Inspection on 01/08/06 for The Limes

This inspection was carried out on 1st August 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

The Limes 16/11/09

The Limes 25/11/08

The Limes 23/01/08

The Limes 22/08/07

The Limes 15/11/05

The Limes 02/06/05

The Limes 21/10/04

The Limes 02/06/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE The Limes 41/45 Church Street Bridgwater Somerset TA6 5AT Lead Inspector Kathy McCluskey Key Unannounced Inspection 10:15 1st August 2006 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 The Limes DS0000015987.V296020.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. The Limes DS0000015987.V296020.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Limes Address 41/45 Church Street Bridgwater Somerset TA6 5AT 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) 01278 422535 MR BRIAN THOMAS MRS ANGELA MARGARET BREWER Care Home 28 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (23) of places The Limes DS0000015987.V296020.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Registered for 23 persons in category OP and 5 persons in category DE(E) An additional bathroom equipped with assisted bathing facilities will be installed within 10 months from Date of Registration The large pond in the rear garden is protected in a manner which prevent accidents to vulnerable service users, within 8 weeks of Date of Registration 15th November 2005 Date of last inspection Brief Description of the Service: The Limes is located in a quiet but central part of Bridgwater. It is currently registered with the Commission for Social Care Inspection to provide personal care to up to 28 people over the age of 65, this includes 5 people who have a dementia. Service user accommodation is arranged on 4 floors, with lift access to all floors. All communal areas are on the lower floors. The registered provider is Mr Brian Thomas and the registered manager is Mrs Angela Brewer. The home is well maintained and furnished in comfortable domestic style. There are twenty-four single bedrooms and two double rooms. Twenty-three of the bedrooms have en suite facilities. The Limes DS0000015987.V296020.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection was conducted over one day (7.25hrs) by CSCI Regulation Inspector Kathy McCluskey. The registered manager was available throughout the inspection. At the time of the inspection 25 service users were living at the home, though 2 were out at a day centre. Two service users were in hospital. The home has one vacancy. A tour of the premises was carried out where all communal areas and the majority of bedrooms were seen. Records were examined relating to service users, staff, medicines and health and safety. As part of this inspection, CSCI comment cards were sent to 28 service users and their representatives. At the time of this report 16 completed comment cards were received from service users and 6 from relatives Comments received were positive and have been incorporated in the report. The inspector would like to thank service users, staff and the registered manager for their time and cooperation with the inspection process. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the service does well: The registered manager assesses prospective service users prior to a decision being made about moving to the home. Service users live in a homely environment where they are encouraged to personalise their private space. Service users have access to a large, well maintained garden. Service users spoken with were complementary about the care they received and of the food available at the home. Service users have access to a range of activities. The Limes DS0000015987.V296020.R01.S.doc Version 5.2 Page 6 The registered manager is very experienced and has established very good links with appropriate healthcare professionals. The registered manager is very knowledgeable regarding the needs and preferences of service users living at the home. What has improved since the last inspection? What they could do better: Although the home is registered for up to 5 people who have dementia, the registered manager ensures that the home is able to meet the individuals needs before offering a placement. For example the layout of the home may not be appropriate for people who like to wander. People who require a high level of staff supervision spend much of their day in the lower ground floor lounge. There is very limited space on this floor and it was not clear that these service users are offered an opportunity for choice. The home does not currently have mobile hoists in the home. The inspector was informed that this was due to limited space in some rooms. This must be reviewed to ensure that the needs of service users can be met. Care plans require improvement as they are not always reflective of an individuals assessed needs. Instructions for staff as to how to meet needs requires more detail. The home’s procedures for the management and administration of service users medication is generally good though further improvements have been recommended. The home needs to ensure that a record of accidents is maintained for service users as it was not clear that records were always being completed. The home needs to inform the CSCI of significant events. Records relating to staff supervision need improving. The Limes DS0000015987.V296020.R01.S.doc Version 5.2 Page 7 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 Limes DS0000015987.V296020.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Limes DS0000015987.V296020.