CARE HOMES FOR OLDER PEOPLE
The Limes Moorfield Close Swinton Manchester M27 0FN Lead Inspector
Helen Dempster Unannounced Inspection 16th November 2005 11:00 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 The Limes DS0000038597.V263907.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. The Limes DS0000038597.V263907.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Limes Address Moorfield Close Swinton Manchester M27 0FN 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) 0161 794 3042 City of Salford Community and Social Services Maria Elnhrawy Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability (0) of places The Limes DS0000038597.V263907.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The number of persons requiring accommodation for personal care at any one time shall not exceed 30 persons aged 60 years and over. One service user aged between 50 - 60 years may be accommodated within the maximum of 30. Care staffing levels will not fall below the minimum levels specified in the Residential Forum Guidance for Staffing in Care Homes for Older People . The dependency levels of service users are assessed on a continuous basis and staffing levels adjusted where appropriate to ensure continued compliance with the Residential Forum Guidance for Staffing in Care Homes for Older People. The service should at all times, employ a suitably qualified and experienced manager, who is registered with the Commission for Social Care Inspection Thirteen (13) beds within the total of 30 situated on the ground floor are used for intermediate care. 2nd June 2005 2. 3. 4. 5. Date of last inspection Brief Description of the Service: The Limes is a two-storey, purpose built, Local Authority provision set in its own grounds within a pleasantly landscaped cul-de- sac. The home offers 13 respite care places, 9 rehabilitation places, 4 assessment places and 4 long term care places. The respite places are allocated by Social Worker referral and these stays are from 1 night to 4 weeks. Residents admitted for assessment are also referred by social workers and these stays can be up to 3 weeks. The aims and objectives of the home are to provide rehabilitation, respite and assessment to service users from the local and wider community. There is also a social work team on site. Rapid response nurses, occupational therapists and physiotherapists support the management and care team. Service users are offered assessment and on going therapeutic services. Care planning and social work support is available to co-ordinate discharge planning and determine future care needs and care packages. The home is operated in partnership with the Salford Primary Care Trust and Salford Royal Hospitals Trust, which offers a multidisciplinary assessment for service users. Accommodation is provided on two levels, all rooms offer single occupancy. The Limes DS0000038597.V263907.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and was carried out on 16 November 2005 over 4 hours. Time was spent talking with the manager, staff and residents. This included discussing welfare matters relating to the residents the home supported and examining documentation in relation to the running of the home, the management arrangements, staffing, care planning and the residents’ satisfaction. The term of address preferred by the users of the service was confirmed as ‘residents’. It was felt this best reflected the function and purpose of the service What the service does well:
Prospective residents’ needs were assessed before they were admitted into the home and residents in receipt of rehabilitation were assisted to develop skills so that they could return home. Residents’ health, personal and social care needs were documented and met. Furthermore, medication practice was good. Without exception, those residents that expressed a view said that they were treated with respect and their privacy was respected. Residents’ social needs are recorded and met. Residents’ independence is maintained at the home, including managing finances as much as possible, to help them to maintain existing skills when they return home. The home held a record of complaints and compliments. A notice board in the home had many thank you cards displayed. The manager said that all staff were attending a course on customer care and some had already completed the course. This is good practice. The ‘Protection of Adults from Abuse Policy’ was readily available at the home and training had been given to staff in protecting adults from abuse. The home was clean, tidy and comfortable, with a good standard of furnishings and fittings. Good hygiene standards and infection control measures protected residents and staff. Staff recruitment practice was appropriate and adequate numbers of committed and well-supported staff were deployed appropriately to meet residents’ needs. There was evidence of the availability of a wide range of
The Limes DS0000038597.V263907.R01.S.doc Version 5.0 Page 6 staff training and the home was on course to meet the target of 50 of staff achieving NVQ level 2 by January 2006. The home was well managed and the manager was well trained. All encounters between the manager, residents and staff were observed to be professional. The manager said that her manager is “supportive”. What has improved since the last inspection? What they could do better:
