CARE HOMES FOR OLDER PEOPLE
The Limes 12 Limes Avenue Mickleover Derby DE3 0DB Lead Inspector
Janet Morrow Unannounced Inspection 20 September 2005 at 10:00am
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 CO2 C52 S1983 The Limes V248412 200905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service The Limes Address 12 Lime Avenue Mickleover Derby DE3 0DB 01332 516819 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) Mrs Bexon and Mrs McGarrity Julie Woodhouse Care Home only 34 Category(ies) of Older People (OP) registration, with number of places The Limes CO2 C52 S1983 The Limes V248412 200905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 13th April 2005 Brief Description of the Service: The Limes is a 34 bedded home for older people situated in Mickleover, a residential area in the suburbs of Derby. The property was originally a private dwelling and has been converted into a care home. It is a listed building with attractive grounds. Accommodation is of a good standard with quality furnishings and fittings. Residents bedrooms are situated on the ground and first floors with the first floor being accessed by a passenger shaft lift and additional stairs by a stair lift. Five bedrooms have en suite facilities. All bedrooms are well decorated and personalised. Private telephone lines are available for those who wish to have them. Communal areas are bright and spacious and have views over the gardens. There is a conservatory which is the designated smoking area. Support services are in place with a choice of General Practitioner and visiting district nurses, chiropodist, dentist and optician. Community psychiatric nurses, occupational therapists, physiotherapists and dietician are accessed as required. Staff training takes place to inform and enable staff to care for residents appropriately. Transport is arranged for those residents wishing to go out and inhouse entertainment and outings are arranged as residents wish. The Limes CO2 C52 S1983 The Limes V248412 200905 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection visit was unannounced and took place over 5.75 hours, with follow up telephone calls being made to two visiting professionals. Staff and care records were examined. Four members of staff, nine of thirty-four service users, one relative and one visiting professional were spoken to during the inspection. What the service does well: What has improved since the last inspection?
A programme of refurbishment has been implemented with all bedrooms either having been decorated or having new carpets. Bathrooms have also been redecorated and had non-slip flooring fitted. Better information on how to deal with risks identified for individual residents has been provided on care plans. The number of staff enrolled on National Vocational Qualification (NVQ) training has increased significantly and this will ensure that the home has a better qualified workforce. Training on specialist areas such as visual and deaf awareness has also been undertaken as recommended at the previous inspection. The Limes CO2 C52 S1983 The Limes V248412 200905 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 CO2 C52 S1983 The Limes V248412 200905 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 CO2 C52 S1983 The Limes V248412 200905 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) 2, 3, 4 and 5 There was sufficient admission information available to establish that the home could meet service users’ needs. Terms and conditions of residence did not enable residents to be fully aware of what to expect from the service or what their contractual obligation were. EVIDENCE: Examination of the terms and conditions of residence (contract) showed that these had not been amended as required at the previous inspections in April and October 2004 and April 2005. They therefore still contained out of date information, which referred to the wrong registering authority, and did not state whom fees were payable by, which room was to be occupied and who was liable if there was a breach of contract. Three service users’ files were examined and there was assessment documentation in place in each that provided sufficient information over a range of needs for staff to provide care following admission. Two visiting professionals contacted by telephone following the inspection both stated that the home was able to meet the needs of residents and that appropriate advice was sought where necessary. The statement of purpose stated that trial visits took place before admission and one resident interviewed confirmed that this occurred.
The Limes CO2 C52 S1983 The Limes V248412 200905 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, 9, and 11 Health care needs were met but aspects of medication procedures had the potential to cause errors, which could put residents’ at risk. EVIDENCE: Three residents’ care records were examined. Care planning and assessment information was included in a combined document and this was available in all three files examined. Risks, such as risk of falling and risk of pressure sores, were identified and there were appropriate interventions detailed to prevent them. Weight was recorded on a monthly basis. One of the three files examined had evidence of consultation with residents about their care and one resident interviewed stated that staff discussed their care needs with them. Access to health services such as General Practitioner, District Nurse and chiropody was facilitated. A visiting professional interviewed during the inspection stated that the home were ‘on the ball’ in picking up needs and calling in other professionals appropriately. Written feedback from relatives described the staff as ‘patient and relaxed’. There was policy in place for caring for residents with terminal illness that covered physical and psychological symptoms as well as dignity and respect.
The Limes CO2 C52 S1983 The Limes V248412 200905 Stage 4.doc Version 1.40 Page 10 The medication administration record (MAR) charts for three residents were examined. These were signed accurately to correspond with the medication given. However, one chart had alterations that had not been checked, signed and dated by two people. Handwritten records had not been signed and dated by two people and one handwritten record did not correspond with the information on the dispensing label form the pharmacy. There were appropriate facilities for the storage of controlled drugs. The record of these was checked for one resident and was accurate. The manager and staff interviewed stated that training on medication was being undertaken via a workbook and the supplying pharmacist had also provided training. The Limes CO2 C52 S1983 The Limes V248412 200905 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) 14 and 15 Meals were well organised which enhanced service users daily life. Personal choice was facilitated but improving access to personal records would further improve the control residents had in their lives. EVIDENCE: The manager was aware of how to contact advocacy services if required. She stated that no residents currently had an advocate. There was evidence in residents’ bedrooms that personal possessions were brought into the home. There was no evidence of residents being given access to their records. Those residents interviewed were not aware that they could see their files. The serving of the lunchtime meal was observed and a meal was also sampled. Residents spoken with during lunchtime enjoyed their meals and praised the food. A choice was available for the main meal. However, one resident interviewed stated they were not made aware of what the choices were. Those residents requiring assistance to eat were given help in a sensitive manner. The Limes CO2 C52 S1983 The Limes V248412 200905 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) 17 and 18 Policies and procedures protected residents from abuse and upheld legal rights. EVIDENCE: The home had a policy on adult protection, which referred to Derby and Derbyshire Local Authority Social Services procedures. Certificates were seen that showed staff had undertaken training in adult protection and those staff interviewed confirmed that they had attended and had found the training beneficial. A system was in place that ensured residents were able to vote in elections. The Limes CO2 C52 S1983 The Limes V248412 200905 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) 20, 21. 22, 23, 25 and 26 The home provided safe, comfortable and homely accommodation for residents although an outstanding matter would further enhance the comfort of residents. EVIDENCE: The home continued to operate a regular audit of the building to identify any repairs or refurbishment required. A handy-person was employed to undertake ongoing repairs. Bedrooms were personalised and comfortable. However, they did not have individual heating controls and this limited resident’ choice in obtaining a suitable room temperature. This was raised as an issue at the previous inspections in October 2004 and April 2005. There were sufficient toilets and bathrooms and these had been re-decorated since the last inspection in April 2005. There had been no changes to room sizes since the last inspection in April 2005.
