Inspection on 26/07/05 for The Limes

This inspection was carried out on 26th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Limes 04/04/07

The Limes 21/12/05

The Limes 02/11/04

The Limes 30/06/04

The Limes 09/03/04

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

CARE HOME ADULTS 18-65 The Limes 17 Walverden Road Brierfield Nelson BB9 0PJ Lead Inspector Julie Playfer Unannounced 26 July 2005 9.15 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 F57 F07 S9515 The Limes V240432 26.7.05 Stage 4 doc.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Limes Address 17 Walverden Road Brierfield Nelson Lancs BB9 0PJ 01282 697414 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) Making Space Mrs Mary Caroline Spencer Care Home 7 Category(ies) of MD Mental Disorder, excluding learning registration, with number disability or dementia 7 of places The Limes F57 F07 S9515 The Limes V240432 26.7.05 Stage 4 doc.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd November 2005 Brief Description of the Service: The Limes is registered with the Commission for Social Care Inspection to provide accommodation and personal care for 7 adults with a mental disorder (excluding learning disability and dementia). The construction of the home dates back to the 16th Century and adjoins a Quaker meeting house. It is situated close to local amenities such as shops, post office and pubs and is approximatley half a mile from Brierfield and one mile fron Nelson town centre. Accommodation is provided on two floors in seven single bedrooms, all of which have ensuite facilities. There is a lounge on each floor, with the lounge on the ground floor providing space for dining. All furnishings and fittings are domestic in character. The home has designated smoking areas. The Limes F57 F07 S9515 The Limes V240432 26.7.05 Stage 4 doc.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over seven and half hours on 26th July 2005. The previous inspection took place on 2nd November 2005. No additional visits have been made to the home since the last inspection. On the day of inspection there were 7 residents accommodated at the home. Information was obtained from staff records, care records and policies and procedures. The inspector also spoke to the residents, the staff on duty and the registered manager. A partial tour of the premises was also undertaken. What the service does well: What has improved since the last inspection? There have been no specific improvements to the service since the last inspection. The Limes F57 F07 S9515 The Limes V240432 26.7.05 Stage 4 doc.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 F57 F07 S9515 The Limes V240432 26.7.05 Stage 4 doc.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection The Limes F57 F07 S9515 The Limes V240432 26.7.05 Stage 4 doc.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 - 5 Residents were provided with useful and informative information about the services and facilities provided in the home. Resident’s needs were properly assessed and reviewed. EVIDENCE: Written information was available for residents in the form of a service users guide and statement of purpose. Both documents were presented in a suitable format and the service users guide had been distributed to all residents. All residents had lived in the home for sometime. Care records indicated that the residents’ needs had been assessed before admission by a social worker and at periodic intervals by the staff in the home. Advice from specialist services had been sought as necessary. In the event of a vacancy it was part of usual practice for a prospective resident to visit the home to enable them to experience day-to-day life and meet the other residents and staff. Each resident had been issued with a license agreement, which formed the contract of accommodation between the resident and Making Space. There was also a statement of terms and conditions on each file seen as part of the case tracking process, which had been signed by the residents. The Limes F57 F07 S9515 The Limes V240432 26.7.05 Stage 4 doc.doc Version 1.40 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 - 9 The care planning system fully addressed the needs of the residents and provided clear guidance to staff on how these needs were to be met. Relationships within the home were good. The established consultation arrangements ensured residents were able to participate in all aspects of life in the home. EVIDENCE: From the case files seen, it was evident each resident had a plan of care, based on the assessment of needs. The plans set out in detail the action needed to be taken by staff to ensure all needs were met. It was apparent the plans had been reviewed at least every six months and agreed with the resident. The plans had been updated in respect to any changing needs. The care plans were comprehensive and were written in a suitable format for both the staff and residents. Personal profiles had been incorporated into the care documentation and these provided details of past life experience. It was the practice of the home to support responsible risk taking and policies and procedures supported this approach. Detailed risk assessments and management strategies covered activities indoors and in the wider community and were included within the residents’ plans. The Limes F57 F07 S9515 The Limes V240432 26.7.05 Stage 4 doc.doc Version 1.40 Page 10 During conversations with residents it was evident they were consulted both informally and formally and they were able to participate in life in the home. Five residents’ meeting had been arranged since the beginning of the year. From the minutes seen it was evident a wide variety of topics were discussed and contributions had been made by the residents. The residents were supported with their financial affairs and detailed written records were maintained of all transactions. The Limes F57 F07 S9515 The Limes V240432 26.7.05 Stage 4 doc.doc Version 1.40 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 - 17 Residents were provided with opportunities to engage in a range of leisure activities and were supported to use community facilities. The residents maintained strong links with their families and enjoyed positive relationships within the home. Arrangements were in place to ensure the residents