CARE HOMES FOR OLDER PEOPLE
The Limes 16a Drayton Wood Road Hellesdon Norwich NR6 5BY Lead Inspector
Hilary Shephard Announced 19 August 2005 9.30am
th 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 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 I55 s27285 the limes v237946 190805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service The Limes Address 16a Drayton Wood Road, Hellesdon, Norwich, NR6 5BY 01603 427424 01603 427009 Telephone number Fax number Email 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 Christine 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 I55 s27285 the limes v237946 190805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Eleven (11) Older People of either sex and forty-one (41) people of either sex with dementia may be accomodated. The total number not to exceed 41. Date of last inspection 31st January 2005 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 I55 s27285 the limes v237946 190805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This planned announced inspection took place over 8 ½ hours during which time the inspector spoke with six residents and five staff. Comment cards were sent by CSCI to the home for completion by residents and relatives, but none were returned. The views of residents and staff, where appropriate, are reflected in the findings in the report. A tour was undertaken of the building accompanied by the manager and some bedrooms, the lounges, dining rooms and the gardens were viewed. Information was also gathered from the preinspection questionnaire, care plans, staff files and records. At the end of the inspection feedback was given to the manager. What the service does well: What has improved since the last inspection?
Improvements have been made to staff training, the manager and deputy have completed in-depth training courses in dementia care and staff have undergone a variety of in-house training about care practice. New staff have received induction training with the deputy manager. Improvements have been made to the interior of the home, a hairdressing salon has been set up, security to the front door has improved, the front garden has been tidied and cleared providing more light to the bedrooms at the front of the home and the fence in the rear garden has been made safe. Improvements have been made to the medication system, which is now audited on a weekly basis, reducing the risk of errors, and is now booked in correctly. The homes adult protection procedure and training is better ensuring they are making every effort to protect residents from harm.
The Limes I55 s27285 the limes v237946 190805 Stage 4.doc Version 1.40 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 I55 s27285 the limes v237946 190805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection The Limes I55 s27285 the limes v237946 190805 Stage 4.doc Version 1.40 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 standard(s) 3 Residents’ needs are assessed using a basic format prior to admission and the home is careful not to admit anyone whose needs they cannot meet. EVIDENCE: Residents’ files were inspected and contained pre-admission assessments completed by the manager who usually visits prospective residents before admission. Residents and families are also encouraged to visit the home before admission to assist them with their choice. The Limes I55 s27285 the limes v237946 190805 Stage 4.doc Version 1.40 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 standard(s) 7, 8 and 9 All residents have a plan of care, but not all their current needs have been assessed or updated, the guidelines for staff are too brief and do not provide enough information for the correct care to be given. Medication is well managed and measures are in place to ensure it is administered safely. EVIDENCE: Residents care plans were inspected, and although they contained some assessments and guidelines, these were very brief and not specific enough to provide staff with the knowledge needed to provide the correct care. Staff were able to discuss specific residents care needs with the inspector and the homes recent quality audit indicated that staff had been complimented on their up to date knowledge of residents changing needs. Assessments for nutrition, falls, pressure areas, social and emotional needs were absent as were guidelines to enable staff to meet these needs. In most cases, good detail regarding the residents life history had been completed, however, the information gathered had not been used to provide staff with guidance in how to address the residents social and emotional needs. One residents care needs had changed and although staff were aware of the changes, the care plan had not been updated to reflect this. Requirements and recommendations have been made regarding care plans and assessments.