The Limes CO2 C52 S1983 The Limes V248412 200905 Stage 4.doc Version 1.40 Page 14 There was equipment for those residents with disabilities including handrails, wheelchairs and hoists. Four new wheelchairs had been provided since the last inspection in April 2005. The home was clean, tidy and odour free. Written feedback seen from a relative described the home as ‘very clean’. The Limes CO2 C52 S1983 The Limes V248412 200905 Stage 4.doc Version 1.40 Page 15 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, 29 and 30 There were sufficient well-trained staff on duty to meet service users’ needs. The procedures for the recruitment of staff were robust and provided the safeguards to offer protection to people living in the home. EVIDENCE: The staff rota for 19th –25th September 2005 was examined. This showed that there were four care staff on duty each morning and three in the afternoons. There were two night staff plus a sleep in member of staff on duty at night. Staff training certificates confirmed that they had undertaken training in health and safety issues and adult protection. Certificates were also seen for courses undertaken in visual awareness and hearing loss. A training course on tissue viability was booked for November. Staff interviewed confirmed that they had good access to training and also stated that they were now undertaking National Vocational Qualification (NVQ) training. The home was therefore set to meet the target of 50 of staff being trained to Level 2 in the next twelve months. One staff file was seen. The manager had organised these to show recruitment information more clearly. The file seen had identity information, references and a Criminal Record Bureau (CRB) check. The application form contained sufficient detail to explain gaps in employment and care work. The Limes CO2 C52 S1983 The Limes V248412 200905 Stage 4.doc Version 1.40 Page 16 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, 33, 34, 35 and 38 The manager showed leadership and direction to staff to ensure that residents received consistent care. Quality assurance systems and financial systems ensured that the home was run in the best interests of residents. EVIDENCE: The manager had completed the Registered Managers award and received praise from visiting professionals, relatives, staff and the proprietor for her leadership qualities. Written feedback from relatives described the home as a ‘well run establishment’. In discussion, the manager stated that she was keen to improve all the time and saw staff training as essential to improving the quality of care. A quality assurance plan had been developed and a questionnaire had been sent to relatives to gauge their opinion of the home. Feedback seen was positive. However, the home had not asked for the opinions of visiting
The Limes CO2 C52 S1983 The Limes V248412 200905 Stage 4.doc Version 1.40 Page 17 professionals. An audit of the building was undertaken on a regular basis and action taken to remedy problems was recorded. Three residents’ financial records were examined and found to be in order. Receipts were available for purchases made. Health and safety issues were addressed with staff having undertaken relevant training in health and safety areas such as moving and handling, fire safety and infection control. A fire lecture was booked for September 2005. Fire extinguishers had received a maintenance check in June 2005 and hoists had been checked in August 2005. The Limes CO2 C52 S1983 The Limes V248412 200905 Stage 4.doc Version 1.40 Page 18 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 2 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 3
COMPLAINTS AND PROTECTION x 3 3 3 3 x 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x 3 3 3 3 3 3 3 x x 3 The Limes CO2 C52 S1983 The Limes V248412 200905 Stage 4.doc Version 1.40 Page 19 YES 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 op2 Regulation 5 (1) (b) (c) Requirement The homes terms and conditions must contain the information as detailed in the report.(Previous timescales of 1/9/04 and 1/7/05 not met) Suitable heating controls must be provided in service users bedrooms.(Previous timescales of 1/2/05 and 1/7/05 not met) All medication adminstration records must be accurate. Previous timescale of 1.8.05 not met Timescale for action 1.11.05 2. op25 23 (2) (p) 1.11.05 3. op9 13 (2) 1.1.06 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. 3. 4. 5. Refer to Standard op12 op34 op14 op15 op33 Good Practice Recommendations More outings to places of interest should be considered. A business and financial plan should be in place. A system for ensuring residents can have access to their personal records should be in place. All residents should be made aware of the choices available on the menu. The views of visiting professionals should be sought as part of ongoing quality assurance.
CO2 C52 S1983 The Limes V248412 200905 Stage 4.doc Version 1.40 Page 20 The Limes 6. op9 Hand written MAR charts shuld be signed and dated by two people and must correspond with information on the pharmacy label. The Limes CO2 C52 S1983 The Limes V248412 200905 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Cardinal Square Nottingham Road Derby DE1 3QT 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 CO2 C52 S1983 The Limes V248412 200905 Stage 4.doc Version 1.40 Page 22 - 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!
