Inspection on 27/04/05 for The Limes

This inspection was carried out on 27th April 2005.

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 21/02/06

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 LN4 3NW Lead Inspector Vanessa Gent Unannounced 27 April 2005 10.00 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 C53 C04 S2448 The Limes V223361 250405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Limes Address Main Street Scopwick Lincoln LN4 3NW 01526 321748 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) Ablegrange (Lincoln) Limited Mrs Jacqueline Mandy Burrows Care Home 40 Category(ies) of Older Person (OP) - 38 registration, with number Dementia (DE) - 2A of places The Limes C53 C04 S2448 The Limes V223361 250405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: A condition of registration is that the maximum number of service users in each category is as follows:The home is registered to provide personal care for service users of both sexes whose primary needs fall within the categories: Old age, not falling within any other category (OP)(38) Dementia, over 63 years of age (DE)(2) The maximum number of service users to be accommodated is 40. Date of last inspection 18/11/04 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 C53 C04 S2448 The Limes V223361 250405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector spoke with several residents, three relatives and two staff during the inspection. Discussion also took place with the manager. A brief tour of the home took place. The main method of inspection used is called case-tracking which involves selecting a proportion of residents and tracking the care they receive through the checking of records, discussion with them, the care staff and observation of care practices. The files of three residents were examined. The people living in the home, the manager, staff and relatives prefer the term ‘resident’ to be used rather than ‘service user’. What the service does well: What has improved since the last inspection? What they could do better: The water temperatures at the residents’ sinks and baths still needs to be attended to. The Limes C53 C04 S2448 The Limes V223361 250405 Stage 4.doc Version 1.30 Page 6 The flooring in the bathroom next to Room 1A is a hazard to residents and staff. It must be replaced and repair to the present lino must be completed immediately. The laundry area is insufficient for the needs of the residents and is a fire hazard. The sluice area is inadequate to meet the needs of residents. The owner of the home has not visited on a regular basis or produced adequate documents on the service provided to ensure that the residents are properly cared for, the staff or the manager are supported and that quality is maintained. The manager has insufficient administration hours to manage the home efficiently, effectively or smoothly. 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 C53 C04 S2448 The Limes V223361 250405 Stage 4.doc Version 1.30 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 C53 C04 S2448 The Limes V223361 250405 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4, 5 Pre-admission assessments completed and good liaison with other healthcare professionals enable the manager and staff to assess and meet the needs of the residents. People are welcome to visit the home on a trial basis. EVIDENCE: The manager visits the prospective resident in their previous accommodation and writes a pre-admission assessment on which to base her evidence that the home can meet the needs of the individual. One relative confirmed the involvement she had in the pre-admission assessment and the creation of the initial care plans. Comprehensive preadmission assessments were seen in the care plans of residents examined. The manager and staff liaise with the district nurses and community healthcare professionals when particular needs are identified. Specialist equipment is provided, after discussion with the district nurse and tissue viability specialist. Interested people can visit the home before making up their mind, although relatives spoken with all confirmed their satisfaction with their original decisions. The Limes C53 C04 S2448 The Limes V223361 250405 Stage 4.doc Version 1.30 Page 9 Staff records show and staff confirm that their induction programme is thorough and they access training courses to ensure that they meet service users’ assessed needs. Several relatives spoken with stated that they visited the home prior to the admission of the residents, felt comfortable with the atmosphere and the pleasant attitude of the staff and “have not been disappointed since”, in fact, they felt the home had a “good, stable workforce” and “a happy, family atmosphere”. The Limes C53 C04 S2448 The Limes V223361 250405 Stage 4.doc Version 1.30 Page 10 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, 9, 10 Care plans are comprehensively completed and reviewed and have involved the resident or relatives. Privacy and dignity is respected. EVIDENCE: A thorough pre-admission assessment of the resident was examined, with relatives spoken with confirming their involvement in the pre-admission assessment, creation of the care plans and ongoing reviews. Where the resident or relatives do not wish or are not able to be involved in the care plans, documentation should confirm these wishes or abilities. The care plans are comprehensively completed, contain well-described risk assessments and show the residents’ current status. The last wishes of residents have not been identified and recorded in the care