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 and 5. Standard 6 is not applicable as the home is not registered to provide intermediate care. The quality for this outcome group is good. Prospective service users are provided with the information they need to enable an informed choice about moving to the home. The home ensures that prospective service users are assessed prior to a decision being made. EVIDENCE: The home has a statement of purpose and service user guide that continue to reflect the scope of the service offered. The inspector was not advised of any changes to these documents. The service user guide is not routinely given out The Limes DS0000015987.V296020.R01.S.doc Version 5.2 Page 10 to service users but is available in the entrance hall and individual copies are given out on request. The home also has a brochure, which gives very basic details about the home. The inspector was advised that the home’s current scale of charges range from £361 and £400 per week. Additional charges are met by the service user for toiletries, clothing, personal items, newspapers, trips out, hairdressing and chiropody treatment. As part of this key inspection, CSCI comment cards were sent out to all service users and their representatives. At the time of this inspection, 16 completed cards had been received from service users and 6 from relatives. Seven service users indicated that they had received enough information to enable them to make an informed decision about moving to the home. Four indicated that they had not received enough information as they ‘had come straight from hospital’ and that ‘my relative found the home’. Social Services have a contract for ten of the 28 beds at the home. The registered manager indicated that there is sometimes pressure to admit service users from hospital. The registered manager stated that she would always ensure that she visited prospective service users to carry out an assessment. The inspector was able to see evidence of pre-admission assessments and, where available, copies of assessments from other professionals in the care records examined. All prospective service users and their representatives are given the opportunity to visit The Limes prior to making a decision to make it their home. The home is registered to provide personal care to 28 service users over the age of 65 years of age. Within the maximum number of 28, the home also has a condition of registration that allows them to admit no more than 5 service users who have dementia. As the home has 5 service users in this category, they are reminded that no further service users should be admitted in the category of dementia at this time. As required at the last inspection, training has been provided for staff in the care of older people with dementia. The numbers and needs of service users with dementia will be further examined at the next inspection. The Limes DS0000015987.V296020.R01.S.doc Version 5.2 Page 11 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 and 11 The quality in this outcome group is adequate. Service user care plans require improvement. The home receives good support from visiting professionals. Service users are positive about the care they receive. The home’s procedures for the management and administration of medication is generally good though would benefit from further improvements. EVIDENCE: Four service user care records were examined at this inspection. Care records identified the preferences of service users and included the individual’s religious preference and preferences following death. The inspector noted that care plans were not always reflective of the individuals assessed needs and that interventions for staff on how needs should be met were limited. The Limes DS0000015987.V296020.R01.S.doc Version 5.2 Page 12 Some examples of this are as follows: Two service users were exhibiting challenging behaviour and a deterioration in their mental health needs. This was determined through discussion with the registered manager and had been documented in the individual’s ‘daily report records’. No care plans had been raised to address these needs. Monthly weights are recorded for service users and the inspector noted that one service user had lost a considerable amount of weight over a short period. No care plan was in place to address these needs. The care plan seen for a service user who is diabetic was very basic. Records indicated that the service user required weekly blood sugar monitoring. Although these records were being maintained, there was no information for staff as to what the acceptable ranges for the individual were or what action staff should take if blood sugar levels were outside of an acceptable range. It has been recommended that some basic information is available for staff on the signs and symptoms of hypo and hyperglycaemia and action to be taken for both. The registered manager needs to ensure that the moving and handling needs of service users are clearly identified. Information should include any aids used by the service user, the level of assistance required and the number of staff needed to assist the service user. The home should review the fact that there are no mobile hoists in use at the home. The inspector was advised that given the space restrictions within the home, it was not always practical to use a hoist. Accident records and care records indicated that there were occasions where service users fell and it was not clear how service users were assisted. Although care records require improvement, service users spoken with were positive about the care they received. Twelve service users indicated in the CSCI comment cards that they always