participated in the life of the home and their rights were respected. EVIDENCE: The individual plans and care records demonstrated that residents had opportunities to maintain and develop practical life skills. Residents were encouraged and supported to participate in the life of the home and carried out domestic tasks commensurate with their abilities and interests. These tasks included tidying bedrooms, helping in the kitchen, going to the local shops and light domestic chores, such as dusting. Residents engaged in activities in the local community, which included walking, cinema, shopping and restaurants. Staff provided assistance with activities as necessary and had knowledge of events in the nearby area. Since the last inspection four residents had been on holiday to Scarborough with three The Limes F57 F07 S9515 The Limes V240432 26.7.05 Stage 4 doc.doc Version 1.40 Page 12 members of staff. The destination of the holiday had been discussed at a residents meeting and all residents were offered the opportunity to have a holiday away from the home. The residents were supported to maintain relationships with their friends and families. During the inspection one resident went to visit her relative. Residents were able to continue with their chosen religion and one person attended a local church on a regular basis. All residents were entered onto the electoral register and exercised their vote by attending the local polling station or by entering a postal ballot form. The residents said the routines in the home were flexible and were designed around their arrangements for the day. As such, there were different routines at the weekend. The registered manager maintained a record of meals served to residents, which included variations served to the main menu. The residents said they liked the meals and there was always plenty to eat. It was part of the ethos of the home for the residents and staff to share mealtimes. On the day of inspection the lunchtime meal was attractively presented and plentiful. The mealtime was a lively social occasion and everyone was given the opportunity to participate in the varied conversation. This approach to mealtimes added considerably to the open and relaxed atmosphere of the home. The Limes F57 F07 S9515 The Limes V240432 26.7.05 Stage 4 doc.doc Version 1.40 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 -20 The residents’ healthcare needs were identified and met. Personal support was provided in a manner, which respected the residents’ rights to privacy and dignity. Appropriate systems were in place to handle medication, however in order to protect residents all medication must be stored securely at all times. EVIDENCE: The residents’ individual care plans set out the personal support each resident required and provided details of how this support was to be delivered. Staff spoken to confirmed personal support was provided in private and the residents’ rights to privacy and dignity were respected. The registered manager and staff ensured consistency and continuity for residents by the use of a key worker system. A record was also maintained of individual likes and dislikes as part of the assessment and care planning processes. Healthcare needs were appropriately assessed and were included in the care plan. There was evidence to indicate the residents had access to NHS services and the advice of specialist services had been sought as necessary. On the day of inspection there were visits by healthcare practitioners and one resident was supported to attend a medical appointment. The Limes F57 F07 S9515 The Limes V240432 26.7.05 Stage 4 doc.doc Version 1.40 Page 14 Appropriate policies and procedures were in place to manage medication in the home. The home operated a monitored dosage system for the administration of medication, which was dispensed into individual blister packs. Records were maintained for the receipt, administration and disposal of medication. Most medication was stored securely in a locked cabinet, however, some medication was stored in a fridge, which was not locked. All staff designated to administer medication had received accredited training. The Limes F57 F07 S9515 The Limes V240432 26.7.05 Stage 4 doc.doc Version 1.40 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 - 23 Systems were in place to ensure any concerns of residents would be acted upon. However, in order to protect residents’ rights the complaints procedure must incorporate information about CSCI. Appropriate policies and procedures and staff training were in place to respond to any allegations or suspicions of abuse. EVIDENCE: Both informal and formal arrangements were in place for the registered manager and staff listen to and act on the views and concerns of residents, by means of the resident’s meetings and everyday conversation. The complaints procedure had been updated in June 2005 and had been distributed and explained to the residents. Whilst the new procedure included details about the timescales and the address and contact number of the organisation, there were no details about the Commission for Social Care Inspection. The home had a copy of “No Secrets in Lancashire” and a specific procedure for responding to any suspicions or allegations of abuse. In addition, all staff had attended mandatory training on the protection of vulnerable adults. The Limes F57 F07 S9515 The Limes V240432 26.7.05 Stage 4 doc.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 and 30 The residents were provided with a clean, safe and well-maintained home. EVIDENCE: The Limes is a listed building attached to a Quaker Meeting House. It is set in its own grounds with car parking facilities for visitors. Accommodation is provided in 7 single rooms, all of which have an ensuite facility. Communal space is provided in one lounge/dining room on the ground floor and a further lounge on the first floor. The furnishings and fittings were domestic in character and of a good quality throughout. At the time of the inspection, the premises were well maintained, comfortable, clean and free from offensive odours. The home had a planned maintenance and renewal programme in the form of a repairs and maintenance file and dilapidation reports for the fabric and decoration of the building. Records were maintained of the work carried out. The Limes F57 F07 S9515 The Limes V240432 26.7.05 Stage 4 doc.