The Limes I55 s27285 the limes v237946 190805 Stage 4.doc Version 1.40 Page 10 Although falls are not formally risk assessed, the manager completes a monthly audit of the accident records and addresses any identified problems with the GP. Medication was inspected and had improved since the last inspection. The deputy manager audits the medicines on a weekly basis to check and correct errors. The deputy manager demonstrated a good awareness of the safe administration of medicines. The Limes I55 s27285 the limes v237946 190805 Stage 4.doc Version 1.40 Page 11 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 standard(s) Not assessed at this inspection. EVIDENCE: The Limes I55 s27285 the limes v237946 190805 Stage 4.doc Version 1.40 Page 12 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 standard(s) 18 The home has developed a good adult protection policy and makes every effort to protect residents from harm. EVIDENCE: The home has updated and improved their adult protection policy bringing it in line with the Norfolk Adult Protection protocol. The manager has a very good understanding of adult protection and has become a trainer in the prevention of abuse. Staff confirmed they have undergone training in house and said that any issues of abuse would be reported to the manager, the deputy, or a senior carer. The Limes I55 s27285 the limes v237946 190805 Stage 4.doc Version 1.40 Page 13 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 standard(s) 19 and 26 Residents’ benefit from a well maintained home that is clean and pleasant smelling. EVIDENCE: A tour of the premises and garden was made, and the home is in the process of making improvements to the garden and the interior. The proprietor advised that he plans to replace the carpet that runs through the dining room and lounges. Improvements need to be made in the back garden to provide an environment more suited to the needs of the residents who have dementia and the inspector gave the manager some information about designing gardens for people with dementia. A recommendation has been made regarding the garden. Building work has been going on for sometime in the home and is now completed with some minor improvements to be made to the interior décor. The Limes I55 s27285 the limes v237946 190805 Stage 4.doc Version 1.40 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 Residents care provision has been compromised by recent staff changes, staffing levels provided are at the minimum required and are just managing to meet the needs of the current residents. The home follows proper recruitment practices ensuring residents are protected and staff are provided with induction and ongoing training. EVIDENCE: Five care staff have been appointed since March 2005, and their inexperience has had a negative impact on the quality of the care given, which is most noticeably reflected in the care plans. Two recently appointed members of staff were spoken with and they confirmed that they have received induction and training in care practice. Five care staff have received basic training in dementia care, and both the manager and the deputy manager have completed more in depth dementia training. The manager advised that further training for staff in dementia care is planned and a new format for recording staff training needs has been implemented. Staff advised that generally they felt there was enough time for them to undertake their care duties and that the mornings were the busiest times. Little positive interaction was observed between staff and residents with the exception of attending to their physical care needs. Requirements have not been made at this inspection as the manager is aware of these issues and is making every effort to address them. The Limes I55 s27285 the limes v237946 190805 Stage 4.doc Version 1.40 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 36 and 38 Residents’ benefit from living in a safe and well-maintained environment and by the home monitoring and measuring the quality of service provided. By staff not having formal supervision it has created a negative impact on their knowledge and understanding of the care provided. EVIDENCE: The manager undertakes an annual quality audit with residents’ relatives and visitors and has produced an informative report. Good feedback was obtained from questionnaires and the manager has used this to make improvements to the service provided. The manager advised that she has recently commenced staff appraisals and will be introducing formal supervision shortly. This will be used to identify training needs and address shortfalls in the staffs knowledge of care practice. Health and safety records were inspected and were in good order.
The Limes I55 s27285 the limes v237946 190805 Stage 4.doc Version 1.40 Page 16 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x x 3 x x 2 x 3 The Limes I55 s27285 the limes v237946 190805 Stage 4.doc Version 1.40 Page 17 None Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Timescale for action 12, 13, 15 The Registered person must 31st ensure that all care plans contain October clear and specific guidelines for 2005 staff to follow and are updated and amended to reflect residents changing needs. . 12 The Registered person must 31st ensure that the residents social October and emotional needs are 2005 identified and guidelines in how to meet these needs are detailed in their care plans. 12, 13 The Registered person must 31st ensure that falls risk asessments October are completed for each resident 2005 and the findings are reflected in a plan of care. 13 The Registered person must 31st ensure that nutitional and October pressure area assessments are 2005 undertaken for each resident and the findings are reflected in a plan of care. Regulation Requirement 2. 7 3. 7 4. 8 The Limes I55 s27285 the limes v237946 190805 Stage 4.doc Version 1.40 Page 18 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 8 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. The Registered person is recommended to research and develop a garden area to meet the needs of confused and disorientated people. 2. 19 The Limes I55 s27285 the limes v237946 190805 Stage 4.doc Version 1.40 Page 19 Commission for Social Care Inspection 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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