Inspection on 16/11/09 for The Limes

This inspection was carried out on 16th November 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Limes 25/11/08

The Limes 23/01/08

The Limes 22/08/07

The Limes 01/08/06

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 17/02/2010.

Key inspection report Care homes for older people Name: Address: The Limes 41/45 Church Street Bridgwater Somerset TA6 5AT     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: David Smith     Date: 1 6 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: The Limes 41/45 Church Street Bridgwater Somerset TA6 5AT 01278422535 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): angelbre2003@yahoo.co.uk Mr Brian Thomas Name of registered manager (if applicable) Ms Paulene Coles Type of registration: Number of places registered: care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: An additional bathroom equipped with assisted bathing facilities will be installed within 10 months from Date of Registration Registered for 21 persons in category OP and 5 persons in category DE(E) 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 Date of last inspection Brief description of the care home The Limes is located in a quiet but central part of Bridgwater. It is currently registered with us to provide personal care to up to 28 people over the age of 65, this includes 5 people who have a dementia. The home is not registered to provide nursing care. 2 5 1 1 2 0 0 8 0 0 Over 65 5 21 Care Homes for Older People Page 4 of 34 Brief description of the care home 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; the Registered Manager is Pauline Coles. The home is furnished in a comfortable domestic style. There are twenty-four single bedrooms and two double rooms. Twenty-three of the bedrooms have en suite facilities. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced visit to the home to enable us to complete a Key Inspection of this service. We spent approximately six and a half hours in the home on the day of our visit. The inspection was carried out by one inspector, but the term we is used in this report. This is because the report, and the judgements within it, are on behalf of the Care Quality Commission (CQC). The pre-inspection planning involved reviewing the report of the last Key Inspection completed in November 2008. We looked at latest Annual Quality Assurance Assessment (AQAA) that was sent to us by the home; this is a self-assessment that focuses on how well outcomes are being met for people living at The Limes. It also gave us some numerical information about the service. We also looked at the service history, which details all other contact with, or about, the home. Care Homes for Older People Page 6 of 34 We sent surveys to the people who live in the home, to staff members and health care professionals who support the home as part of this Key Inspection; 10 were completed and returned. The views of each person who wrote to us have been included in this report. This inspection was supported by an Expert By Experience who, because of their shared experience of services, helped us to get a picture of the quality of care and support provided at The Limes. They spent all of their time speaking with a number of people who live in the home and others on short term stays. We gathered additional information for this report by speaking with the Manager and some members of staff who were working on the day of our visit. We looked at a number of records within the home such as individuals care records, risk assessments, finance records, medication administration, staff records, complaints and some health and safety procedures. We viewed all communal areas of the home, on all of the floors, and some of the bedrooms used by the people who live here. It is important to note that this inspection was carried out during a time of significant change for the home. The Manager has been in post for approximately one year and has worked hard, together with the staff team, to develop and improve the standard of care and support provided to people. Whilst there are many things listed under what they could do better many of these had already been identified by the manager and included within their own plans for improvements. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: The Registered Person must complete the development and improvement of each persons care plan and their risk assessments. This would ensure staff have clear and accurate information relating to each persons care needs. The Registered Person must ensure that each persons medication is correctly recorded and stock levels are correct. This will ensure that people are supported with their medicines in a safe and consistent way. The Registered Person must ensure that the activities programme is reviewed and Care Homes for Older People Page 8 of 34 improved where possible. This will ensure that each person receives adequate social stimulation. The Registered Person must ensure the planned refurbishment of the home is completed. This would ensure the people who live at The Limes are provided with a comfortable and homely environment. The Registered Person must ensure staff complete their training programme. This would ensure staff have the knowledge and skills to support people properly. The Registered Person must review how the home records financial transactions for people and ensure the balances held for people are correct. This would help to make the system safer and may reduce the likelihood of errors being made. The Registered Person must ensure each member of staff is supervised regularly. This would ensure staff are being given the support they need to provide good quality care to people who live in the home. The Registered Person must ensure that monthly audits of the home are carried out and a report written. This will ensure the home is effectively monitored to ensure the people who live here receive a safe and accountable service. The Registered Person must ensure that the improvements required to fire safety in the home by the Fire Officer are carried out. This will ensure the people who live in the home, and the staff who support them, are safe in the event of a fire. The Registered Person