CARE HOMES FOR OLDER PEOPLE
The Limes 41/45 Church Street Bridgwater Somerset TA6 1AN Lead Inspector
Jane Poole Unannounced 2nd June, 2005 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 D53-D02 S15987 The Limes V225127 160605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service The Limes Address 41/45 Church Street, Bridgwater, Somerset, TA6 5AT 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) 01278 422535 Mr Brian Thomas Mrs Angela Margaret Brewer Personal Care Home only 28 Category(ies) of Old age (28) registration, with number Dementia - over 65 (28) of places The Limes D53-D02 S15987 The Limes V225127 160605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Registered for 23 persons in category OP and 5 persons in category DE(E) An additional bathroom equipped with assisted bathing facilities will be installed within 10 months from Date of Registration 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 21 October, 2004 Brief Description of the Service: The Limes is located in a quiet but central part of Bridgwater. It is currently registered with the Commission for Social Care Inspection to provide personal care to up to 28 people over the age of 65, this includes 5 people who have a dementia.Service user 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 and the registered manager is Mrs Angela Brewer. The home is well maintained and furnished in comfortable domestic style. There are twenty four single bedrooms and two double rooms. Twenty-three of the bedrooms have en suite facilities. The Limes D53-D02 S15987 The Limes V225127 160605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over a 7 hour period. The inspector was given unrestricted access to all communal areas, was able to speak with staff and service users, view records and observe care practices. The manager and the home-owners were available throughout the inspection. What the service does well: What has improved since the last inspection? The Limes D53-D02 S15987 The Limes V225127 160605 Stage 4.doc Version 1.30 Page 6 The activities in the home continue to improve. Care staff now incorporate activities into their daily routines and there is evidence that service users are benefiting from this additional social stimulation. Additional staff hours have been provided to enable service users to access community facilities. These include trips to local shops and pubs. At the last service user meeting people were asked to provide ideas for trips that they would like to have arranged. The day before the inspection the home had hired a coach to take service users out for afternoon tea and a tour of the coast. Further outings are planned over the summer in line with suggestions made at the service user meeting. Since the last inspection an extra lounge area has been created and many staff stated that the additional lounge had created a space where service users were able to take part in activities without disturbing people who did not wish to be involved. The number of care staff who have NVQ qualifications has increased since the last inspection and further staff are working towards the award. The current owners of the home continue to up grade many areas to create a pleasant and comfortable environment for service users. What they could do better:
Care plans seen by the inspector had not been up dated to reflect the current needs of service users. The records of medical appointments had not been kept up to date and some risk assessments had not been reviewed. Therefore personal files did not give a true picture of the needs of individuals or provide accurate information to staff. The care staff currently use a kardex system to record significant events. Nothing had been written in some running records for over a month. The recording of accidents is being reviewed by the manager and will be discussed with staff at the next meeting. The home has policies and procedures in relation to caring for some one who is dying and what to do in the event of a death. Some staff felt that they would benefit from further training and support in this area. The portable electrical appliance testing was last carried out in February 2004. These appliances should be tested annually. The Limes D53-D02 S15987 The Limes V225127 160605 Stage 4.doc Version 1.30 Page 7 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 D53-D02 S15987 The Limes V225127 160605 Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Limes D53-D02 S15987 The Limes V225127 160605 Stage 4.doc Version 1.30 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3, 4 & 5. The home sees and assesses all prospective service users prior to admission to ensure that they are able to meet their needs. Service users and their representatives are able to visit The Limes before making a decision to make it their home. EVIDENCE: There have been no changes to the statement of purpose or the service user guide since the last inspection. The service user guide is not routinely given out to service users but is available in the entrance hall and individual copies are given out on request. The home also has a brochure, which gives very basic details about the home. All prospective service users are assessed by relevant professionals and in addition to this the home also carry out their own assessment to ensure they feel able to meet their needs. The inspector saw copies of the pre admission assessment for the newest service user. The Limes D53-D02 S15987 The Limes V225127 160605 Stage 4.doc Version 1.30 Page 10 Various aids and adaptations have been put in place in the home and there is appropriate signage to assist people to move around independently. The home is registered to provide care to older people and up to 5 people who have a dementia. Staff spoken to stated that they have received training in the care of older people including caring for people who have mental health needs. The home currently has ten beds that have been block contracted by Somerset Social Services. The manager stated that she continues to have full control of the admission process and only admits people whos needs she is confident that the home can meet. Service users spoken to stated that they had had the opportunity to visit the home with friends or family before making a decision to move in. The Limes D53-D02 S15987 The Limes V225127 160605 Stage 4.doc Version 1.30 Page 11 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, 9 &11. The care plans in the home are poor and do not reflect the up to date needs of the service users and therefore do not provide adequate information to staff. The manager regularly audits the Medication Administration Records and addresses issues of poor practice. EVIDENCE: The inspector initially viewed the personal files of three service users. In one file, belonging to a person who had been at the home for three months, there was no care plan. The care plan of another had not been updated to reflect their current needs. A further three care plans were then viewed and found not to be fully reflective of current needs. The care plan format is very personal and covers areas of need and preferences for how people wish to be cared for. The staff write a very short care plan review at the end of each month but the care plan is not amended to take into account the changes in a persons care needs. Each care plan had a personalised risk assessment but again these had
