Inspection on 16/07/07 for The Limes

This inspection was carried out on 16th July 2007.

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

The inspector 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 12/12/06

The Limes 06/02/06

The Limes 04/05/05

The Limes 26/08/04

The Limes 16/04/04

Similar services:

The Lodge Nursing Home

Bracken House

Sunnycroft

Field Farm House

Edgeview Nursing Home

Church Terrace Nursing & Residential Home

The Forbury

The Maples

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

CARE HOME ADULTS 18-65 The Limes 39 Queens Road Donnington Telford Shropshire TF2 8DA Lead Inspector Sue Woods Key Unannounced Inspection 16th July 2007 09:30 The Limes DS0000020568.V345269.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Limes DS0000020568.V345269.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Limes DS0000020568.V345269.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Limes Address 39 Queens Road Donnington Telford Shropshire TF2 8DA 01952 402295 01952 410779 lavelle@lasma.fsnet.co.uk 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) prOKare Ltd. Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (6) of places The Limes DS0000020568.V345269.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: The Limes Care Home provides personal care and accommodation to six adults with a mental disorder. It is owned by PrOKare Ltd and was first registered in July 2001. Situated in a residential area of Donnington the Home is within easy walking distance of local amenities, i.e. shops, public houses, transport, and in close proximity to Telford Town Centre. The Home is a detached two-storey property with communal sitting and dining areas, six bedrooms offering single occupancy, including three bedrooms on the ground floor benefiting from en-suite facilities. The property is well maintained, with décor and furnishings providing a warm, homely and comfortable ambience. Consultation with people who live at the home takes the form of regular meetings, discussions and involvement in the development of care and activity plans. The home makes their services known to prospective service users in The Statement of Purpose and Service User Guide that contain a copy of the latest CSCI inspection report. Fees are reviewed annually but were not available at the time of completion of this report. The Limes DS0000020568.V345269.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection of The Limes took place on 16th July 2007 from 09.15 am until 03.00 pm. The inspection reviewed all 22 key standards and information to produce this report was gathered from the findings on the day and also by review of information received by CSCI prior to the inspection date. A quality rating based on each outcome area for service users has been identified. These ratings are described as excellent/good/adequate or poor based on findings of the inspection activity. As part of the fieldwork activity the inspector met with the people who live at The Limes and spoke in private with the staff on duty at the time of the inspection. The inspector also met with a visiting social worker. The registered manager no longer works for the organisation and management responsibilities are currently being carried out by the deputy manager, supported by registered managers from the organisation’s nearby care homes. The inspector met with two registered mangers during the inspection and had a detailed telephone conversation with the deputy manager on the day following the inspection. The inspector reviewed three care files and other documentation referred to within the report. What the service does well: People who live at The Limes are supported by a team of dedicated and knowledgeable staff who deliver a high quality of direct personal and health care support. This is especially evident at the moment as the needs of one person living at the home are changing rapidly. Staff are sensitive and kind. A visiting social worker commended this support saying staff offer ‘the best’ care. The home is effectively using additional and specialist health care professionals to improve the quality of life for people living at home. Management support arrangements are good with managers of other homes offering time and expertise to assist the deputy manager of the home. The Limes DS0000020568.V345269.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. The summary of this inspection report can be made available in other formats on request. The Limes DS0000020568.V345269.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Limes DS0000020568.V345269.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who live at The Limes are supported by appropriate procedures that have enabled their successful admission to the home. EVIDENCE: There are currently three people living at The Limes. Two people have been supported to move into their own homes. The latest person to move into the home did so following a full assessment of needs and after the home had made the decision that they could meet his current and future changing needs. The social worker for this person spoke with the inspector at the time of the inspection about the admission process and was more than satisfied with the outcome for her client. The Limes DS0000020568.V345269.