plans of all residents, to ensure their dignity. The home’s supplying pharmacist has visited recently and staff who administer medications are up-to-date with their training. Residents stated that their privacy is respected and dignity observed at all times. One stated that he has a key to his bedroom door and bathrooms and toilets have ‘privacy locks’ on them. He also has a lockable facility in his room. The Limes C53 C04 S2448 The Limes V223361 250405 Stage 4.doc Version 1.30 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) 12, 14, 15 Activities are sufficient in variety and quantity to meet the needs and choices of the residents. The atmosphere is very happy. Choice and autonomy are encouraged for all residents and their opinions sought for many aspects of the running of the home. Privacy and dignity is respected. The food supplied is varied and nutritious. Choice is given for all meals. EVIDENCE: The activities organiser works twenty hours per week. Residents, relatives and staff all say how much improved the activities are, that there is a “much livelier atmosphere in the home now” and that residents look forward to these regular events. Residents were laughing and joking with the staff in an ‘engaging manner’. Group activities include music and exercise and communal games such as bingo, etc., outside entertainers. Individual activities include reminiscing and chatting with staff, although this latter, individual activity is often not documented. A church service is held once a month at which a local vicar officiates. Residents stated that they have choice in their daily lives and have privacy and dignity. A residents’ survey had been circulated and residents’ meetings established at which both residents and relatives could and do have their say. They stated that the manager values their opinions. The Limes C53 C04 S2448 The Limes V223361 250405 Stage 4.doc Version 1.30 Page 12 One relative stated that the staff “spoil people at their birthdays” and “are always friendly”. The seasonal menu is varied, with plenty of fresh vegetables and fruit served at each main lunch mealtime. Residents stated that the food is excellent, “always hot and fresh with plenty of choice”. Plenty of drinks are available during the day and night-time. Assistance with meals is given discreetly where needed, with staff seated, wearing aprons and chatting to the residents during the meal. The Limes C53 C04 S2448 The Limes V223361 250405 Stage 4.doc Version 1.30 Page 13 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 home provides the facility for encouraging an open forum for any complaints. EVIDENCE: A Complaints policy was seen displayed publicly in the reception area which clearly displayed the information required. A relative spoken with stated that she would know who to go to, and certainly would complain if there were any cause. She stated that she goes to the manager if she is not happy with any situation and the manager has always put things right straight away. It was stated by residents that the staff are friendly and “things have improved since the staffing levels are higher”, making them feel safer. Training in the prevention of abuse has taken place for some staff spoken with. The Limes C53 C04 S2448 The Limes V223361 250405 Stage 4.doc Version 1.30 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 standard(s) 19, 20, 24, 25, 26 The standard of decoration and furnishings provides the residents with a homely environment. The outstanding matter in relation to the hot water system does not ensure the residents’ safety. The laundry and sluicing facilities do not provide the staff with safe, comfortable surroundings in which to work. EVIDENCE: Residents and relatives stated that they are happy with the home environment, that their rooms are decorated as they wish and that the communal areas are spacious, pleasant, light and airy. The garden is secure and well-tended. One relative says and it was observed that a ramp is needed to get wheelchairs from the lounge to the garden safely. The home is clean, tidy and mostly fresh-smelling although some corridor and room carpets smell mal-odorous. The carpet ‘wet cleaner’ has not worked for The Limes C53 C04 S2448 The Limes V223361 250405 Stage 4.doc Version 1.30 Page 15 some time, although the responsible person is aware of this and has not had the machine repaired or replaced. The sluice facilities are too small and without the appropriate equipment. The laundry is too small and inadequate to cater for the laundry needs of the residents. The ironing and storage of clothes and linen in the corridors is inappropriate and is a fire hazard as well as a danger to staff and residents using the corridors. Staff say they “struggle to cope” with the facilities available. The water temperatures of the residents’ sinks and the communal bathrooms, are too high. A further requirement has been set which must be complied with, within the stated timescale, to prevent enforcement action being taken. The Limes C53 C04 S2448 The Limes V223361 250405 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, 30 Adequate numbers of staff are on duty at all times, with a sufficient skill mix. The home’s recruitment practices and staff attitudes encourage residents to feel safe. Staff training is comprehensive and encouraged by the manager. EVIDENCE: Staffing levels, according to the manager, residents, staff and relatives, have improved considerably. The manager is still advertising to recruit more staff. The activities organiser works for twenty hours every week and provides a varied and