Inspection on 18/05/06 for The Limes

This inspection was carried out on 18th May 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Limes 25/07/07

The Limes 21/02/06

The Limes 27/04/05

The Limes 18/11/04

The Limes 11/05/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE The Limes Main Street Scopwick Lincoln Lincs LN4 3NW Lead Inspector Moya Dennis Key Unannounced Inspection 18th May 2006 09:00 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 DS0000002448.V294620.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 DS0000002448.V294620.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Limes Address Main Street Scopwick Lincoln Lincs LN4 3NW 01526 321748 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) Ablegrange (Lincoln) Limited Mrs Jacqueline Mandy Burrows Care Home 40 Category(ies) of Dementia (2), Old age, not falling within any registration, with number other category (38) of places The Limes DS0000002448.V294620.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Conditions of Registration A condition of registration is that the maximum number of service users in each category is as follows: Up to 2 DE, 63 years and over. Up to 38 OP. Date of last inspection 21st February 2006 Brief Description of the Service: The home, a single storey building, was originally a school and is situated in the village of Scopwick. There are no local shops but the home is close to the main Sleaford to Lincoln bus route. There is a railway station in Metheringham, approximately three miles away. There is a public house, a church and a small community centre nearby. The home provides personal care for people over the age of 65, with two rooms for people with dementia over the age of 63 years. There are thirty-one single bedrooms, sixteen en suite, and three double bedrooms, all of on the ground floor. Ablegrange Ltd owns the home and a registered manager runs it on their behalf. Fees range from £335 to £425 per week. Services such as hairdressing, chiropody, toiletries, magazines and newspapers, transport and recreational opportunities are charged separately. The home is advertised in hospital predischarge information packs, supplied to patients and their families by the United Lincolnshire Health Trust and in British Legion information literature. There are plans to develop a web site in the near future. The Limes DS0000002448.V294620.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection was undertaken using a review of all the information provided by the manager relating to The Limes and visiting the home. The main methods of inspection used were case tracking the care of selected residents, inspecting their records and discussing their experience of care received. Other residents, visitors and staff were also asked for their views. The inspector toured the home with the deputy manager in charge of the shift and generally observed interactions between staff and residents and care practices throughout the visit. Many of the key standards were inspected at the last visit and have therefore not been inspected at this visit. What the service does well: What has improved since the last inspection? A refurbishment programme has been implemented; new carpets have been fitted, kitchen, small lounge and bedrooms redecorated. The manager has worked hard to comply with the requirements and recommendations made at the last inspection. • • All policies and procedures have been reviewed. New assessments and care plans are more detailed and identify individual needs. The Limes DS0000002448.V294620.R01.S.doc Version 5.1 Page 6 • Medication administration policies have been reviewed and residents’ medication is to be moved to more appropriate storage in the next few days. New privacy screens have been provided for shared rooms. Residents are supported and protected by improved recruitment policies and practices. • • The home has produced a newsletter to inform residents, relatives and friends about forthcoming events and information. A copy of the first issue was made available for the inspection. Service user meetings are held three times a year. Relatives are invited to attend and contribute. 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 DS0000002448.V294620.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 DS0000002448.V294620.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): 1, 3, 4, 5. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Prospective residents are visited by the manager and have an assessment of needs completed. Service users’ guides give information about the home. Pre admission and trial visits are encouraged. EVIDENCE: The service users’ guide is written in plain English and includes descriptions of the home and levels of care delivered. The manager visits prospective residents and completes an assessment of need. This, together with any social work and/or medical assessment is used to determine whether the home is able to meet assessed needs. Some residents completed user surveys that formed part of the inspection. Comments included, “ The home came to see me and I was able to ask questions; I had no choice, it was the only place The Limes DS0000002448.V294620.R01.S.doc Version 5.1 Page 9 available; It was decided by my family and the social worker”. Most residents were asked for their views during the inspection and confirmed that whilst choice had been limited because of available vacancies, they had been provided with information about the home before deciding to move there. Relatives present during the inspection also confirmed that they had visited the home prior to their relative moving and had spoken to the manager and staff and been fully involved with their relative’s care plans. The Limes DS0000002448.V294620.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 10, 11. