CARE HOMES FOR OLDER PEOPLE
The Limes High Street Henlow Bedfordshire SG16 6AB Lead Inspector
Katrina Derbyshire Unannounced Inspection 27th April 2006 10:40 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 DS0000014929.V290185.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 DS0000014929.V290185.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service The Limes Address High Street Henlow Bedfordshire SG16 6AB 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) 01462 811028 01462 811028 info@limescarehome.co.uk Mr Michael Wilkinson Mrs Joan Wilkinson Mrs Joan Wilkinson Care Home 22 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (22), Mental disorder, excluding learning of places disability or dementia (3), Old age, not falling within any other category (22) The Limes DS0000014929.V290185.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The maximum number of service users must not exceed 22. The home shall accommodate persons of either sex. No one falling into the category of MD (age range over 65 years) may be admitted into the home where there are already 3 persons of category MD (Age range - over the age of 65 years) accommodated within the home. No person aged under 45 years of age who falls within the category of DE may be admitted to the home. 3rd February 2006. 4. Date of last inspection Brief Description of the Service: The Limes is a privately owned residential care home, providing care for 22 residents who have physical and mental health needs. The property is situated within the village of Henlow on the High street. It was built in 1840 and has been sympathetically converted by the proprietors to retain much of its original character and charm. In 2001 a further large extension was added to increase the registered accommodation to its present occupancy. Bedrooms located on the upper floor of the original house are accessed via staircases and a chair lift; bedrooms in the extension are accessible via a shaft lift. There is a large well-maintained enclosed rear garden and car parking is available at the front of the home. The fees for this home vary from £450.00 per week, to £800.00 per week, depending on the funding source. The Limes DS0000014929.V290185.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced key inspection took place on 27th April 2006 and was undertaken by two Regulation Inspectors. The Registered Manager Mrs. Joan Wilkinson was present throughout the inspection alongside two senior members of staff. Many of the areas within The Limes were visited and the inspectors spent time with many of the residents’ in the lounge area of the home. The care of three residents’ was examined in depth by looking at their records and interviewing the residents’ and staff who look after them. Observations of care practice and communication between the residents’ was also made at the inspection. The focus of this inspection was to look at the key National Minimum Standards and to follow up on requirements made at the previous two inspections. What the service does well:
Residents spoke of their involvement in the day-to day running of the home, residents for example are involved in maintaining the garden, growing plants and vegetables and the care of two dogs at the home. One resident said “ its important to me that l do the garden it gives me a purpose, it just makes me feel better”. The relationships between the residents and staff are also very supportive, staff work very hard to find out about each resident and they do this by talking to them and listening to their views. Several residents commented on ‘how good the staff are’ and one resident said, “ l can’t fault them l have been here nearly two years and they have always been so kind to me”. Residents also benefit from the way the home organises access to healthcare services. They have built up good working relationships with Doctors and District Nurses, and call upon them very quickly when a resident needs their help. This means residents receive medical care in a way that makes sure they receive medical attention that promotes their overall health. The home is also very good at supporting residents in maintaining their individual interests and development. One resident spoke of their employment for a charity and how the home had encouraged and arranged this and how they now support them in their job. This resident spoke of the ‘purpose’ that this gave him in his life and how important it was to him The Limes DS0000014929.V290185.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? 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 DS0000014929.V290185.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 DS0000014929.V290185.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): 1, 2, 3 & 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents receive a good standard of pre admission information so that they can make an informed decision about moving into the home. Residents terms and conditions are set out in simple terms so residents are clear on what services they can expect the home to provide and at what cost. EVIDENCE: It was noted that changes made to the homes statement of purpose resulted in the home meeting a previous requirement. Residents confirmed that they were aware of this document and it had been made available to them prior to their admission to the home. Terms and conditions seen within the individual records of residents showed that this document met this standard. The term of residency was set out in a simple easy to understand format and had been signed by the resident or their representative.
The Limes DS0000014929.V290185.R01.S.doc Version 5.1 Page 9 Assessments were in place within the individual records seen at this inspection. The manager confirmed that a new format was to be introduced shortly alongside a new style of care planning and risk assessments. Those assessments seen and undertaken by social services were comprehensive and clearly described the individual needs of the resident. Intermediate care is not provided at this home. The Limes DS0000014929.V290185.R01.S.doc Version 5.1 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 the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Systems for the management of medication is good so residents receive prescribed medicines when required. Access to healthcare services are also managed well so residents benefit from specialist medical advice and attention promoting their overall health. EVIDENCE: Care records were examined and seen to contain several documents with various entries relating to the individual needs and how staff should support them. In having information in several areas it was not clear in all instances the guidance that staff should follow and this was discussed with senior staff at the time of inspection. The manager stated that the care planning system was to change and a structured template format is soon to be used within the home, the new structure was also seen. Medication stocks and records were inspected. The system in place for the ordering of medicines was sufficient to provide a clear audit trail. Staff had received training in the safe administration of medication and the medication administration records were seen to be in order.