should ensure that clear records are kept of when actvities are offered and declined by people who live in the home. This would help to ensure that the activities programme continues to meet peoples needs. The Registered Person should review the current dining arrangements and how tables are laid. This may help to improve the dining experience for the people who live in the home. The Registered Person should ensure the homes application form is updated to request a full employment history of staff who are applying to work in the home. This may help to make the recruitment process more thorough and promote the safety of the people who live in the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with clear, accurate and up to date information about the home to help them decide if they wish to live here. People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. Evidence: The home have a Statement of Purpose and Service User Guide which provides people with information about the home and services offered; copies of both these documents were on display in the home and were last updated in September 2009. The people who wrote to us, and those we spoke with, said they did have enough information to decide if this was the right service for them; one person said I knew the home already and another person said they were able to walk to the town centre Care Homes for Older People Page 11 of 34 Evidence: and this was one of the reasons they chose this home to live in. To ensure the home is able to meet the needs of new people, thorough assessments are carried out on anyone wishing to move in. We looked at the records for two people who have moved into the home since our last visit; these showed that an assessment was carried out and if other information was available, such as reports or assessments from other professionals, copies were also obtained to ensure the home was able to meet each persons needs. The home has developed an improved assessment tool since our last visit; one of the assessments we looked at showed that this tool had been used. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health, personal and social care needs are usually met. People do not yet have a fully detailed plan of care that they, and people close to them, have been involved in making. Peoples privacy and dignity is respected; they are not always supported with their medicines in a safe way. Evidence: People who live at the home are supported by appropriate health care professionals to ensure their healthcare needs are met; all appointments with health and social care professionals are recorded. Records show that people have access to professionals including GPs, district nursing staff, opticians and chiropodists. The professional who wrote to us said peoples needs are usually met and are properly monitored by the home. The Manager has also introduced a system where each health issue is recorded separately and then tracked; for example, if a person had an infection which required Care Homes for Older People Page 13 of 34 Evidence: additional medication, this episode is recorded until the medication course is completed and the persons health has improved. This appears to be a very effective way of monitoring peoples health, although the quality of recording by staff does still vary and the manager is aware of this. Each person who lives in the home has a care plan; we looked at four of these in detail. Following our last visit we said that care plans needed to be improved as they did not give enough information about health care needs to ensure that staff are able to support people appropriately. The home has worked hard to ensure care plans have been improved; staff are now encouraged and supported to become involved with care planning, where they were not before. The Manager told us that not all care plans are as detailed and informative as they would like. For example, the new risk assessments are not in place for each person who lives at the home and the monthly reviews carried out by staff are not yet completed in a consistent way. Some reviews are done well; others do not reflect all of the records maintained about people to monitor their care and support as some focus mainly on social activities or how people have appeared to have been. It is clear there is a genuine commitment to completing these improvements; it has been a significant change for staff to actively become involved in care planning and in helping review peoples care and it will take some time for all of the improvements to be completed and for reviews to be carried out in a consistent way. Risks to people are identified using assessments; the assessments we looked at covered areas such as how to move and handle people safely and how likely people are to suffer from falls. The Manager is currently reviewing each persons risk assessments and has introduced a much clearer template which will now be used. They wish to add clearer assessments to each persons care plan which cover the following areas: falls, moving and handling, nutrition, physical dependency and one which is more general; these have not yet be added to each care plan but are in the process of being done. People who live in the home who spoke with the Expert, and those who wrote to us, said the staff are very good, they do receive the care and support they need and staff are available when they need them. There appeared to be sufficient staff on duty during our visit to meet peoples needs, and people said that staff came quickly when they used their call bells to request help. Care Homes for Older People Page 14 of 34 Evidence: Staff listen to them and act on what they say; each person felt their privacy is respected and that staff maintained dignity when supporting them with personal care. One person said Im not rude to them and they are not rude to me and other comments were the staff are very dedicated, they give time when it is needed and I have a bath regularly and receive very good care from staff. We saw that people were able to choose to spend time in their own rooms or in communal areas; staff were friendly and polite, knew people well and always addressed them using their names. The home uses a monitored dosage system of medication