Some of residents’ skills assessments, which were used as care plans, had limited information. This lack of detail could compromise their care being delivered in a way that maximises their independence. Each resident needed a care plan for the administration of medication, including when required” (PRN) medication, which confirms why medication is prescribed and in what circumstances and for what conditions PRN medication is given. Staff training needed to be consistently audited and planned so that training, including mandatory training, did not lapse. The home has a business plan, but needs to have a formal quality assurance system. Formal staff supervision needed to be audited to ensure that it was consistently undertaken. The Limes DS0000038597.V263907.R01.S.doc Version 5.0 Page 7 Weekly checks of the means of escape and monthly checks of the emergency lighting were not being recorded consistently. 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 DS0000038597.V263907.R01.S.doc Version 5.0 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 DS0000038597.V263907.R01.S.doc Version 5.0 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 and 6. Prospective residents’ needs were assessed before they were admitted into the home and residents in receipt of rehabilitation were assisted to develop skills so that they can return home. EVIDENCE: In response to a requirement made at the previous inspection, the manager had produced a service users guide. The home made good use of notice boards in residents’ rooms which had key information for residents. Assessment documents sampled at the time of inspection were of a high standard. These included the single assessment and overview inspection. Good practice was evident in that both documents were based on questions/conversation with the prospective resident and therefore included their views in the care to be delivered. Wherever possible these assessments take place in the potential resident’s own home in the community. Dedicated facilities and staff, including physiotherapists and occupational therapists were provided for residents in receipt of rehabilitation.
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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, 9 and 10 Residents’ health, personal and social care needs were documented and met. However, the lack of detail on resident’s skills sheets could compromise their care being delivered in a way that maximises their independence. EVIDENCE: Care plans were drafted by social workers before admission. Examples of these were viewed and found to contain appropriate information. All residents had a ‘skills assessment sheet’ in their bedroom which serves as a basic care plan. The information on the skills assessment sheet was updated on a weekly basis at a multidisciplinary meeting in the home. This was good practice. As was the case at the previous inspection, some of the skills assessments had limited information and included statements including ‘requires assistance’. A requirement made at the previous inspection to the effect that this information is more detailed and specific in terms of what tasks a resident can do independently and what they need help with was reiterated. Medication at the home was administered from a Venalink system or from the original pharmacist’s containers. Risk assessments were in place for the 2 residents who self medicated. This good practice would be enhanced by
The Limes DS0000038597.V263907.R01.S.doc Version 5.0 Page 11 having a care plan for the administration of medication for each resident, including when required” (PRN) medication, which confirms why medication is prescribed and in what circumstances and for what conditions PRN medication is given. A requirement was made accordingly. Without exception, those residents that expressed a view said that they were treated with respect and their privacy was respected. The Limes DS0000038597.V263907.R01.S.doc Version 5.0 Page 12 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 14. Residents’ social needs were recorded and met. Residents’ independence was maintained at the home, including managing finances as much as possible, to help them to maintain existing skills when they return home. EVIDENCE: Social interests were recorded in the “ daily living skills” questionnaire, which was completed with residents on admission. This is good practice. Activities were advertised on notice boards and the manager said that residents were also consulted informally about activities. The manager said that the home had a long-term plan to employ a hobbies therapist. Residents have access to an advocacy service. They are encouraged to bring in their own possessions. The home did not manage finances for residents in receipt of short-term care. The home did, however, provide safe storage for valuables, including a lockable unit in each room. The Limes DS0000038597.V263907.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): 16 and 18. The residents’ views were listened to and acted upon and systems were in place that safeguarded them from abuse. EVIDENCE: A requirement made at the previous inspection to the effect that the complaints procedure is specific to the home and makes reference to the CSCI had been addressed. The new complaints procedure was user friendly. The home held a record of complaints and compliments. A notice board in the home had many thank you cards displayed. The manager said that all staff were attending a course on customer care and some had already completed the course. This is good practice. The “Protection of Adults from Abuse Policy” was readily available at the home and a laminated summarised user-friendly version of this was displayed throughout the home. Training had been given to staff in protecting adults from abuse. The Limes DS0000038597.V263907.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): 19 and 26. The home was clean, tidy and comfortable, with a good standard of furnishings and fittings. Good hygiene standards and infection control measures protected residents and staff. EVIDENCE: A partial tour of the premises was conducted. The home was clean, tidy and comfortable. A requirement made at the previous inspection concerning a bad smell in several bedrooms, where the management of continence was an issue, had been addressed and there were no unpleasant odours picked up. Since the previous inspection, the home had introduced the use of sanitising alcohol gel throughout the home and at entrances and exits. This is good practice. The home had also received a silver award from Salford Council for food hygiene. Since the previous inspection, the smoking area had been moved from the entrance hall to a designated smoking room.