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 6,7 and 9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Care-planning systems are in place to provide staff with the information they need to meet the assessed needs of people who live at the home. People are appropriately supported with decision-making processes and enabled to take responsible risks. EVIDENCE: As part of the inspection the inspector reviewed one care file in detail and saw extracts from the other two. The home is currently supporting one person whose health care needs have begun to increase significantly and his care plan is being updated as and when changes occur. The latest care review took place only a few days before the inspections and staff were waiting for the new guidelines to be written up. Staff were however aware of the new procedures. The Limes DS0000020568.V345269.R01.S.doc Version 5.2 Page 10 Goal planning continues to play an important part of the care planning process and the weekly activity sheets reflect individual preferences and choices. At the time of the inspection staff constantly consulted with the people who live at the home, in relation to how they were feeling, what they wanted to eat and drink and what they wanted to do in line with their pre agreed plans. Risk assessments were seen to be detailed and supported information in the care plans. In discussions staff demonstrated detailed knowledge of potential risks and gave examples of how these risk are managed. The Limes DS0000020568.V345269.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 and 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who live at The Limes benefit from varied daytime opportunities. Family links are supported and maintained and people are provided with a diet in accordance with their personal preferences and requirements. EVIDENCE: Daily activity sheets detail a full programme of daily activities both in house and within the local community. One person living at the home attends college. People are supported and encouraged to maintain family contacts and friendships and this was evident when staff reported that one person has now moved out of the home to live with his family. Menus were not reviewed as part of this inspection but the people who live at the home were seen to get up and have breakfast when they were ready and The Limes DS0000020568.V345269.R01.S.doc Version 5.2 Page 12 had a choice of cereal and drinks. At the time of the last key inspection of the home menus seen reflected a varied diet with choices available. One person told the inspector that he like the meals at the home and staff explained how one person now has a liquidised diet as per his care plan and risk assessment. The Limes DS0000020568.V345269.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19, 20 and 21 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who live at The Limes benefit from good support from staff and health care professionals meaning that their needs can be effectively met. People are generally safeguarded by the home’s system for handling, storing and administering medication EVIDENCE: Due to the rapidly changing health and support needs of one person living at The Limes much of this inspection concentrated around reviewing his care. Staff were seen to be sensitive, supportive and patient with the person and have worked as a team to ensure he receives constant support and company in order to make him comfortable and relaxed. The visiting social worker at the time of the inspection commended this support and commitment and felt that the individual was receiving ‘the best’ care. Staff were fully aware of how one persons health was going to deteriorate and the organisation has implemented training and support for staff. The Limes DS0000020568.V345269.R01.S.doc Version 5.2 Page 14 Care plans show that all aspects of the personal care needs of individuals are being closely monitored. A protocol has also been developed to support a potential health care emergency and the home is effectively using the community nursing team and specialist nurses to provide additional care and support. Medication arrangements have been found to be satisfactory at previous inspections of the home however the inspector observed the administration of medication for one person and the process seemed to be ‘messy’. The manager from the sister care home also observed this and committed to immediately review arrangements and make changes in line with organisational policy. She fed back her concerns to the staff carrying out the procedure who acknowledged there were areas of confusion. Issues were in relation to the recording of information and not in relation to dosage. The funeral wishes of one person living at the home were seen to have been clearly documented. The Limes DS0000020568.V345269.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 22 and 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints system in place and arrangements for the protection of people from abuse are also satisfactory. EVIDENCE: At the time of the inspection the complaints book was inaccessible as the senior manager for the organisation had the cabinet key and she was not on site. Staff or managers from other care homes were unaware of any complaints in relation to the home and there have been none received by CSCI. Likewise there have been no referrals under the adult protection procedures. At the time of the last inspection the complaints procedure was reviewed and found to be satisfactory therefore the judgement within this outcome group will be carried forward from that inspection. A finance sheet belonging to one person living at The Limes was seen by the inspector. Although transactions were limited records were clear and accurate with receipts supporting purchases. The Limes DS0000020568.V345269.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 24 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users are provided with a clean, comfortable and homely place to live. EVIDENCE: As part of this inspection the inspector saw communal areas and one persons bedroom. All areas seen were clean and staff were aware of issues in relation to smoking arrangements and management were looking at minimising exposure of staff to smoke. At the time of the inspection a maintenance worker was on site doing general repairs. The Limes DS0000020568.V345269.