Inspection on 21/02/06 for The Limes

This inspection was carried out on 21st February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 18/05/06

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 Jill Clifton Unannounced Inspection 21st February 2006 09:45 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.V281720.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.V281720.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.V281720.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 27/04/05 Brief Description of the Service: The home, a single storey building which was originally a school, is situated in the rural village of Scopwick. There are no local shops although the home is close to a bus route, which serves Sleaford and the city of Lincoln. A railway station is situated in Metheringham, which is approximately three miles from the home. The home is close to a public house, a church and a small community centre. The home provides personal care for people of both sexes over the age of 65 years, with two rooms for people with dementia over the age of 63 years. There are thirty-one single bedrooms, sixteen of which are ensuite, and three double bedrooms not ensuite, all of which are situated on the ground floor. The home is owned by Ablegrange Ltd and a manager runs the home on their behalf. The statement of purpose states that the manager and staff wish to help make the lives of the people in their care more comfortable. The Limes DS0000002448.V281720.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is an unannounced inspection, which took place over 5 and a half hours. The main method of inspection used was called ‘case tracking’ which involved selecting three residents and tracking the care they receive through the checking of their records, discussion with them, the care staff and observation of care practices.. A tour of the building was undertaken and care and staff records were examined and feedback given to the manager at each stage. There were 37 service users living in the home at the time of this inspection. Six residents and two members of staff were formally interviewed. What the service does well: What has improved since the last inspection? What they could do better: There are a number of requirements made in this report which relate mainly to risks and potential hazards that may affect service users and other people; these include: excessively hot water temperatures which may cause injury through burns, this has been highlighted in the previous two inspections with no effective action taken to protect service users. An immediate requirement has been given to the home to address this issue. The lack of space in the laundry is compromising fire safety because linen trolleys, laundry skips and wardrobes used for linen storage partially block the corridor. There are serious The Limes DS0000002448.V281720.R01.S.doc Version 5.1 Page 6 shortfalls in medication administration, which the manager was positive in addressing to ensure that service users are not placed at unnecessary risk. 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.V281720.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.V281720.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): 3 and 6 Service users are assessed prior to being offered a place in the home this ensures that staff can meet individual needs. Intermediate care is not provided. EVIDENCE: A service user was able to describe how following a tentative enquiry for respite she and her family were invited to look around the home and participate in a pre assessment of her needs before being offered a place within the home. ‘We were made to feel welcome and the staff were very friendly’. A letter of confirmation from the home was given to confirm that her needs could be met. Documentation kept in the home supported these arrangements. Three pre assessment documents were checked it was noted that it was not always clear on pre assessments who had supplied the information. The Limes DS0000002448.V281720.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9 Detailed plans of care and risk assessments instruct staff how to deliver the individual care that is required; however there is little evidence to show that the individual service user had been consulted about their plan. Shortfalls in medication administration may put service users at unnecessary risk. EVIDENCE: Care plans were comprehensive and there was a clear plan of action for staff to follow, however these did not always demonstrate that consultation with the service user had taken place. Individual risk assessments were in place but these need to show that the service user or where appropriate relatives have been consulted. The home has a good rapport with health professionals and agencies who provide support to service users as and when required. Care plans and service users spoken with confirmed that there is access available to health professionals and services. Additional professional support and assessment should be sourced for a service user who is independent but at risk of falls, this professional input may help manage the risk effectively without compromising the service users independence. Arrangements need to be confirmed regarding the taking of a The Limes DS0000002448.V281720.R01.S.doc Version 5.1 Page 10 service users blood glucose levels following discharge from hospital to ensure that there is some monitoring as suggested on discharge, this is yet to action. There are some serious shortfalls in medication administration and recording for which the manager is going to address as a matter of priority because the present systems could put service users at unnecessary risk. Staff training should be reviewed to ensure correct administration procedures are followed to ensure that service users are protected. A service user who is partly selfmedicating did not have a risk assessment