received the care and support they needed. Three indicated that they ‘usually’ did. In the CSCI comment cards received from relatives/visitors, all confirmed that they were consulted and kept informed of important matters regarding the care of their relative. All service users are registered with a GP. The registered manager confirmed that the home had good support from visiting professionals including mental health professionals. In the completed CSCI service user comment cards, thirteen stated that they always received the medical support they needed and two stated ‘usually’. Service users spoken with at the inspection informed the inspector that they were treated with respect by staff. Many spoke of the kindness of staff and that they ‘would do anything for you’. During the inspection, staff were heard communicating with service users in a kind and respectful manner. The Limes DS0000015987.V296020.R01.S.doc Version 5.2 Page 13 The home’s procedures for the management and administration of service users medication were examined at this inspection and were found to be satisfactory. The home uses the monitored dosage system (MDS) with pre-printed medication administration records (MAR). MAR charts seen had been appropriately completed and included photographs of service users to aid identification. All medicines were found to be securely stored. Records and storage arrangements for controlled drugs were good. It has been recommended that the room storing medicines is monitored daily to ensure that the temperature does not exceed 25C. Several creams in use had not been identified with an expiry date. The registered manager maintains a list of all staff who have been trained to administer medicines. Records include the signature of staff members. The Limes DS0000015987.V296020.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 and 15 The quality in this outcome group is good. Service users are offered a range of activities. The majority of service users are supported to choose how and where to spend their day though this needs to be kept under review for less able service users and those with dementia. The home offers a wholesome and varied menu where choices are offered. EVIDENCE: The home has many activities, some organised by the home’s care staff and others by a dedicated activity worker. Records are maintained of activities undertaken these include music and singing, films, ball games, knitting, quizzes and trips out to the local town and cafes. Some staff have had training in reminiscence therapy and the home regularly hires prompt boxes. Many service users informed the inspector that they chose how and where to spend their day and were positive about the range of activities offered by the home. The Limes DS0000015987.V296020.R01.S.doc Version 5.2 Page 15 Eight service users who completed CSCI comment cards stated that there were ‘always’ activities arranged by the home that they can take part in. Six indicated ‘usually’. One service user who likes gardening, enjoys growing vegetables in a greenhouse in the garden. Individual preferences relating to hobbies/activities were seen in the care records examined. Records are also maintained in individual care records relating to activities that have taken place. No structured activities were seen taking place on the day of the inspection though service users in the lounges on the ground floor were busy either knitting, reading, chatting, watching TV or doing crosswords. Several areas of the lounges had been ‘personalised’ by service users with magazines, newspapers, photos etc. This made the areas appear very ‘homely’. A selection of bedrooms were seen and it was apparent that service users are encouraged to personalise their private space. The lounge on the lower ground floor was occupied by more dependant service users, the majority having dementia. Whilst pleasant music was playing, interactions by staff appeared limited during the time the inspector spent in the lounge. The majority of these service users remained in their chairs during the afternoon. The registered manager stated that these service users often spent time in the garden with staff assistance. Given that the lower ground floor does not afford many areas for service users to wander, the registered manager should keep this arrangement under review to ensure that these more dependant service users are offered variety and choice as to how and where to spend their day. No visitors were seen at this inspection though all CSCI comment cards received from relatives/visitors stated that they were made to feel welcome at any time and could visit their friend/relative in private. The inspector arrived in the dining room just as service users were finishing lunch. Although the meal was not observed by the inspector, service users were very complimentary about the home cooked food, especially the cooks pastry! The home makes good use of local fresh produce such as meat, fish, fruit and vegetables. This was confirmed by service users though some comments received included that they would like more new potatoes sometimes and ‘less mash’. The Limes DS0000015987.V296020.R01.S.doc Version 5.2 Page 16 In completed CSCI comment cards, nine service users stated that they ‘always’ liked the meals at the home and five indicated ‘usually’ Prior to lunch and later in the day, the inspector observed staff offering service users choices for lunch and tea. This was also confirmed by service users who were able to express a view. Cold drinks were available in communal areas for service users to help themselves throughout the day. The main dining room is situated in the lower ground floor. This is accessed by stairs or a shaft lift. The Limes DS0000015987.V296020.