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 32, 34 and 35 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Service users benefit from being supported by a knowledgeable and committed staff team. The people who live at The Limes may benefit from additional resources (time and staffing) being available to support activities and increased personal care needs and safety may be compromised if adequate staffing levels are not implemented and sustained (at all times) EVIDENCE: As part of this inspection staff were asked to speak in private with the inspector. The rota reflects that there are a minimum of two staff on duty during the day and although this is thought to be generally sufficient the increased care needs of one person who lives at the home are impacting on this arrangement. A few days before the inspection funding was agreed for an additional eight hours a day to provide one to one support. After discussions with managers from the organisation’s sister homes it was agreed that additional support needs to be risk assessed to allay staff concerns of insufficient cover. Following the inspection this assessment was completed and The Limes DS0000020568.V345269.R01.S.doc Version 5.2 Page 18 sent to CSCI. Managers and staff acknowledged that staffing levels will need to be in constant review. In discussions with staff and the deputy manager it was identified that staff have been ‘struggling’ lately and examples of this were shared with the inspector. The issue of unpaid breaks was discussed and it was positive to note that managers have already raised this issue with senior managers who are looking to make positive changes in this area. It is recommended that this happens as staff work long hours and are currently under additional pressure meeting additional support needs. Although staff stated that they had attended all mandatory training, one support worker supporting the person with increased support needs had not yet attended her first aid course. Managers later identified a date in the near future to attend this training. Staff are also due to attend refresher adult protection training in September. The majority of staff have now completed a recognised distance learning course in relation to the administration of medication in care homes. During the inspection it was apparent that staff were unaware of a number of issues in relation to their roles and responsibilities. It was also felt that communication could be improved especially between senior managers and the staff team. The deputy manager was aware of recent staffing issues but was positive that the imminent start of a manager and two new support staff would ease the current situation. She recognised current challenges for staff and also felt confident that she was ‘addressing staffing matters’. Staff Personal Files were unavailable for inspection however the last key inspection of the home found ‘evidence of full compliance with the ‘Standard’ relating to employment practices aimed at ensuring safety of Residents e.g. full employment history, references, ‘POVA’ clearance and satisfactory CRB disclosure’. The Limes DS0000020568.V345269.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 38 and 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Generally the people who live at The Limes and the staff team benefit from a knowledgeable and proactive management team who operate flexibly within the service to offer good support. Health and safety is promoted within the home protecting the people who live there. EVIDENCE: Staff spoke very positively about the manager who left in May 2007 and of the deputy manager who is currently assuming management responsibility. The deputy manager spoke with the inspector following the inspection and stated that she receives good support from managers of the organisations sister homes and from the area manager. The Limes DS0000020568.V345269.R01.S.doc Version 5.2 Page 20 It was reported that a new manager has been appointed for The Limes. In discussions with managers who visited to support the inspection it was evident that they are aware of issues affecting the home and are proactive in their support to resolve them for example the requirement made at the end of the inspection in relation to the production of a risk assessment was immediately actioned to a good standard. Staff felt that better communication with senior managers would improve the overall quality of the service. A review of fire safety checks demonstrated that health and safety monitoring continues in the absence of a full time manager and a health and safety audit was completed by the area manager on 24th June 2007. The Limes DS0000020568.V345269.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 2 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 2 3 3 3 X X X 3 X The Limes DS0000020568.V345269.R01.S.doc Version 5.2 Page 22 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 YA31 Good Practice Recommendations It is recommended that roles are clearly established within the home and that staff are aware of the limitations of those roles for example: can an associate worker stay in the home without other staff in attendance? Also see recommendation re medication. It is recommended that the arrangements for unpaid breaks is reviewed as this time out is currently dependent on additional staff cover and the needs of the individuals living at the home. If staff are not paid for the break they have the right to leave the premises if they wish and this could compromise safety within the home. It is recommended that staff be reminded of their responsibilities (and limits of their responsibilities) in relation to recording practices regarding the administration of medication. This is to ensure that they do not contravene the organisations policy in relation to medication procedures and as a result put themselves and the people who live at the home at risk of errors. DS0000020568.V345269.R01.S.doc Version 5.2 Page 23 2 YA33 3 YA20 The Limes Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Limes DS0000020568.V345269.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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