in place. Medications are stored in the main electricity cupboard but there should be monitoring of the air temperature to ensure that medication storage is within the correct limits as identified on the medication boxes. The Limes DS0000002448.V281720.R01.S.doc Version 5.1 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 the following standard(s): These standards were not assessed as part of this inspection. EVIDENCE: The Limes DS0000002448.V281720.R01.S.doc Version 5.1 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 the following standard(s): 16 and 18 Major shortfalls in recording the investigation and outcomes of received complaints may mean that appropriate action has not been taken which may leave service users dissatisfied or in some instances at risk. Shortfalls in the homes policies and procedures may put service users at risk because staff are unsure about reporting procedures related to abuse. EVIDENCE: Three complaints received by the home since the last inspection did not have any details of how these had been investigated; there was no action plan and no response to the person who made the initial complaint. This matter needs to be addressed as a matter of priority. The manager should ensure that all service users have a copy of the homes complaints procedure, and the manager and staff must ensure that complaints are responded to as per complaints procedure; the proprietors should monitor outcomes of complaints as part of the regulation 26 visits to ensure that these have been addressed and recorded appropriately. Service users spoken to during the inspection were happy with their environment and care given and said that staff were very kind and would quickly sort out any problems or worries that they may have. The manager confirmed that she chatted to service users on a daily basis to establish if they had any concerns, problems or suggestions. One service user felt unsettled at the home and could hear the laundry machines during the night because her bedroom was next to the laundry; the manager agreed to investigate this service users concerns. The Limes DS0000002448.V281720.R01.S.doc Version 5.1 Page 13 9 staff had undertaken adult protection training in March 2005 and the manager was attending training on this subject next month. All staff must have access to this training and in the interim period the manager must ensure that staff are made aware of correct procedures. The homes policy and procedure relating to abuse needs to be reviewed as it did not identify clear reporting procedures, and did not reflect the Local Lincolnshire Policy. Staff spoken to were able to clearly identify abuse and demonstrated that they would have no hesitation in reporting this but were unsure of the reporting system. Service users when asked said that they felt safe living in the home with kind staff to look after them. The Limes DS0000002448.V281720.R01.S.doc Version 5.1 Page 14 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 22,23,25 and 26 Ongoing decoration enhances the pleasant environment for service users who live in the home. Service users and visitors are not protected from passive smoking. It is unclear is bathroom facilities meet service users needs. It is unclear as to whether privacy arrangements for service users in shared bedrooms are adequate because of one screen made available. Service users are placed at risk of injury because accessible hot water outlets are not regulated. Fire safety is compromised because of inadequate laundry facilities. Good hygiene procedures protect service users from cross infection. The Limes DS0000002448.V281720.R01.S.doc Version 5.1 Page 15 EVIDENCE: The home is generally well maintained in terms of decoration and fittings. A new carpet was due to be laid in the lounge area and redecorated along with the dining room on the night following inspection, this was arranged to cause minimal disruption to service users. A service user said that she was looking forward to seeing the improvements the next day. An outside ramp was now provided which made easier access to the secure garden area from the lounge. The main lounge has a smoking lounge attached but the doors provided are not used to protect service users and visitors from passive smoking. The manager should review this with the fire officer to establish if the doors meet fire safety standards. The home has three shared bedrooms, one at present is used for single occupation; privacy and dignity is maintained by a medical type privacy screen which is shared between two bedrooms. The manager should reassess this arrangement to ensure these arrangements are suitable and meet the needs of the service users who share a room. The manager must review bathroom facilities to ensure that they meet service users needs because 2 baths were noted to be placed against a wall, which would make using a hoist difficult. One bath had a hoist provided. Random checks on hot water outlets, which service users have access to ranged between 49 to 65 degrees Celsius. There were no risk assessments in place and therefore service users could be at risk from burns or scalding due to the water temperatures in excess of 43 degrees Celsius, this was identified at the previous inspection and no action has been taken; therefore and immediate requirement is given to the home in which they must respond within 14 day as to how they intend to keep service users safe from the risk of injury. The laundry room does not provide adequate space for the ironing and storing of clothes, service users and staff are at risk from injury from fire because the corridor next to the laundry is blocked by laundry trolleys and wardrobes; service users safety is further compromised because the laundry manager has to iron in a corridor which also is partially blocked by linen skips. Recent circumstances showed that the manager had followed good infection control