administration and this appears reasonably well managed. All medicines are stored securely in one room of the home; a medicine fridge is available and the temperature is checked each day. The home does not currently have any medication which requires additional storage and recording. The medication records we looked at were generally well kept; there are clear instructions for staff to follow and staff members sign when they dispense medication. However, staff had signed to say that medication had been administered to one person; the medication in question was still contained in the blister pack. In another persons blister pack, one tablet was missing from the current supply; this was not contained in the medication which was considered spoilt and due to be returned to the pharmacy and staff had not recorded if or when this medication had been given to this person. These issues were discussed with the Manager during our visit, who agreed with these findings. Staff who help people with their medicines are provided with training; this is completed in house and includes an assessment to decide if they are considered competent. Care Homes for Older People Page 15 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person is treated as an individual and they make choices about their lives. People have opportunities to follow personal intetrests or take part in activities: they would like these to be improved. People are supported to keep in touch with family and friends. People have nutritious and attractive meals and snacks. Evidence: The people living at the home spoken with, and those who wrote to us, said they are happy living at The Limes. They are able to choose how to spend their time and staff respect their wishes. Holy communion is held twice a month, alternating between an Methodist and Anglican service, and a hairdresser visits the home regularly. Breakfast is served to most people at 8.30 a.m. in the dining room; people said they were happy to get up at this time. People get ready for bed, with help if necessary, at the time of their choosing. However two people told the Expert they were usually the last ones up at 9.00 p.m. and one of these said they seem to expect you to go up to bed when they have given you the last medication at 9 p.m. but I would prefer to stay Care Homes for Older People Page 16 of 34 Evidence: up another hour. We did note that peoples preferred time and method for rising and going to bed are noted on their assessment and in their care plan, although staff said they do let people choose each day. An activity organiser is employed two mornings a week for two hours; in addition, bingo is organised and care staff sometimes have a sing along. They organise activities such as craft work, quizzes and the entertainers who visit. Records are kept of who attends which activities and they will alert care staff if they notice significant changes in a persons behaviour or motivation. However, they do not have enough time to do any life history work with people nor are they able to give much individual time to those with dementia or those not wishing to join in group activities. They speak with all of the people who live in the home and do adapt activities according to peoples needs; for example they bring in crosswords and word searches for those not wishing to join the main activity. Trips are also organised but these can be dependent on having enough care staff available to help. However, one person said you could hear a pin drop in the afternoons when there are no activities and another person said they preferred to stay in their room when there was no specific activity because all the others are asleep. At times they become bored and would welcome more going on. One person who wrote to us said there could be more activities to keep people entertained or rather to keep the mind more alert and another said they would like more individual time; sometimes staff are too busy to talk. Clearly with more allocated activity time individual work could be done to meet specific needs and preferences and prevent people feeling this way. Staff we spoke with, and those who wrote to us, said they do work hard to provide activities which people enjoy. One staff member said the home does day trips and we have a lot of in house entertainment such as singers and pottery classes. Another member of staff said maybe we could do more activities outside of the home for residents. The Manager told us that activities are sometimes offered, but people decline them; the home should ensure that this is recorded consistently by staff. Each person is supported to maintain contact with their families and friends. Visitors to the home are welcome and relatives are kept up to date about important issues. People said that their visitors were made welcome by the staff. People are asked the day before which of two choices they would like for lunch the following day. They told the Expert this sometimes causes problems as people forget what they have chosen, although the choices are written on a board in the dining room and this may help some people to remember. People spoken with and those who Care Homes for Older People Page 17 of 34 Evidence: wrote to us were very happy with the meals and snacks provided in the home; the meal served during our visit was home made with fresh vegetables, and smelt appetising. One person said the meals are fantastic, well cooked, wholesome and there is plenty of variety. People usually eat their meals in the dining room, which is located on the lower ground floor; this area was seen as people arrived to have lunch. The dining tables were sparsely equipped with just cutlery and a glass for water from the jugs on the tables. Meals were served directly on to plates at a serving hatch. There was no evidence of serviettes or any decoration to make the dining experience more pleasant for people; many people appeared to have been able to serve themselves if there had been vegetable dishes on the tables, so they could take the quantity they wished. Care Homes for Older People Page 18 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If people have concerns with their care, they or people close to them know how to complain. Any concern