Inspection on 11/10/05 for The Limes

This inspection was carried out on 11th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Limes 08/02/07

The Limes 26/05/05

The Limes 07/10/04

The Limes 15/04/04

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

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

CARE HOMES FOR OLDER PEOPLE Limes, The The Limes 43 Foreland Road Bembridge Isle of Wight PO35 5XN Lead Inspector Neil Kingman Unannounced Inspection 11th October 2005 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 Limes, The DS0000054200.V249012.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 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. Limes, The DS0000054200.V249012.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Limes, The Address The Limes 43 Foreland Road Bembridge Isle of Wight PO35 5XN 01983 873655 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) the_limes@tesco.net Mrs Susan Jennifer Betteridge Mrs Alison Neve-Dewen Mrs Lynne June Preston Care Home 32 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (18), of places Physical disability over 65 years of age (9) Limes, The DS0000054200.V249012.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26 May 2005 Brief Description of the Service: The Limes is a care home providing personal care and accommodation for up to 32 older people. It is located in a residential road in Bembridge village; a few minutes walk from a range of local shops and the nearby beach. There is some off road parking for visitors or on road parking is to the front of the premises. The accommodation offers a range of mostly single rooms on 3 floors, all with en-suite facilities. Access for residents is via a passenger lift to all but 4 rooms on the mezzanine floor, which are not suitable to be occupied by people with mobility difficulties. There is access to an enclosed garden at the rear with a seating area for residents. Limes, The DS0000054200.V249012.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second of two unannounced inspections for the year at The Limes and took place over 6¼ hours. The manager was not available on the day so the inspector returned on 13 October 2005 to discuss the outcome with her. The inspector toured the building, examined a selection of records and spoke with nine residents, four care staff and a visitor. Residents were spoken with both as a small group in the dining room and individually in the privacy of their rooms. A total of eight questionnaires were received from residents, visiting relatives and social care professionals. Comments about the service were generally very positive and no concerns were raised. What the service does well: What has improved since the last inspection? On 8 August 2005 an additional inspection of The Limes was carried out in response to a complaint that comprised ten elements, broadly around resident’s safety, qualifications of staff and recording in care plans. Three elements were partially upheld and seven were not upheld. There was one requirement and six recommendations arising from that inspection. A follow-up to these issues was carried out during this inspection. The home was found to be meeting the requirement and five of the six recommendations. Advice was given in order for the home to move forward with the outstanding recommendation. Additionally the inspector noted the following improvements: • • The ground floor hallway redecorated. Additional radiator covers fitted. DS0000054200.V249012.R01.S.doc Version 5.0 Page 6 Limes, The • • The home’s central heating system overhauled. A new sewer installed at the front of the building. What they could do better: The registered person needs to address the following issues identified during the inspection: • The manager confirmed that a misunderstanding of the procedure led to new care staff commencing work before appropriate clearance had been obtained, even though the criminal record checks had been sent off as required. Based on comments received a review of the activities on offer is recommended. Views sought by way of a resident’ meeting may assist in the process. • 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. Limes, The DS0000054200.V249012.R01.S.doc Version 5.0 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 Limes, The DS0000054200.V249012.R01.S.doc Version 5.0 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): 5 and 6 The Limes encourages and provides opportunities for prospective residents to visit the home and to move in on a trial basis, before they and/or their representatives make a decision to stay. The Limes does not provide dedicated accommodation for short-term intermediate care or specialised facilities for rehabilitation. Limes, The DS0000054200.V249012.R01.S.doc Version 5.0 Page 9 EVIDENCE: Residents are routinely admitted to The Limes on a trial basis and preadmission visits are flexible according to their wishes and circumstances. In conversations with the proprietor and manager it was clear that the two most recent admissions were as a result of emergency situations where both residents had been in hospital prior to moving into the home. Records showed that the manager had carried out pre-admission assessments at the hospital. In both cases there had been a friend or relative familiar with the home who was able to recommend it. The inspector spoke with two residents who had paid visits to the home before actually moving in full time. One said she had received a period of short-term respite care and liked the home so much she decided to stay. Where admissions are planned there are opportunities