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 and 18 The quality in this outcome group is good. The home has an appropriate complaints procedure in place and the views of service users are responded to. The home has appropriate systems in place to reduce the risk of abuse to service users. The home’s whistle blowing procedures would benefit from information on abuse. EVIDENCE: The inspector was informed that the home has not received any complaints since the last inspection. No complaints have been raised directly with the CSCI. Service users spoken with during the inspection informed the inspector that they would not hesitate in raising concerns with the manager if they had any. Some service users informed the inspector that they were encouraged to raise any concerns/issues and their regular meetings. Service users indicated that their comments were listened to and responded to as appropriate. This was also indicated in the CSCI comment cards received from service users. All six comment cards received from relatives/friends stated that they had never had to make a complaint. The Limes DS0000015987.V296020.R01.S.doc Version 5.2 Page 18 The inspector was informed that all service users are registered to vote. Whilst no service user is currently using the services of an advocate the registered manager maintains contact details at the home. The home has a whistle blowing policy for staff though this relates more to the Public Disclosure Act and does not highlight abuse issues. It has been recommended that the home provides appropriate information for staff on the different types of abuse and action to be taken by staff should they suspect any form of abuse. The home follows appropriate recruitment procedures which include enhanced CRB checks and vulnerable adult checks (POVA). The Limes DS0000015987.V296020.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26 The quality in this outcome group is good. The home provides a ‘homely’ environment for service users and, given the layout of the home is more suited to more independent service users. The home is not best suited to those who like to wander or for those with a cognitive impairment. The home needs to ensure that it only admits service users who needs can be fully met at the home. Some areas of the home cannot accommodate the use of a mobile hoist. EVIDENCE: The Limes is located in a central residential area of Bridgwater, within walking distance of the town centre. It is a large older style building with service user accommodation set over 4 floors. The home has many staircases and a shaft lift giving access to all floors. There are also two stair lifts. A call bell system is fitted throughout the home. The Limes DS0000015987.V296020.R01.S.doc Version 5.2 Page 20 At the rear of the home there is a large well maintained garden area with a large fish pond. The pond has been suitably ‘guarded’ to ensure the safety of service users. The Limes provides a very homely atmosphere for service users though is not purpose built. Given the layout of the home, the home is best suited to service users who are more able and mobile. The majority of corridors are narrow and some bedrooms and bathrooms are quite small. As previously mentioned in this report, manoeuvring a mobile hoist in these areas would be very difficult. The home does not have a mobile hoist in the building at present and it has been recommended that this is reviewed as the inspector identified some incidences where a hoist could have been required. On the ground floor there are three lounge areas and a smaller room which is utilised as additional dining space. On the lower ground floor is the main dining area and an additional lounge. As previously mentioned in this report, this lounge is mainly used by more dependant service users and those with dementia. The only natural light to this lounge is from a patio door and the room can only be ventilated by opening the door. The home is looking into ways that the room can be more appropriately ventilated. There is little space on the lower ground floor for people to wander and because of the layout of the home it would be difficult for people using this room to find their way back to their own room if they wished to be alone. There are 26 bedrooms, 24 singles and 2 doubles. 23 of the bedrooms have en suite toilet facilities. There are communal bath/shower rooms on the ground floor, lower ground floor and second floor. All bedrooms seen by the inspector were comfortably furnished and had been personalised to reflect the individual tastes of service users. Some furniture within the home and bedrooms was looking ‘tired’. The plaster under a window in one upstairs bedroom required attention as it was coming off the wall. Lockable storage facilities are not available in all bedrooms. On examination of the premises some health and safety issues were noted. These included upstairs windows not restricted and some wardrobes not secured to the wall. The registered person is also required to provide warning signage on doors that open on to stairwells. Refer to Standard 38 Keypads have been fitted to external doors which are linked to the fire alarm system and automatically release in the event of a fire. A CCTV system covers all outside areas of the home. The Limes DS0000015987.V296020.R01.S.doc Version 5.2 Page 21 Hand washing facilities are appropriately sited throughout the home. On the day of this inspection, all areas of the home seen were clean and free from malodours. The