The Limes D53-D02 S15987 The Limes V225127 160605 Stage 4.doc Version 1.30 Page 12 not been updated and there was no evidence of reviews. An immediate requirement was issued to up date all care plans by the 10th June 2005. The house uses the kardex system to record significant events and running records. Nothing had been written in some running records for over a month. All service users are registered with local GP’s and other healthcare professionals. There is a sheet in the personal file to list medical appointments but this had not been completed in all personal files. The manager stated that staff record appointments in the kardex. Staff and service users stated that assistance is offered to enable people to attend medical appointments outside the home. There is evidence that extra staff are made available to ensure that service users are supported with hospital and other appointments. The home has a policy on the care of someone who is dying. And doctors and district nurses assist with this care where appropriate. Some staff stated that they felt comfortable in this area of work whilst others felt that they would benefit by further training and support to care for some one who is terminally ill. The home uses the Boots Monitored Dosage System for medication and there is appropriate storage, including storage for controlled drugs and medication that requires refrigeration. The inspector viewed the controlled drugs and found them to correctly correlate to the entries in the controlled drugs register. The Medication Administration Records were seen and the inspector noted that there were a few gaps in signing and that one hand transcribed entry had not been signed and witnessed. This was discussed with the manager who had already noted these areas and discussed with staff. The Limes D53-D02 S15987 The Limes V225127 160605 Stage 4.doc Version 1.30 Page 13 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) 12, 13 & 15 There have been great improvements in the activities available in the home. Service users are now benefiting from a range of activities and trips out. All service users were happy with the quality of food in the home. EVIDENCE: Service users spoken to stated that they were generally happy with the routines in the home. Care plans give details of the times that people like to get up and go to bed. The inspector observed that people able to move freely around the home. In the last year there has been a great improvement in the activities available to people living at The Limes. Some senior staff have received training in reminiscence therapy and the home regularly hire prompt boxes from the local reminiscence centre. Care staff now incorporate activities into their daily routines and there is evidence that service users are benefiting from this additional social stimulation. This is particularly evident in service users who are unable to occupy themselves. Additional staffing is made available at least twice a week to enable service users to access community facilities such as shops and pubs. On the day before the inspection the home had hired a coach to go out for afternoon tea and tour the West Somerset coast. This had been very much enjoyed by many of the service users that the inspector spoke with.
The Limes D53-D02 S15987 The Limes V225127 160605 Stage 4.doc Version 1.30 Page 14 Trips out were discussed at the last service user meeting and suggestions have been incorporated into future planned outings. The home has purchased a DVD played and holds a film show twice a week. Again some service users spoken to were very much enjoying this. Service users stated that there is a weekly gentle exercise class and a regular visitor from the church. On the day of the inspection some service users were listening to music and playing ball games with staff, some people were knitting, some were watching TV and others attended a bingo session organised by an outside facilitator. All service users stated that they were able to entertain visitors at any time either in communal areas or in the privacy of their rooms. Service users spoken to all stated that the quality of food in the home was very good. People said that there was always a choice at every meal and that ample portions were provided. There is a four-week menu that offers a wide range of food, but people spoke to stated that in addition to the set menu they are always able to make special requests. The main dining room is on the lower ground floor and there is a small additional dining room on the ground floor. The Limes D53-D02 S15987 The Limes V225127 160605 Stage 4.doc Version 1.30 Page 15 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) 16 & 18. The manager in the home is extremely approachable and staff and service users felt that they could approach her with any worries or concerns. EVIDENCE: The home has policies in respect of making a complaint, recognising and reporting abuse and whistle blowing. The inspector noted that whistle blowing had been discussed at a recent staff meeting. The complaint procedure is available in the service user guide. All staff undergo an enhanced Criminal Records bureau check. Service users spoken to stated that they would be comfortable to approach the manager or a member of staff with any concerns or complaints. Staff stated that the homes manager was very approachable and was always ready to listen to any worries that they may have. Regular staff and service user meetings are held where people are free to express opinions and raise complaints. No complaints have been made since the last inspection. The Limes D53-D02 S15987 The Limes V225127 160605 Stage 4.doc Version 1.30 Page 16 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, 20, 21, 22, 23, 24, 25 & 26. The home provides a comfortable, safe environment for service users. The current home owners have up dated many areas of the building and continue to do so. EVIDENCE: The home is a large old building set in the centre of Bridgwater. Accommodation is provided over four floors with lift access between. Outside there is a large pleasant garden area with seating. Key-pads have been fitted on external doors which are linked to the fire alarm system and automatically release in the event of a fire. CCTV has been installed to monitor the entrance and provide additional security. Since the last inspection the home have created a new lounge area on the ground floor, meaning that there is now 2 lounges on the ground floor and 1