would be looked into and action taken to put things right. People are safeguarded from abuse and neglect and action would be taken to follow up any allegations. Evidence: The home has policies and procedures on how to recognise and report abuse (known as safeguarding), making a complaint and whistle blowing, which staff can use in confidence to raise any issue or concern they have regarding poor practice or possible abuse. The people who live in the home who wrote to us, said they know they are able to complain if they are unhappy about any aspect of the home. The staff we spoke with and those who wrote to us know what to do if an individual, family member or a friend is concerned about any aspect of the care and support they provide. The Expert asked people what they would do if they were not happy about something; one person said they wouldnt say anything because they didnt like to go behind peoples backs and another person said they would put up with it. However there was a notice about how to complain displayed in the hall and, when pressed, people did say they would speak to the manager if they became very unhappy. Care Homes for Older People Page 19 of 34 Evidence: The homes AQAA states they have had 10 complaints in the last 12 months and we looked at the records for these. Each complaint had been investigated in line with the homes policy and where they needed to advise other agencies, this had been done. One complaint did not have an outcome noted; this was discussed with the Manager who explained the outcome to us and said they would record this in the appropriate place. The home also has a comments, compliments and suggestions box, which people can use when they wish. There are also regular residents meetings and the records of recent meetings we looked at show that people who live in the home do discuss things they are happy with and other areas they wish to be improved. Checks are carried out on staff to ensure they are suitable to work in the home and to protect people from abuse. Staff are subject to enhanced Criminal Record Bureau disclosures (known as CRBs), before they start work in the home. They have also completed safeguarding training. The home maintains a record of each accident, incident or other significant event which occurs in the home. We are notified of significant events together with any other concerns regarding individuals who live in the home. Care Homes for Older People Page 20 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Limes generally provides a homely, clean and comfortable environment for people to live in. Evidence: The Limes is an older property located in a central, but quiet, area of Bridgwater. The home does not have its own car park; there is limited parking on the road outside and at the rear of the home. Other than this, people visiting the home need to park on nearby roads. Accommodation is arranged over four floors; there is a passenger lift and additional stair lifts to help people who have mobility problems. All of the communal areas are on either the ground or lower ground floors; these include lounge areas, a dining room, hairdressing salon and a small visitors room. Bedrooms are located on the ground, first and second floors. There are 24 single bedrooms and two doubles; 23 bedrooms have their own en-suite facilities. There are additional bath or shower rooms on the lower ground, ground and second floors. All of the communal areas of the lower, first and second floors were light, well maintained and tastefully decorated. The people who live in the home are encouraged to bring in personal items; rooms were personalised with their own possessions and in some cases people had brought in their own furniture. There were no noticeable Care Homes for Older People Page 21 of 34 Evidence: odours and bedrooms were bright and clean. The exception to this was on the lower ground floor; two toilets were in need of redecoration and a thorough clean. The dining area and the lounge on this floor also lacked warmth and would benefit from some new soft furnishings and pictures to make these areas more homely. This would be especially important to people with dementia who used these rooms. The homes AQAA states that there have been many improvements made to the home in the last 12 months; these include one bedroom being redecorated, one having new carpets and curtains, two having new bathroom flooring laid, the carpet in the entrance hall being replaced and door guards fitted to some of the doors. It also notes that there are further improvements planned such as redecorating the lower ground floor stairway and repainting the outside of the front of the home. Staff have access to personal protective clothing such as gloves and aprons and there are hand wash facilities available around the home; the homes AQAA confirms they have an action plan for prevention and control of infection and that staff have had appropriate training in this area. Care Homes for Older People Page 22 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have appropriate support; staff are generally provided with the training they need to ensure peoples needs continue to be met. Thorough checks are carried out on new staff to ensure they are suitable to work in the home. Evidence: The home currently employs 21 members of staff on either a full or part time basis; there are 15 members of the team who are classed as permanent care staff. Seven staff members have attained a National Vocational Qualification (NVQ); five are currently working towards their awards. There appears to be a good skill mix within the staff team to enable them to meet peoples current and changing needs. On the day we visited there were four care staff on duty during the day; they were supported by the Manager, Housekeeper, Activity Co-ordinator, two domestic staff and a cook. During the night, two waking night staff are on duty. These staffing levels appear to be sufficient to meet the needs of the people who currently live at the home. The people who live in the home spoken with, and those who wrote to us, said they are treated well by staff; they are available when they need them and they listen to Care Homes for Older People Page 23 of 34 Evidence: them and act