Limes DS0000015987.V296020.R01.S.doc Version 5.2 Page 22 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 and 30 The quality in this outcome group is good. The home ensures that there are sufficient staff on duty over a 24 hour period. Staffs’ knowledge in caring for service users with dementia has improved. The home follows the correct procedures for the recruitment of staff. The home’s staff application form needs improving. EVIDENCE: The manager ensures that there are sufficient staff on duty throughout the day to meet the needs of service users. There are 4 care staff on duty each morning until 2pm, between 2 and 5pm this falls to 2 staff and then raises to 3 carers in the evening. At night there are two waking night staff. The manager’s hours and all domestic hours are in addition to this. Service users spoken with did not express any concerns about the numbers or skills of staff on duty. Six completed CSCI comment cards were received from visitors/relatives and all stated that there were sufficient staff on duty. The registered manager provided the inspector with details which indicated that of the 16 care staff, 8 had achieved an NVQ level 2 and the inspector was informed that more staff were due to commence this training. The Limes DS0000015987.V296020.R01.S.doc Version 5.2 Page 23 The inspector examined the recruitment records for the two most recent staff. Both contained information as required in schedule 2 of the Care Homes Regulations 2001, which included a CRB and POVA first check. It was recommended that the manager reviews its’ current staff application form to include a section for the applicant to sign and date the form and more space for employment history. The manager was advised to ensure that any gaps in employment history are explored. The registered manager maintains individual training records for staff to ensure that they receive appropriate mandatory and specialised training. Records indicated that all staff received training in dementia earlier this year by an external training. It has been required that the home ensures that there is a suitably qualified first aider on ever shift – Refer to Standard 38. The Limes DS0000015987.V296020.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36, 37 and 38 The quality for this outcome group is adequate. The registered manager is very experienced and promotes an open and inclusive style of management where the views of service users are encouraged. The home’s procedures for the management of service user’s finances need improving. Staff are supervised but records need improvement. The home’s procedures for ensuring the health and safety of service users, staff and visitors requires improvement. The Limes DS0000015987.V296020.R01.S.doc Version 5.2 Page 25 EVIDENCE: The registered manager of the home is Angela Brewer. She has worked at the home for 18 years and has been the manager for 5 years. She is currently undertaking the Registered Managers Award (NVQ Level 4). It should be noted that the scoring of ‘2’ at the end of this report does not reflect the registered managers ability to manage the home, merely that she has not yet achieved an appropriate management qualification as specified in the National Minimum Standards. There are no concerns regarding Angela Brewers ability to manage the home. The manager is able to demonstrate a good knowledge of staff and service users and liaises with other relevant professionals. Service users were positive about the manager and stated that they found her very approachable. Regular meetings are held for service users and staff. Minutes of the latest meetings were seen and it was apparent that service users and staff were encouraged to express their views. Questionnaires are sent out to service users and their representatives quarterly to seek their views on the quality of the service provided by the home. A selection received in May were examined and comments were positive. The home currently manages monies on behalf of three service users. The records and monies relating to these service users were examined at this inspection. Financial transactions had been confirmed by the registered manager and one of the owners. Receipts were available for transactions. When money held was checked against balances, in two cases there was an excess in cash held. Amounts ranged from £2 to £4.40. The inspector was very concerned about the large amount of cash that was being held for one service user. The registered manager stated that this was in the process of being addressed. It has been recommended that amounts held on behalf of service users do not exceed £50. It has also been recommended that service users monies and transactions are audited at least monthly. The registered manager informed the inspector that care staff received regular supervision sessions. The only evidence available to support this was a list of staff and dates supervision had taken place. The manager confirmed that she does not maintain records as to the content of the supervision. This is only completed in twice yearly appraisals. The Limes DS0000015987.V296020.R01.S.doc Version 5.2 Page 26 It has been recommended that the registered manager maintains appropriate records which demonstrate that supervision sessions cover those topics listed in Standard 36 of the NMS. It is good practise to ensure that the staff member signs to agree the record. The home’s procedures for ensuring the health and safety of service users, staff and visitors were examined and the findings were as follows: FIRE SAFETY – the home conducts weekly checks on the fire alarm systems and