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 - 35 Staff were well qualified and had access to a wide range of training opportunities, which gave them a good understanding of their role and the needs of the residents. In order to safeguard residents a robust recruitment and selection procedure should be devised. EVIDENCE: Staff were issued with job descriptions, which set out their roles and responsibilities. It was evident the job descriptions were linked to meeting the needs of the residents. From discussions with staff during the inspection, it was evident they had a good understanding of the residents’ needs and knew the residents well. Staff referred to the residents in respectful terms and were observed to interact in a positive and pleasant way. The staff rotas indicated that the staffing levels were regularly reviewed and additional staff were placed on duty, where necessary, to meet the needs of the residents. The recruitment and selection of new staff was underpinned by the organisation’s Equal Opportunities Policy. However, the home had no specific recruitment and selection procedure. There had been no recruitment of new staff, since the last inspection. The Limes F57 F07 S9515 The Limes V240432 26.7.05 Stage 4 doc.doc Version 1.40 Page 18 Staff were offered a range of training opportunities and information was available in respect to the care and support of people with an enduring mental illness. Each member of staff had a training assessment and profile and there was an overall training development plan for the staff team as a whole. At the time of inspection 80 of the care staff were qualified above NVQ level 2. Staff meetings were held on a regular basis, with seven meetings held since the beginning of the year. The meetings gave the opportunity to staff to share experiences and develop teamwork. The staff received supervision, but had not had an appraisal of their work performance. The Limes F57 F07 S9515 The Limes V240432 26.7.05 Stage 4 doc.doc Version 1.40 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 - 43 The home was able to demonstrate that it was meeting the needs of the residents. The management approach promoted positive relationships between the staff and the residents and the overall atmosphere was open and friendly. Appropriate policies and procedures were in place to safeguard the health and safety of the staff and residents, however the fire equipment must be improved in line with the requirements of the Fire Authority. EVIDENCE: The registered manager had the overall responsibility for the management of the home and had a job description, which reflected the aims and objectives of the home. The manager had completed an NVQ level 4 in Care and Management and undertaken periodic training to update her knowledge and skills. The management approach was consultative and there were systems in place to consult both staff and residents. Relationships within the home were positive and staff spoke about the residents with respect. The Limes F57 F07 S9515 The Limes V240432 26.7.05 Stage 4 doc.doc Version 1.40 Page 20 The home achieved an Investor’s in People Award in October 2004. The registered person had developed systems to monitor the quality of care in the home and had an annual development plan/business plan based on a systematic cycle of planning, action and review, which reflected the aims and outcomes for residents. A satisfaction survey had been carried out of residents and their relatives/representatives. Results of the surveys had been collated, published and feedback to all interested parties. There was a full set of policies and procedures, which had been signed and dated by the registered manager. Staff received health and safety training, which included moving and handling, food hygiene, first aid and fire safety. Documentation was seen during the inspection which, confirmed gas and electrical systems were serviced at regular intervals. To minimise the risk of scalding all water outlets were fitted with preset valves. Window restrictors were fitted as appropriate. The fire log demonstrated staff and residents had participated in regular fire drills. However, during the inspection a visit by the Fire Authority highlighted the need to upgrade the fire alarm panel. The home had public and employers liability insurance cover in place against loss or damage to the assets of the business and business interuption costs. Budgets had been allocated to the home and a financial plan was available. The Limes F57 F07 S9515 The Limes V240432 26.7.05 Stage 4 doc.doc Version 1.40 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 3 Standard No 22 23 ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 4 Standard No 31 32 33 34 35 36 Score 3 4 3 2 3 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Limes Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 2 3 F57 F07 S9515 The Limes V240432 26.7.05 Stage 4 doc.doc Version 1.40 Page 22 No 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. 2. Standard 20 22 Regulation 13 22 Requirement The fridge used to store medication must be fitted with a lock. The complaints procedure must include the name, address and telephone number of the local office of the Commission for Social Care Inspection and inform residents they can refer a complaint to the Commission at any stage should they wish to do so. The fire alarm panel must be upgraded in line with the requirements of the Fire Authority. Timescale for action 25th August 2005 25th August 2005 3. 42 23 31st August 2005 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 34 36 Good Practice Recommendations A robust recruitment and selection procedure should be devised. Staff should have an annual appraisal to review performance against job description and agree career development plans. F57 F07 S9515 The Limes V240432 26.7.05 Stage 4 doc.doc Version 1.40 Page 23 The Limes The Limes F57 F07 S9515 The Limes V240432 26.7.05 Stage 4 doc.doc Version 1.40 Page 24 Commission for Social Care Inspection Unit 4 Petre Road Clayton-le-Moors Accrington BB5 5JB 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 F57 F07 S9515 The Limes V240432 26.7.05 Stage 4 doc.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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