for prospective residents to view their room, and to meet staff and other residents before making the decision to stay. In some cases an opportunity may arise for a resident to move to another room within the home. This was apparent in discussions with two residents. With emergency situations the resident is assessed and given information about the home in the first few days after admission. A copy of the home’s service users’ guide is available in each room. Most residents at The Limes are long term. The home does not provide dedicated accommodation for short-term intermediate care or specialised facilities for rehabilitation. The home’s statement of purpose includes the provision of respite care, which is offered when accommodation is available. There was no evidence that the provision of this service has a negative impact on the resident group. Limes, The DS0000054200.V249012.R01.S.doc Version 5.0 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): 10 The home ensures that staff respect residents’ privacy and dignity at all times and responds to issues as and when they are raised. EVIDENCE: During the inspection the inspector noted that staff at all times treated residents with respect and addressed them by their preferred name. While staff were seen to knock before entering rooms it was noted that many residents preferred their room doors to be held open. Approved devices were fitted to the doors in each case. Many have their own telephone installations; those with a sight impairment have a phone with large numbers. There is a pay phone in the lounge for residents’ use and they can use the home’s portable phone if privacy is required. Residents’ rooms are spacious with ample room in which to receive personal care, consultations and examinations by health and social care professionals. Shared rooms are used as singles except when a specific request to share is made. Limes, The DS0000054200.V249012.R01.S.doc Version 5.0 Page 11 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 and 13 Residents are encouraged to maintain their independence with flexible routines within the home. While there was once a range of activities on offer throughout the week activities are now limited to just two days. Development of leisure and recreational activities is recommended to increase opportunities for stimulation, in line with residents’ needs, preferences and capacities. Visitors are welcome at all reasonable times and are able to meet with residents in private. EVIDENCE: The inspector received mixed messages about the activities on offer at the Limes. All residents who had filled out a satisfaction questionnaire felt the home provided suitable activities. Those spoken with during the inspection were less certain. They were clear that something musical took place each week but three residents said they were not interested in taking part, due either to mobility difficulties or other interests. One in particular was independent enough to go out each day to the local shops and even by bus to the library in Ryde. Two preferred their own company in their rooms and chose their visits to the dining room at meal times as opportunities for social interaction. The manager said that the full range of daily activities had Limes, The DS0000054200.V249012.R01.S.doc Version 5.0 Page 12 dwindled to just two days, due either to the activity being unavailable or to lack of interest on the part of the residents. On the morning of the inspection an outside provider was organising games and exercises in the lounge. This was attended by approximately one third of the resident group. Based on comments received a review of the activities on offer is recommended. Views sought by way of a resident’ meeting may assist in the process. The home aims to meet residents’ spiritual needs with communion once each month and supporting those who wish to attend church on a Sunday. Visiting arrangements can be found in the Service Users Guide. Visitors are welcome at all reasonable times but the home asks them to respect meal times. Residents can receive visitors in their own rooms, the conservatory, lounge, or if privacy is required a secluded part of the dining area can be used. During the course of the inspection several relatives came to visit residents. The inspector noted that staff made them feel welcome and the atmosphere was always warm and friendly. Limes, The DS0000054200.V249012.R01.S.doc Version 5.0 Page 13 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): 18 The home’s policies, procedures and practices ensure that residents are safeguarded from abuse. Procedures for responding to suspicion or evidence of abuse are robust. EVIDENCE: The home has its own adult protection policy, which is clear and concise. It links with the policy guidance provided by Isle of Wight social services. Staff spoken with during the inspection showed an understanding of how to recognise abuse and were very clear about reporting issues of concern without delay. Limes, The DS0000054200.V249012.R01.S.doc Version 5.0 Page 14 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): 20 and 21 The home’s communal areas are comfortable and spacious. There is level access into the home and out to the rear garden. Toilet, washing and bathing facilities are provided in sufficient numbers to meet the needs of the residents. EVIDENCE: The home’s collective communal space comprises 2 lounges, a large dining room divided into 2 areas and a conservatory stocked with flowerbeds. There is sufficient accommodation suitable for the provision of social activities and for residents to meet