monthly checks on the emergency lighting. Annual checks on the home’s fire detection systems and fire fighting equipment are carried out by external contractors. EQUIPMENT SERVICING - The home has two bath hoists which were last serviced on 02/06/06. There are no mobile hoists currently in use in the home. The home’s shaft lift was last serviced on 03/01/06 and the two stair lifts on 24/10/05 ELECTRICAL SAFETY – The home has an up to date electrical hardwiring certificate dated 31/07/03, which is valid for 5 years. Portable appliances have recently been checked. GAS SAFETY – The home has an up to date annual Landlords Gas Safety Certificate dated 16/12/05. ACCIDENTS – The home maintains appropriate records for accidents though the inspector noted accidents for service users were not always being recorded. This was discussed with the registered manager at the time. It appeared that the home was not always advising the CSCI when service users were being admitted to hospital. The home must ensure that there is a suitably qualified first aider on every shift. The allocated staff member should be clearly identified i.e.; on the duty rota. On examination of the premises, the inspector found that a large majority of upstairs bedroom windows were not restricted and were wide open. The inspector was informed that restrictors were fitted but had been ‘disabled’ to ventilate the bedrooms. The home must ensure that where windows are not restricted, risk assessments must be completed and that appropriate action must be taken to ensure that this does not pose a risk to other service users. Bedroom doors were either open or unlocked and anybody could have accessed and been at risk. A number of wardrobes had not been secured to the wall. This requires attention to reduce any risk to service users. The Limes DS0000015987.V296020.R01.S.doc Version 5.2 Page 27 The Limes DS0000015987.V296020.R01.S.doc Version 5.2 Page 28 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 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 2 3 2 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 3 2 2 3 1 The Limes DS0000015987.V296020.R01.S.doc Version 5.2 Page 29 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 OP7 Regulation 15(1) Requirement The registered person must ensure that care plans are fully reflective of an individual’s assessed needs and that they contain clear instructions for staff. Particular attention must be given to psychological/mental health needs. Previous timescale of 31/12/05 not met The registered person must ensure that the moving and handling needs of service users are clearly identified in the plan of care. The home must review the use of mobile hoists to ensure that needs can be met. The registered person must ensure that care plans are raised for service users who have nutritional needs/weight loss. The registered person must ensure that there is a suitably qualified first aider on every shift. The registered person must ensure that records of all accidents are maintained and that the Commission is notified DS0000015987.V296020.R01.S.doc Timescale for action 10/09/06 2 OP7 15(1) & 13(4) 10/09/06 3 OP8 14(2) 30/08/06 4. OP38 13(4) 30/10/06 5. OP38 17(2) Schedule 4 (12) & 37(1) 10/08/06 The Limes Version 5.2 Page 30 6. OP38 13(4) of significant events. The registered person must take appropriate action to ensure that all wardrobes are secured to the wall. Where restrictors are removed from upstairs windows, a robust risk assessment must be completed and appropriate action must be taken to ensure that there is no risk to other service users. 20/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 3 4 5 Refer to Standard OP2 OP8 OP9 OP9 OP14 Good Practice Recommendations The terms and conditions should be updated to ensure that they give correct details of the registration body and complaints procedure. The registered person should give serious consideration to including in care plans for diabetics, appropriate information on diabetes and clear instructions for staff. The registered person should ensure that creams in use are identified with the open/expiry date. The registered person should ensure that the room storing medicines does not exceed the acceptable temperature of 25c. The registered person should keep the arrangements for those service users utilising the lower ground floor lounge, under review to ensure that the more dependant service users are given the opportunity to choose how and where to spend their day. The registered person should update the homes whistle blowing policy to include detailed information on the types of abuse and action to be taken by staff should they suspect any form of abuse. The registered person should ensure that lockable space is made available in all bedrooms. The registered person should ensure that the staff DS0000015987.V296020.R01.S.doc Version 5.2 Page 31 6 OP18 7 8 The Limes OP24 OP29 9 OP35 10 OP36 application form has a section for the applicant to sign and date. The application form should allow for detailed employment history to ensure that any gaps can be explored. The registered person should ensure that monies held at home on behalf of service users does not exceed £50. It is strongly recommended that records and balances are audited at least monthly. The registered person should maintain appropriate records relating to staff supervision. The Limes DS0000015987.V296020.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Limes DS0000015987.V296020.R01.S.doc Version 5.2 Page 33 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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