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Care plans are detailed, covering all aspects of assessed need and evidence residents’ and family involvement. Residents are treated with respect at all times. Care plans include information about residents’ wishes concerning end of life and arrangements after death. EVIDENCE: Care plans were comprehensive and gave information that would enable carers unfamiliar with the resident to deliver appropriate care. Care plans were signed by residents or their supporters, evidencing user involvement. Plans are reviewed regularly and any changes agreed with the resident and/or their supporters, as appropriate. The Limes DS0000002448.V294620.R01.S.doc Version 5.1 Page 11 Residents said the staff always treated them with respect; staff were seen to knock on doors before entering but did not always wait for a response. One resident has a key to their room and prefers to keep it locked at all times. Bathrooms and toilets are fitted with privacy locks. One resident who had recently moved to the home was unsure about routines concerning getting up. Relatives said they felt able to raise this with the manager on behalf of the resident and thought the misunderstanding had been the result of a minor breakdown in communication. Other comments made by residents included, “ It’s all very satisfactory and I’m very happy … Very comfortable and satisfied, they couldn’t treat me better”. Arrangements for end of life care, preferred extent of family involvement, spiritual needs and practical arrangements following death are recorded and kept in separate files. Brief notes explaining the location of this file are made within the main care plan. The Limes DS0000002448.V294620.R01.S.doc Version 5.1 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, 14, 15. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home employs an activities co-ordinator for 20 hours each week. Residents’ views are sought in many aspects of the home. Meals are varied, with choices offered. EVIDENCE: There is a programme of activities inside the home that includes bingo, exercise, art, baking, quizzes and organised entertainers. Activities outside the home include pub lunches, coffee mornings, church fetes, walks, theatre trips and other outings. Residents’ and relatives’ input is invited and encouraged by means of the Newsletter and service users meetings. Church services are held at the home once a month but two residents said they would prefer to go to church to worship with others, as had been their cultural habit. The manager was aware of this but staff shortages made it hard to meet the request. The Limes DS0000002448.V294620.R01.S.doc Version 5.1 Page 13 Residents completed user surveys prior to the inspection and two described themselves as other than British. This was not reflected in their care plans and staff said it made, “no difference in the way we treat them”. When asked, both residents said their cultural needs were not acknowledged. The manager should ensure that all residents have choices in how and where they worship, being mindful of cultural differences. One resident had difficulty in sending mail to their family, having to ask visitors to post letters in Sleaford. The deputy manager agreed that it would be simple to introduce informal postal arrangements, such as a collection point for residents’ outgoing mail and selling stamps within the home. Most residents said they enjoyed the food but one resident said they “were sick of shepherds pie”. Menus follow a four-week rota and copies were made available for the inspection. Some frailer residents said they were often given too large portions and this spoilt their appetite. More attention to individual preference would be appropriate. During a recent service user meeting it was suggested that there was too much red meat on the menu and alternatives would be supplied when red meat was served. Residents had contributed ideas for a new summer menu and this would start soon. On residents’ suggestions, wine, beer and sherry is served with Sunday lunch for those who want it. The Limes DS0000002448.V294620.R01.S.doc Version 5.1 Page 14 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): These standards were not assessed during this inspection. EVIDENCE: The Limes DS0000002448.V294620.R01.S.doc Version 5.1 Page 15 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, 20, 25, 26. Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. Residents, visitors and staff are not protected from the discomfort and hazards of passive smoking. It is unclear whether bathroom facilities meet the needs of all residents. Residents are at risk of scalding because the temperature of hot water in the taps is not regulated. EVIDENCE: The home is generally well maintained in respect of decoration and fittings. The small lounge has had a new carpet fitted and been redecorated. The main lounge is adjacent to a smaller smoking lounge. This is fitted with doors but they were open at the time of inspection. Although the home is The Limes DS0000002448.V294620.R01.S.doc Version 5.1 Page 16 otherwise odour free, the large lounge smelled strongly of cigarette smoke. Several residents said the doors were always open and the smell went through the home. Some residents had breathing difficulties and none appreciated the pervading smell. Staff have to sit with residents while they smoke although no staff on duty were smokers. The manager should review this policy to reflect the rights of non-smokers and the duty to protect vulnerable residents. The manager must review bathroom facilities to ensure they meet the needs of all residents. Two baths are sited next to walls, making the use of a hoist impossible. Only one bathroom has a hoist in place. A bath panel in one bathroom was broken, the sharp edge posing a risk of injury to residents or staff. This was pointed out to the deputy manager, who