interesting programme. An activities sheet was displayed in the reception area. Residents say they enjoy the activities now provided. Relatives stated that there is a “good, stable staff team” in the home, “a family atmosphere”; “it’s a happy place if someone has to live in a care home”, “nothing is too much for the staff to undertake”; “they go the extra mile”. Residents feel safe with the staff and are happy with the quality of care provided. Some overseas nurses have been recruited by the company to work as care assistants whilst completing their adaptation to gain registration in Britain. A new staff, recently recruited, stated that the induction programme is thorough and comprehensive and she was supervised until she felt competent to do her job safely. Induction records were seen to be signed and dated by both manager and employee. Staff files seen contain all the information required. Criminal Records Bureau (CRB) certificates have been obtained for all staff and before new staff are taken on, a Protection of Vulnerable Adults (POVA) list check is made. The Limes C53 C04 S2448 The Limes V223361 250405 Stage 4.doc Version 1.30 Page 17 Staff state that the manager is encouraging for them to be well-trained and undertake National Vocational Qualifications (NVQs). Some already have NVQs; others are taking them currently. The Limes C53 C04 S2448 The Limes V223361 250405 Stage 4.doc Version 1.30 Page 18 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, 37 The manager is experienced, competent and communicates well with resident, relatives and staff. The responsible person has not confirmed to the Commission that the residents’ health, welfare and safety is safeguarded or that staff are following safe working practices. EVIDENCE: The manager has many years’ experience with people with mental health problems and the care of the elderly. She has worked at the home for several years and is working towards completing the Registered Manager’s Award. The residents and relatives spoken with confirmed that the manager “communicates well with them”, “she always goes round to speak with everyone and is very pleasant” and they feel confident in her, and for staff, shows a sense of direction and leadership, which is clearly understood. The Limes C53 C04 S2448 The Limes V223361 250405 Stage 4.doc Version 1.30 Page 19 The quality satisfaction questionnaire used to obtain residents’ opinions, is a substantial document. Service users’ meetings have been held at which residents stated that they have “had their say and felt they were being heard”. On three occasions, the responsible person has visited the home and produced a report. However, these documents do not cover the information as required. A copy of the home’s insurance certificate was displayed publicly. The home’s policies and procedures still need updating, particularly the health and safety policy but the manager has no supernumery time in which to do administrative work and has no business administrator. The Limes C53 C04 S2448 The Limes V223361 250405 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 x 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 4 COMPLAINTS AND PROTECTION 2 3 x x x 3 2 2 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 x 3 3 2 x x x 2 2 The Limes C53 C04 S2448 The Limes V223361 250405 Stage 4.doc Version 1.30 Page 21 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. 2. Standard 11 19 Regulation 12.3,4.a 13.4.a, 23.2.a 23.2.b Timescale for action The last wishes of residents must 30/09/05 be identified and recorded in the care plans of all residents. Access to the garden from the 30/09/05 lounge must be made safe for wheelchair users by the provision of a ramp. The lino flooring in the bathroom 30/09/05 next to Room 1A must be made safe without delay and replaced within the given timescale. A safe and adequate water outlet 30/09/05 system must be installed to meet the needs of all residents. Timescale of 30/04/05 has not been met. Cleaning equipment in good 30/09/05 working order must be provided and carpets in residents rooms and communal areas must be cleaned appropriately to prevent mal-odours occurring. The responsible person must 30/09/05 seek the advice of the Fire Officer and make provision for the laundry area to be re-housed in a more appropriate place. The provider must give the 30/09/05 manager sufficient administration time to fulfil her duties as manager and ensure Version 1.30 Page 22 Requirement 3. 25 4. 25 23.2.c 5. 26 23.2.c 6. 26 23.2.a 7. 31 10.1 The Limes C53 C04 S2448 The Limes V223361 250405 Stage 4.doc 8. 33 9. 37 that the home is run safely and efficiently. 26.1.a,3,4 The responsible person must 5.1 visit the home, unannounced, monthly to ensure that the residents health, safety and welfare are maintained. 12.1, 24.1 The homes policies and procedures must be kept up-todate to ensure the health, safety and welfare of the residents. 30/09/05 03/09/05 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 7 12 Good Practice Recommendations A ‘social history’ of the resident would provide a fuller picture and enable staff to more fully meet the needs of each resident. The manager and staff should document all activities, group or individual. The Limes C53 C04 S2448 The Limes V223361 250405 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Unity House, The Point Weaver 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 C53 C04 S2448 The Limes V223361 250405 Stage 4.doc Version 1.30 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. 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