The registered person must ensure that care plans are drawn up with service users and/or their relatives and risk assessments for the use of bed rails where appropriate. Previous requirement of 31/01/06 not met. The registered person must ensure that the home is conducted in such a manner that makes proper provision for the health and welfare of service users. Care must be delivered in accordance with agreed care plans and guidance. A record of care and support given to service users must be accurately recorded on all relevant documents. The registered person must ensure that all service users are given the opportunity and support to self-administer their medication unless they have been risk-assessed as not being able to. The registered person must ensure that an individualised DS0000043119.V290330.R01.S.doc 01/08/06 01/08/06 01/08/06 01/08/06 01/08/06 31/08/06 31/08/06 Page 27 Limetree Care Centre Version 5.2 13 OP9 17 (1)(a) 14 OP9 13(2) 15 OP9 17(3)(a) 16 OP9 17 (1)(a) 17 OP12 16 (2) m,n. 18 OP30 OP28 OP27 18 (1) a 19 OP31 9(2)(b) procedure is available on the handling of covert administration of medication. The registered person must ensure that all instructions on MAR charts are written in English. The registered person must ensure that the system on the handling of refusals of medication is implemented. The registered person must ensure that the list of staff authorised to administer medication is up to date. The registered person must ensure that the use of all prescribed items is documented, in particular external products. The registered person must ensure that service users or their representatives are consulted about their interests and favoured lifestyles, these must be recorded and appropriate opportunities are given to service users in relation to meeting these needs. The registered person must ensure that at all times qualified competent and experienced persons are working at the home to ensure consistency and continuity of care for service users. The registered person must ensure the manager has the skills for managing a care home. 01/08/06 31/08/06 01/08/06 01/08/06 01/08/06 01/08/06 01/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Limetree Care Centre DS0000043119.V290330.R01.S.doc Version 5.2 Page 28 No. 1 Refer to Standard OP9 Good Practice Recommendations The registered person should ensure that the frequency of all blood monitoring is indicated on the blood-monitoring sheet, including the action to be taken for high/low readings, or refusals to have monitoring carried out. The registered person should ensure that the Homely Remedies list is authorised by the GP annually and that any residents who cannot be given one or more Homely Remedies are identified. 2 OP9 Limetree Care Centre DS0000043119.V290330.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH 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. 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