visitors in private. The inspector noted lounges to be bright with a good standard of decoration and furnishings. Every resident’s room has an en-suite facility. There are a further 6 separate accessible toilets with one sited near to the dining area/lounges. There are 2 assisted baths and a walk-in shower. Limes, The DS0000054200.V249012.R01.S.doc Version 5.0 Page 15 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 and 29 Staff at The Limes have the necessary skills and experience to meet residents’ needs and ensure they are in safe hands. While the procedures for the recruitment of staff are generally robust safety checks (POVA First checks) must be carried out before new staff commence work, to ensure the proper safeguards that offer protection to people living in the home. EVIDENCE: On the morning of the inspection staff on duty in the home comprised four care staff, domestic, catering and maintenance staff. The proprietor was also on duty. Duty rotas confirmed that a minimum of three care staff work in the home during the day with one extra between the hours of 09:00 and 14:00. Residents made very favourable comments about staff and raised no concerns about staffing levels. Response to the call bell was said generally to be prompt. At the time of the inspection 50 of care staff had achieved the NVQ at level 2. Five were qualified at level 3. Training profiles showed that another four were currently undertaking the training. While the home meets the minimum standard in terms of the ratio of NVQ trained staff the ratio was 75 at the last inspection. The proprietor and the manager recognised the importance of an ongoing NVQ training programme to be sure of meeting the minimum standard when staff turnover fluctuates. Limes, The DS0000054200.V249012.R01.S.doc Version 5.0 Page 16 Staff recruitment was assessed at the last inspection when turnover was very low. The inspector noted that two new care staff had been recruited just before this inspection. Their recruitment records were checked and found generally to be in order. However, while the forms used to check for criminal records had been sent off POVA clearance had not been obtained before they commenced work in the home. This was discussed with the proprietor and later the manager who confirmed that there had been a misunderstanding of the procedure. They resolved to rectify the problem without delay. Limes, The DS0000054200.V249012.R01.S.doc Version 5.0 Page 17 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): 33 and 36 The home has effective quality assurance systems for measuring its performance based on seeking the views of residents. A programme of formal supervision is in place for staff. EVIDENCE: The home has achieved the Investors in People Award. The inspector was shown the home’s business plan for 2004/5, which amongst other things sets out long and short-term objectives for the development of the service. The manager said that the plan was ongoing. Service user satisfaction questionnaires are issued to residents or their representatives and a comments section appears in the home’s visitors’ book. A file of ‘thank you’ cards and letters is kept to illustrate the high level of satisfaction showed by relatives. One of the questionnaires received from a visitor made mention of the fact that comments “seem to be welcomed”. The manager said residents’ meetings, which had been successful in previous years had ceased to be held due Limes, The DS0000054200.V249012.R01.S.doc Version 5.0 Page 18 generally to lack of attendance. The inspector spoke with at least one resident who felt that meetings would be a useful way of raising concerns and discussing issues as a group. This was fed back to the manager who resolved to reintroduce them in the future. The home operates a programme of regular formal staff supervision. All staff spoken with confirmed the regularity of formal supervision, the last one being six weeks before the inspection. Many of the care staff at The Limes have worked there for several years. Those spoken with felt competent to fulfil their roles with the minimum of daily supervision. However, they confirmed that the manager or the proprietor were always available for advice and guidance. One carer had been in the home for only one week and was under supervision by senior staff as part of her induction. She said she was enjoying the work but as yet had just been shadowing other staff. Limes, The DS0000054200.V249012.R01.S.doc Version 5.0 Page 19 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 x x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 3 x 3 3 x x x x x STAFFING Standard No Score 27 3 28 3 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 3 x x 3 x x Limes, The DS0000054200.V249012.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? No 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 OP29 Regulation 19(Sch 2) Requirement To ensure that no person commences work in a care position in the home without the POVA First list having been checked. Timescale for action 31/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP12 Good Practice Recommendations Development of leisure and recreational activities is recommended to increase opportunities for stimulation, in line with residents’ needs, preferences and capacities. Limes, The DS0000054200.V249012.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA 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 Limes, The DS0000054200.V249012.R01.S.doc Version 5.0 Page 22 - 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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