on what they say. Those staff we observed supporting and interacting with people who live in the home had a good understanding of peoples needs and how to communicate effectively with them. Staff had a good rapport with individuals; there was a relaxed, homely atmosphere. One person who lives in the home said all the staff are lovely and they are always around if you need them. The staff we spoke with, and those who wrote to us, said they are happy working at The Limes. They said there are enough staff to meet peoples needs and the way information is shared, between care staff and the manager, generally works well. When asked what the home does well comments included: I think we provide an excellent service to our residents, The Limes is a very friendly home and gives good care to all residents, the staff retention here is very good, that must tell you something and everything is done well, all the staff get along. It is noticable that staff feel things are improving since the new Manager started working in the home; there are many postive comments about them in the next section of this report. The Manager told us that it has at times been difficult for the staff team as they have had to change some of their work practice and are now involved in areas such as care planning and reviewing peoples care. There are still some inconsistencies, detailed earlier in this report, however staff members appear to enjoy these new roles. Staff are provided with a variety of training courses to enable them to provide care and support to the people who live here. The training records we looked at show that staff are provided with the following courses: emergency aid, food hygiene, safeguarding, infection control, nutrition and fire safety. Following our last visit we said that staff should be provided with training to meet the needs of people who have dementia and staff atttended this training last April. The Manager also told us they wish to develop staff training further to ensure staff had the knowledge and skills to meet peoples current or changing needs. Staff require updated training in how to move and handle people safely; the last course involved staff watching a DVD and then answering questions but the Manager would prefer this to be a more practical course, where they could practice different tecniques and use equipment. None of the staff have yet completed health and safety training and this needs to be addressed. The home has a safe recruitment process. The personnel records of staff who have recently joined the team contain copies of their application form, documents proving their identity and eligibility to work in the UK, two satisfactory references, an Care Homes for Older People Page 24 of 34 Evidence: Enhanced CRB and an additional check known as POVA First. (The application form contains details of the last 10 years of employment, but does not ask for a full employment history). The home a thorough induction process to help new staff when they start working in the home; this covers a wide variety of areas. Staff spoken with were happy with the induction that they received; one member of staff said my induction is ongoing and its very thorough. I worked alongside a senior member of staff when I first started. Care Homes for Older People Page 25 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have growing confidence in The Limes as the management of the home has significantly improved. Staff members must be given regular supervision to support them to meet peoples needs. People control their own money and choose how they spend it; recording must be improved to ensure peoples money is kept safe for them. The environment is generally safe for people and staff because health and safety practices are carried out. Evidence: The home now has a Registered Manager, Pauline Coles, who is well qualified and experienced to run the home; she has worked at the home for approximately one year. Mrs Coles told us that she has identified many areas where the home could Care Homes for Older People Page 26 of 34 Evidence: improve and has worked hard to implement improvements with others planned. It is clear from speaking with her that the home is not yet at the standard she wishes it to be; what is clear is there is that many things have improved, such as care practice, care planning and allowing care staff to be involved in this. The people who live in the home we spoke with said they like the Manager and that they felt able to speak to her about any issue. Mrs Coles was seen speaking with people who live in the home and with staff members at various times during our visit; she had a good rapport with them both. Staff told us everything in the home is now well run, I think The Limes is run very well now and we are always kept informed about things and made aware of any changes. The home have a system in place to ensure a Quality Assurance review is carried out; people are given questionnaires to complete so they may comment on the quality of the care and support provided by the staff team and there is the comments and suggestions box which people can use at any time. The people who live in the home are invited to attend regular residents meetings. The records of recent meetings we looked at show that between eight and ten people attend; a wide range of topics are discussed including meals in the home, activities, staffing and any changes or improvements people feel are needed. The record of each meeting also include an in reply section which notes the action the home has taken in view of peoples comments; this is good practice as it shows peoples views are listened to and acted on. Peoples records are stored securely. The Manager told us they do not act as a financial appointee or power of attorney for anyone. People are generally responsible for their own money, or they are helped by people close to them, such as family members. The Manager told us people are able to deposit small sums of money for safe keeping; this is kept in a safe for them. We therefore looked at the records for two people; one persons balance was not correct as the money being kept was slightly less than it should have been, the balance shown on the finance form was found to be incorrect