made arrangements to have it replaced. As previously noted, water remains excessively hot and assurances have been made that this will be rectified in the very near future. Future checks will be made to ensure this has happened. The laundry area is inadequate for the needs of residents and does not provide staff with a safe, comfortable working environment. There is insufficient space for the laundry worker to iron in the room and this is done in a bedroom at the opposite side of the building. Whilst the laundry worker is ironing, the washing machine and drier is unattended and when the worker is in the laundry room, the iron is unattended. The lack of organisational facilities in both the laundry room and the ironing room makes it difficult to sort residents’ clothing efficiently. The sluice cupboard is inadequate for residents’ needs and does not contain a sluice, merely a deep sink. This often becomes blocked with matter and staff clear it by hand. The sluice cupboard also serves as a storeroom for the vacuum cleaner and other cleaning equipment. There is no designated area for staff to take breaks; these are taken in the dining room, in full view of residents and visitors. There are no staff facilities for the purpose of changing or storing coats and personal belongings. The Limes DS0000002448.V294620.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. There are sufficient numbers of staff on duty at all times. The home’s recently reviewed recruitment practices are more robust and safeguard residents. EVIDENCE: The deputy manager, care staff, residents and visitors all said staffing levels had improved. A new deputy manager had recently been recruited and was on induction during the inspection. A kitchen assistant has also been appointed in the last few months. A notable feature of the inspection was that all members of staff took an active interest in proceedings and offered their views and opinions. Induction records were seen; these were signed and dated by staff members and manager. Files of recently recruited staff were seen; these evidenced that more rigorous checks are now made to investigate gaps in employment history. All appointments followed correct procedure. Staff members said they were encouraged to take advantage of training opportunities and undertake National Vocational Qualification (NVQ) awards. Currently, 35 of care staff have level 2 or above. The Limes DS0000002448.V294620.R01.S.doc Version 5.1 Page 18 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): 32, 36. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The manager is experienced and has good communication with staff, residents and relatives. Staff received regular formal supervision. EVIDENCE: The manager has over 20 years experience of mental health care and has been home manager for 6 years. She also has extensive knowledge of the ageing process and the impact of associated physical limitations. Although not present during the inspection the manager was said by staff, residents and visitors to be “approachable … very helpful”. Residents and their visitors said they had had no reason to complain but would have no hesitation in bringing concerns to the manager’s attention and were confident that they would be listened to. The Limes DS0000002448.V294620.R01.S.doc Version 5.1 Page 19 The home has an ‘Employee Of The Month Award’, which recognises good practice. Any employee can be nominated by other staff, residents, visitors or any other source and is rewarded by official recognition and gift vouchers. Staff said the manager was very supportive and constantly brought the lack of staff facilities and defects of the home to the attention of the registered providers. The manager has implemented methods of involving residents, relatives and staff to have a say in the way that the home is run. Most residents and some staff were not aware of the identity of the providers, as regulation monthly visits routinely involved the same shift workers each visit. Residents said they had not been asked for their views, nor had most care and housekeeping staff. Staff interviewed confirmed that they had formal supervision every two months and their practice was observed on a regular basis. Supervision and staff appraisal was also used to identify training needs. The Limes DS0000002448.V294620.R01.S.doc Version 5.1 Page 20 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 X 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 1 1 X X X X 2 2 STAFFING Standard No Score 27 3 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 X X X X X X The Limes DS0000002448.V294620.R01.S.doc Version 5.1 Page 21 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 OP20 Regulation 23 (2) (p) Requirement The registered person must ensure that appropriate ventilation is provided to safeguard residents, visitors and staff from the discomfort and hazards of passive smoking, or alternative arrangements made to accommodate smokers. The registered person must assess present bathroom facilities to ensure that they meet the needs of all residents. Timescale for action 30/07/06 2. OP22 23 (2) (j) (n) 21/08/06 The Limes DS0000002448.V294620.R01.S.doc Version 5.1 Page 22 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 OP25 Good Practice Recommendations A safe and adequate water outlet system must be installed to meet the needs of all residents. Timescale of 30/04/05, 30/09/05 and 06/03/06 has not been met. Assurances were received from Ablegrange (Lincoln); 06/03/06 that this will be rectified “in two more months”. The responsible person must visit the home each month, unannounced to ensure that the residents health, safety and welfare are maintained. 2. OP33 The Limes DS0000002448.V294620.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Limes DS0000002448.V294620.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!