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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. Adequate numbers of committed and well-supported staff were deployed appropriately to meet residents’ needs. There was evidence of the availability of a wide range of staff training, but this needed to be consistently audited and planned so that training, including mandatory training, did not lapse. EVIDENCE: The home had 2 floors, with the minimum staffing levels of 3 staff in the morning and 2 staff in the afternoon was provided, covering both floors. Three waking staff were provided at night. A staff meeting was observed and it was noted that the meeting focused on meeting residents’ needs and that residents were referred to respectfully. It was also clear that the staff were committed to ensuring that residents are able to stick to their normal routines as much as possible while receiving short-term care. This is good practice. There are 38 support workers at the home, 14 of whom have NVQ level 2 and 11 of whom are studying towards this qualification. The manager said that the home should meet the target of 50 of staff achieving this qualification by January 2006. Recruitment practice at the home was managed by Salford Council’s personnel department and included obtaining appropriate references and a CRB check. The manager completed the shortlist of candidates and interview procedure. The Limes DS0000038597.V263907.R01.S.doc Version 5.0 Page 16 At the previous inspection, a requirement was made to the effect that a full audit of training, including mandatory training, needed to be undertaken to facilitate planning of training so it did not lapse. This had not been fully actioned and was therefore been reiterated. The Limes DS0000038597.V263907.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): 31, 33, 35, 36 and 38. The home was well managed and residents’ needs were prioritised. Staff had good access to training but needed formal supervision. Overall, residents and staff were protected from the risk of fire, but some fire safety checks needed to be consistently made and recorded. EVIDENCE: The manager has managed the home for 23 years. She holds NVQ level 4 and consistently updates her training. All encounters between the manager, residents and staff were observed to be professional. The manager said that her line manager was ‘supportive’. The home has a business plan, but did not have a formal quality assurance system. A requirement was made accordingly. The home was not an appointee for any residents’ finances. Short- term care residents were encouraged to maintain independence with their finances,
The Limes DS0000038597.V263907.R01.S.doc Version 5.0 Page 18 although lockable facilities were provided to store money for safekeeping. The families of the 4 residents in receipt of long-term care assist them to manage their finances. The manager stated that staff had good access to informal supervision. However, as noted at the previous inspection, formal supervision needed to be audited to ensure that it was consistently undertaken and a requirement was reiterated accordingly. A fire risk assessment was readily available. This had been updated recently. The fire log book was viewed and it was noted that fire bells were tested weekly and fire drills were completed frequently. Weekly checks of the means of escape and visual checks of the emergency lighting were not being recorded on a weekly basis. A requirement made at the previous inspection was reiterated accordingly. The Limes DS0000038597.V263907.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 3 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 2 The Limes DS0000038597.V263907.R01.S.doc Version 5.0 Page 20 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 Requirement The skills information/care plans which included statements including requires assistance. must be more detailed and specific in terms of what tasks a resident can do independently and what they need help with. A care plan for the administration of medication, including when required” (PRN) medication, which confirms why medication is prescribed and in what circumstances and for what conditions PRN medication is given must be in place for each resident. Staff training audit must be completed and be consistently reviewed to ensure that training, including mandatory training, does not lapse. Formal staff supervision arrangements must be audited and reviewed. Weekly tests of the means of escape and monthly tests of the emergency lighting must be made consistently and the outcomes recorded.
DS0000038597.V263907.R01.S.doc Timescale for action 20/12/05 2 20/12/05 OP9 13 3 OP30 18 20/01/06 4 5 OP36 OP38 18 23 20/01/06 17/11/05 The Limes Version 5.0 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Limes DS0000038597.V263907.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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