and it was not possible to see why these mistakes had occurred. Another persons records were very difficult to follow; the receipts for money they had spent had several items listed although they did not all relate to the amount the person had spent. It was also difficult to see what had been spent as this is not noted on the finance forms, only the amount taken out and the change (if any) being put back in. This was discussed with the Manager during our visit who agreed that one persons records were not correct and that the Care Homes for Older People Page 27 of 34 Evidence: recording system used in the home could be improved. The home has a number of policies and procedures, which are designed to ensure that both the people who live in the home and the staff team are safe, the service complies with the law and remains aware of best practice or new ways of working. Full details of these policies were provided in the AQAA the Manager completed for us; all are up to date as they were reviewed last September. There are systems in place to ensure the health and safety of people living and working at the home. The AQAA confirms that appropriate safety checks are carried out on the electrical wiring in the home, portable electrical appliances, the stair lifts and passenger lift, the heating system and other lifting equipment such as bath hoists. The Limes had been visited by the local Fire Safety Officer, who advised that some improvements in fire safety are needed in the home. Their report has not yet been sent to the home and we are yet to see a copy. Once the home receives this report they must comply with all the improvements to ensure the people who live in the home, and the staff who support them, are safe in the event of a fire. The owners of the home visit the home regularly; they were both in the home on the day of our visit. However, as they now have a manager in post they should be carrying out monthly audits of the home, speaking with the people who live here, with staff members and looking at a selection of records to enable them to write a report. The Manager told us these audits are not being completed, although they have spoken to the owners and explained that they need to do them. These audits must be completed; if they were they would help the Manager to monitor the home. The errors we found during our visit in medication records and finance records may well have been picked up earlier and addressed, if thorough audits were carried out. Formal supervision of staff has been re-started, although these are still irregular. The Manager told us they wish for staff have at least six supervision sessions a year, which may include one or two staff meetings depending on their content; they also plan for senior care staff to supervise more junior members of the team. The records we looked at show that most staff have only had one supervision meeting this year; this is significantly lower than the home wishes to provide and should be improved when the number of supervisors increases. Care Homes for Older People Page 28 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The Registered Person must complete the development and improvement of each persons care plan and their risk assessments. This would ensure staff have clear and accurate information relating to each persons care needs. 16/02/2010 2 9 13 The Registered Person must ensure that each persons medication is correctly recorded and stock levels are correct. This will ensure that people are supported with their medicines in a safe and consistent way. 16/01/2010 3 12 16 The Registered Person must ensure that the activities programme is reviewed and improved where possible. 16/01/2010 Care Homes for Older People Page 30 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will ensure that each person receives adequate social stimulation. 4 19 23 The Registered Person must ensure the planned refurbishment of the home is completed. This would ensure the people who live at The Limes are provided with a comfortable and homely environment. 5 30 18 The Registered Person must ensure that staff complete their training programme. This would ensure staff have the knowledge and skills to support people properly. 6 32 26 The Registered Person must ensure that monthly audits of the home are carried out and a report written. This will ensure the home is effectively monitored to ensure the people who live here receive a safe and accountable service. 7 35 16 The Registered Person must review how the home records financial transcations for people and ensure the balances held for people are correct. 16/01/2010 16/01/2010 16/03/2010 16/02/2010 Care Homes for Older People Page 31 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This would help to make the system safer and may reduce the likelihood of erors being made. 8 36 18 The Registered Person must 16/01/2010 ensure each member of staff is supervised regularly. This would ensure staff are being given the support they need to provide good quality care to people who live in the home. 9 38 10 The Registered Person must ensure that the improvements required to fire safety in the home by the Fire Officer are carried out. This will ensure the people who live in the home, and the staff who support them, are safe in the event of a fire. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 16/02/2010 1 12 The Registered Person should ensure that clear records are kept of when activities are offered and declined by people who live in the home. This would help to ensure that the activities programme continues to meet peoples needs. The Registered Person should review the current dining Page 32 of 34 2 15 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations arrangements and how tables are laid. This may help to improve the dining experience for the people who live in the home. 3 29 The Registered Person should ensure the homes application form is updated to request a full employment history of staff who are applying to work in the home. This may help to make the recruitment process more thorough and promote the safety of the people who live in the home. Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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