The Limes D53-D02 S15987 The Limes V225127 160605 Stage 4.doc Version 1.30 Page 17 on the lower ground floor. Staff stated that the additional lounge had created a space where service users were able to take part in activities without disturbing people who did not wish to be involved. At the time of the inspection the main lounge was in the process of being re decorated. There is a large dining room on the lower ground floor. There are 24 single bedrooms at the home and 2 doubles, 23 of the 26 rooms have en suite facilities and there are communal bath/shower rooms on the ground, lower ground and second floor. Aids and adaptations have been put in place around the home. These include handrails, raised toilets, assisted bathing facilities and clear signage. All bedrooms seen were comfortably furnished and had been personalised to reflect the individual tastes and needs of the service users. Since the last inspection some rooms have been re carpeted and redecorated and the owners stated that this is an ongoing process. A team of domestic staff are employed and on the day of inspection all areas appeared clean and fresh. The manager is reminded that appropriate hand washing facilities, including paper towels, should be available in all communal toilets and locks must be fitted to ensure the privacy of service users. The Limes D53-D02 S15987 The Limes V225127 160605 Stage 4.doc Version 1.30 Page 18 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, 28 & 30. The staff team interact with service users in a friendly respectful manner and are enthusiastic about their jobs. There are adequate numbers of staff on duty to meet the needs of service users. EVIDENCE: The inspector was able to speak privately to staff on duty on the day of the inspection. There is a two week set rota and some staff stated that they work additional hours to cover for any shortfalls due to sickness and holidays. All staff were extremely enthusiastic about their jobs and spoke respectfully of service users at the home. All staff spoken to felt that there were adequate numbers of staff. The minimum staffing levels are four carers in the morning, two in the early afternoon and three in the evening. At night there are two waking night staff. Some staff are regularly employed to provide hours in addition to this to enable service users to access community facilities and attend appointments. The home employs a total of 19 care assistants who work full and part time. 6 staff have NVQ 2 in care and a further 2 have almost completed the award. Staff stated that they have undertaken training in manual handling, fire safety, food hygiene, reminiscence, care of people with dementia and diabetes.
The Limes D53-D02 S15987 The Limes V225127 160605 Stage 4.doc Version 1.30 Page 19 The inspector was able to observe care practices in the home and noted that staff interacted with service users in a friendly respectful manner. All service users spoke highly of the staff team, describing them as friendly, helpful and patient. There is a stable staff team and no new staff have been employed since the last inspection in October 2004. The Limes D53-D02 S15987 The Limes V225127 160605 Stage 4.doc Version 1.30 Page 20 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) 31, 32, 36, 37 & 38. The manager of the home creates an open and inclusive environment and is approachable to staff and service users. Some records relating to service users have not been kept up to date. EVIDENCE: The registered manager of the home is Angela Brewer, she has worked at the home for approximately 17 years and has been the manager for over 4. She is able to give evidence that she keeps her knowledge of care practices up to date by reading and attending training courses. She is currently undertaking the Registered Managers Award - NVQ level 4. The manager is open and approachable and was co operative throughout the inspection. There are regular staff meetings and all staff felt that this was a
The Limes D53-D02 S15987 The Limes V225127 160605 Stage 4.doc Version 1.30 Page 21 genuine opportunity to express their views and suggestions for the running of the home. There is evidence that the home liaises with other professionals and shares information appropriately. There is always a senior carer on duty who offers informal supervision and support to other carers. All staff receive formal supervision on a two monthly basis. The management of the home do not act as a financial appointee for any service users but the home does hold small amounts of cash for a small number of people. Records were not examined at this inspection. As previously mentioned records maintained in respect of service users needs had not been kept up to date. All other records seen appeared to be reasonably maintained and up to date. A fire detection system is fitted throughout the home and is regularly tested both in house and by outside contractors. There are records of hot water temperatures which show that these are checked on a monthly basis. The inspector viewed the accident book and noted that very few accidents are recorded, it is difficult to tell whether this is a true reflection of the incidents in the home. The inspector noted that un witnessed falls that were entered into the kardex were not recorded in the accident book. This was discussed with the manager who gave assurances that she will revise the use of the accident book and discuss with all staff. Servicing records for equipment were not viewed at this inspection. Portable electrical appliances had not been tested since February 2004. Whilst touring the building the inspector noted a carpet that was causing a trip hazard, this was addressed by the home-owner before the end of the inspection. The Limes D53-D02 S15987 The Limes V225127 160605 Stage 4.doc Version 1.30 Page 22 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 3 x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 x x x 3 2 2 The Limes D53-D02 S15987 The Limes V225127 160605 Stage 4.doc Version 1.30 Page 23 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 Regulation 15 (2) Requirement All care plans must be kept up to date to ensure that they accurately reflect the care needs of service users. All risk assessments must be reviewed. All accidents must be recorded. Timescale for action 10/06/05 2. 38 17 (1) Sch 3 (j) 30/06/05 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. 2. Refer to Standard 11 26 Good Practice Recommendations Staff should receive training in the care of someone who is dying. The manager should ensure that locks are fitted on all communal toilets and washing facilities. Appropriate handwashing facilities should be available in all communal toilets and washing facilities. All electrical portable appliances should be tested annually. 3. 38 The Limes D53-D02 S15987 The Limes V225127 160605 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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