CARE HOMES FOR OLDER PEOPLE
The Limes 16a Drayton Wood Road Hellesdon Norwich Norfolk NR6 5BY Lead Inspector
Hilary Shephard Unannounced Inspection 18th January 2006 2.20 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 DS0000027285.V275930.R01.S.doc Version 5.1 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 DS0000027285.V275930.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service The Limes Address 16a Drayton Wood Road Hellesdon Norwich Norfolk NR6 5BY 01603 427424 01603 429003 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) Mr Michael Christophi Mrs Christina Dawn Laffey Care Home 41 Category(ies) of Dementia (41), Old age, not falling within any registration, with number other category (11) of places The Limes DS0000027285.V275930.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Eleven (11) Older People of either sex and forty-one (41) people of either sex with dementia may be accommodated. The total number not to exceed 41. 19th August 2005 Date of last inspection Brief Description of the Service: The Limes is a care home providing care for 41 older people with dementia, which includes the facility to accommodate 11 older people who do not have dementia. All accommodation, including a choice of lounges, is on the ground floor, and there are secure gardens, which are accessible to all residents. Car parking is provided at the front of the home. The Limes DS0000027285.V275930.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This routine unannounced inspection took place over 5 ¼ hours during which time the inspector spoke with 8 residents and 5 staff. The views of residents and staff, where appropriate, are reflected in the findings in the report. A tour was made of the building including one of the bedrooms, and the inspector also looked at samples of care plans, and financial records. Feedback was given to the Manager by telephone the following day. A total of four requirements, three repeated from the previous inspection and two recommendations also repeated from the previous inspection were made as a result of this inspection. What the service does well: What has improved since the last inspection?
Care plans have improved slightly, and the manager is in the process of changing them to reflect an individualised and person centred approach to the residents care. Staff have started to compile a life story for each person, which is good to see. Assessments regarding pressure areas, nutrition and falls have improved, but the pressure area and nutritional assessments could be better. Staffing levels have improved in the afternoons allowing staff more time to spend with the residents. Good interaction was seen between staff and residents, and residents were being involved in activities and meaningful occupations. The Limes DS0000027285.V275930.R01.S.doc Version 5.1 Page 6 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 Limes DS0000027285.V275930.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Limes DS0000027285.V275930.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards not assessed at this inspection. EVIDENCE: The Limes DS0000027285.V275930.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8 and 10. Care plans and assessments have improved but further work is needed. Residents are treated with respect and dignity. EVIDENCE: The manager explained that care plans were being updated into a new more person centred format. Some work has been done to improve current care plans, some of the residents social and emotional needs have been identified, but this needs to be much more detailed and recorded better. Care staff have started to write life stories for the residents which is good, and this area also needs further work. Risk assessments for nutrition have been completed, but the home needs to undertake formal nutritional screening to determine the residents level of dietary needs. Pressure area assessments are being used, but the assessment is basic. The Waterlow score would be better to use, as this asks for more detailed information and gives a more accurate result. Risk assessments for falls have been recorded, and the home is more aware of residents at risk of falls. Requirements have been repeated regarding care plans and assessments. Staff were observed treating residents with respect, and residents felt the staff respected them.
The Limes DS0000027285.V275930.R01.S.doc Version 5.1 Page 10 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): Standards 12, 13, 14 and 15 Interaction between staff and residents has improved significantly, visitors are welcomed at any time, staff help residents to make choices and residents enjoy the food provided. EVIDENCE: The manager has increased the staffing levels recently to provide residents with more stimulation, activities and meaningful occupation. Residents were seen to be joining in card games, household tasks and one to one interaction with staff. Staff need to make sure that all residents are included and should be aware of those residents who appear to be constantly sleeping. Staff discussed how they help residents make choices on a daily basis and were seen offering a choice of sandwiches at tea time. Although some staff thought the menus were repetitive and unadventurous, the residents all said they liked the food. The Limes DS0000027285.V275930.R01.S.doc Version 5.1 Page 11 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): Standard 16 Although most residents would not be able to formally complain, the staff help them make their wishes known. EVIDENCE: Because most of the residents have dementia, they are not able to make formal complaints and are generally not able to understand how to use the homes complaints policy. The staff however, discussed how well they know the residents and said they would know if they were unhappy, and would soon report any issues to a senior member of staff. One complaint from a residents relative had been received and investigated by the Commission in November 2005. This was regarding poor care practice and staffing levels. Some of the complaint was upheld, and the manager has addressed the issues raised and has made improvements to care practice and staffing levels. The Limes DS0000027285.V275930.R01.S.doc Version 5.1 Page 12 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): Standards not assessed at this inspection. EVIDENCE: The Limes DS0000027285.V275930.R01.S.doc Version 5.1 Page 13 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27 and 28 Staffing levels have improved enabling residents to receive more stimulation and interaction. Residents would benefit from more staff having NVQ training in care practice. EVIDENCE: At the previous visit to the home to investigate a complaint, it was noted that there were not enough staff on duty during the afternoons to provide residents with proper stimulation or interaction. The manager has increased the staffing levels in the afternoons to allow staff to spend more time with the residents. Out of 27 care staff, 3 have achieved NVQ level 2 and 2 are waiting to start their training. Some staff have had many years experience in caring for older people although have not yet achieved NVQ. The manager tries to make sure that experienced care staff work alongside those less experienced. The Limes DS0000027285.V275930.R01.S.doc Version 5.1 Page 14 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): Standards 31 and 35 Residents’ benefit from living in a home that is well run by a competent manager and also by the home making sure their finances are safely managed. EVIDENCE: The manager, who is also a trained nurse is currently working towards achieving the Registered Managers Award and has recently completed a 12week course in dementia care. Difficulties are sometimes experienced with staff recruitment and competency and the manager is good at identifying and addressing problems that arise. Records of residents’ finances were inspected, and with one exception were in good order. One account was found to contain a few pence more than the balance stated. The manager and deputy regularly audit these accounts. The Limes DS0000027285.V275930.R01.S.doc Version 5.1 Page 15 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 3 28 2 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X X The Limes DS0000027285.V275930.R01.S.doc Version 5.1 Page 16 Are there any outstanding requirements from the last inspection? Three. 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 Requirement Timescale for action 30/04/06 2. OP7 3. OP8 4 OP28 12, 13, 15 The Registered person must ensure that all care plans contain clear and specific guidelines for staff to follow and are updated and amended to reflect residents changing needs. Repeated. Deadline of 31.10.05 not met. 12 The Registered person must 30/04/06 ensure that the residents’ social and emotional needs are identified and guidelines in how to meet these needs are detailed in their care plans. Repeated. Deadline of 31.10.05 not met. 13 The Registered person must 30/04/06 ensure that nutritional assessments are undertaken for each resident and the findings are reflected in a plan of care. Repeated. Deadline of 31.10.05 not met. 18 The Registered person must 31/07/06 ensure that at least 50 of care staff, excluding the manager have or are working towards NVQ level 2 (minimum). The Limes DS0000027285.V275930.R01.S.doc Version 5.1 Page 17 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 OP8 Good Practice Recommendations The Registered person is recommended to undertake research into providing a person centred approach to the residents care needs and introduce this concept within the home. Repeated. The Registered person is recommended to research and develop a garden area to meet the needs of confused and disorientated people. Repeated. 2. OP19 The Limes DS0000027285.V275930.R01.S.doc Version 5.1 Page 18 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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