management, which prevented further spread of infection. The appropriate authorities had been informed and staffing levels increased as required. The Limes DS0000002448.V281720.R01.S.doc Version 5.1 Page 16 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): 29 Shortfalls in staff recruitment procedures may place service users at risk. EVIDENCE: The files of newly recruited staff were checked to ensure that the homes recruitment procedure kept service users protected, a new member of staff was able to confirm the manner in which she was recruited. Although there was evidence that staff have not been recruited without either a POVAFirst and supervision or a Criminal Records Bureau check the manager had not investigated gaps in employment history or obtained satisfactory references, which may put service users at risk of abuse. The Limes DS0000002448.V281720.R01.S.doc Version 5.1 Page 17 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): 33,35 and 38 Systems are in place to gain service users views but these are in need of development. Service users finances are safeguarded by the homes policies and procedures. EVIDENCE: The manager has tried to establish regular resident meetings but there is little interest from service users and relatives. The home intends to produce a regular newsletter, which will be available for both service users and visitors. A quality questionnaire had been given to service users earlier in 2005 to complete but the outcome had not been recorded, together with where necessary, an action plan. The manager said that she spoke to service users on an individual basis daily and service users were able to confirm this. The Proprietors completed a report on a monthly basis following a visit to the The Limes DS0000002448.V281720.R01.S.doc Version 5.1 Page 18 home, it was noted that there was little feedback recorded from service users. Service users and some staff were not aware of who the proprietors were. When Completing these report the proprietors must ensure that the information recorded is accurate, this was discussed with the manager. Monies held by the home on behalf of three service users were checked and found to be recorded satisfactorily. The manager should ensure that oxygen cylinders are stored securely; the manager should review the storing of oxygen cylinders within the main electric cupboard as this may increase the risk of possible combustion. The Limes DS0000002448.V281720.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 3 X X 2 2 2 X 3 STAFFING Standard No Score 27 X 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 X X 2 The Limes DS0000002448.V281720.R01.S.doc Version 5.1 Page 20 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 OP7 Regulation 14 (1) (b) Requirement Care plans and risk assessments should show that service users have been consulted about the decisions and care to be delivered. Appropriate arrangements should be made to ensure that the monitoring of a diabetics blood glucose reading are addressed as per hospital discharge advice. Medications must be administered safely. The present system of leaving medications with a service user and not providing a signature of administration is unsafe. A risk assessment must be in place for all service users who self or partially self medicate, the risk assessment must be reviewed on a frequent basis. The air temperature must be assessed and monitored to ensure that medications stored in the electrical cupboard are within the recommended storage temperatures. Timescale for action 30/03/06 2. OP8 13 (1) (1) (b) 28/02/06 3. OP9 13 (2) 28/02/06 4. OP9 13 30/03/06 5. OP9 13 (2) 30/03/06 The Limes DS0000002448.V281720.R01.S.doc Version 5.1 Page 21 6. OP16 22 (3) (4) 7. OP18 13 (6) 8. OP22 23 (2) (j) (n) 9. OP24 16 (2) (C) 10. OP25 23 (2) (c) 11. OP26 23 (2) (a) 12. OP29 19 (1) (c) 13. OP33 14 (1) (c) 26 14. OP38 13 (5) The manager must record, investigate and show outcomes and responses to all complaints received. The manager must review the homes policy and procedure for the protection of vulnerable adults and ensure that it reflects the arrangements made in the Local Social Services Policy. The manager must assess present bathroom facilities to ensure that these meet the dependency levels of service users. The manager should review the present privacy screen arrangements for shared bedrooms A safe and adequate water outlet system must be installed to meet the needs of all residents. Timescale of 30/04/05 and 30/09/06 has not been met. An immediate requirement has been left at the home to respond within 14 days as to how the home intends to protect service users from the potential risk of injury. The responsible person must seek the advice of the Fire Officer and review the laundry space and storage facilities. This is unmet from 30/09/05 The manager must ensure that gaps in employment history are investigated and appropriate and suitable references are obtained. The manager should evaluate the questionnaires received from service users. The Registered provider must ensure that details in Regulation 26 reports are accurate. Oxygen must be stored securely and the location should be reviewed. DS0000002448.V281720.R01.S.doc 30/03/06 30/04/06 30/04/06 30/03/06 06/03/06 28/02/06 28/02/06 30/09/05 28/02/06 The Limes 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. 2. 3. Refer to Standard OP7 OP7 OP12 Good Practice Recommendations The source of information provided on pre assessment information should be identified. A social history of the resident would provide a fuller picture and enable staff to more fully meet the needs of each resident. This unmet The manager and staff should document all activities, group or individual. This was not checked at this inspection The Limes DS0000002448.V281720.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.V281720.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!