The Limes DS0000014929.V290185.R01.S.doc Version 5.1 Page 11 Residents, staff and documents seen within care records confirmed that resident’s had access to a variety of healthcare services including chiropody, physiotherapy and speech therapists. District nursing services also attend the home and information on these visits and treatments given was also available for inspection. Residents spoke of the way in which they felt that both their privacy and dignity were met by staff, all residents spoken with confirmed that staff addressed them in a manner that was supportive. Privacy screens were in place in a shared room and staff were seen to knock on residents doors before entering. The Limes DS0000014929.V290185.R01.S.doc Version 5.1 Page 12 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): 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The systems in place to support residents in pursuing individual interests are good, so residents continue to develop personally. Meals at the home are of a good standard and residents receive a varied diet, which meets their nutritional needs. EVIDENCE: Menus were on display within the home; these showed that a varied and balanced diet including all the main food groups was on offer. Observations of lunch showed resident’s had been given a choice in their main meal, staff were seen to assist those who required help to eat their meals. Many of the residents commented that the food was good and they enjoyed their meals. Information seen within the individual care records of residents and residents themselves confirmed that a programme of activities were in place. Examples included going to the local pub, gardening, music and movement and quiz’s, all activities detailing the time and date is on display in the home. Residents spoke of the flexibility in when their friends and families could visit them at the home, one resident said “ my daughter visits anytime really sometimes we sit here in the lounge other times if we want to be alone we sit
The Limes DS0000014929.V290185.R01.S.doc Version 5.1 Page 13 in my room”. Information on resident’s families and friends was seen within the care records of resident’s, this included how staff should contact them if the resident needed them. Observation of the interaction between all staff and residents was made throughout this inspection; a good level of communication was noted during this time. Within the communal areas of the home staff were seen to instigate communication with residents, offering an explanation of the actions that they were taking so that the resident were kept fully informed at all times. The Limes DS0000014929.V290185.R01.S.doc Version 5.1 Page 14 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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Systems in the home for the protection of vulnerable adults are sufficient and protect the residents from risk from of harm. EVIDENCE: The local protection of vulnerable adults policy was in place alongside the homes own policy. When questioned the staff were able to describe how to whom they should report any suspicion of abuse, and they also confirmed that training had been undertaken in this area. The home has a clear complaints policy, which details how to complain, who to complain to and how long you wait until you receive a response to your concerns. Through discussion staff were able to demonstrate that they knew how to respond to residents concerns or complaints, and their description matched the details in the home policy. Records of complaints received are kept by the home; they show how the complaint was investigated and how they responded to the complainant. Residents also spoke of their awareness of their right to complain, and were very clear that they would ask to speak to the manager if they wanted to. The Limes DS0000014929.V290185.R01.S.doc Version 5.1 Page 15 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 & 26 Quality in this outcome is good. This judgement has been made using available evidence including a visit to the service. The standard of furnishings and décor in this home is good and provides a pleasant environment for the residents to live in. EVIDENCE: All areas of the home that were seen were clean and free of odours. The accommodation is provided across two floors, the ground floor providing lounge/dinning room facilities alongside the individual rooms of the residents. Access to each floor can be through the use of a passenger lift or stairlift. Several residents made comments on how they were satisfied with their living space and that they found that the home met their individual needs in this area. Televisions and music centres were also seen to be in use in the communal areas for the entertainment of the residents. The Limes DS0000014929.V290185.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): 27, 28, 29 & 30 Quality in this outcome is good. This judgement has been made using available evidence including a visit to the service. Residents are supported by welltrained and experienced staff. EVIDENCE: The induction care staff receive, meets the Sector Skills Council targets and timescales, documentary evidence of this is kept by the home. Staff spoke of their roles in the home and were very clear on the responsibilities that they held; examples included supporting residents’ in achieving their personal aims and objectives, attending training to further develop their knowledge, and working together as a team to benefit the residents’ at the home. All residents’ complimented the staff team. Recruitment of staff follows the homes policies and procedures. Records and staff demonstrated that a structured interview had taken place and references were secured prior to the appointment of a staff member. However although a checklist had been ticked to indicate that a check against the Protection of Vulnerable Adults list had taken place, there was no other documentary evidence to support this. Evidence that a check has been undertaken must be available for inspection, and a requirement has been made. Supervision of staff is carried out and again staff spoken to supported this, however the home should ensure that this meeting is recorded in a manner
The Limes DS0000014929.V290185.R01.S.doc Version 5.1 Page 17 that makes clear the discussion that has taken place for the development of the member of staff. The Limes DS0000014929.V290185.R01.S.doc Version 5.1 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 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): 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Systems in place for the management of health and safety are good and protect the residents at the home. EVIDENCE: The assessment of standards 31 and 33 could not be undertaken at this inspection. The homes policy on health and safety was noted to be clear in its guidance to staff and comprehensive. Records were seen that evidenced that required safety checks had been carried out relating to fire, gas and electrical equipment. Servicing of equipment had been undertaken by approved contractors and regular maintenance checks had been undertaken by the homes personnel.
The Limes DS0000014929.V290185.R01.S.doc Version 5.1 Page 19 Staff and their training records confirmed that they had attended training in fire safety, food hygiene, moving and handling and risk assessment. Observations showed staff carrying out safe practices throughout the inspection, for example maintaining hygiene through the homes policy on health and safety was noted to be clear in its guidance to staff and comprehensive. Records were seen that evidenced that required safety checks had been carried out relating to fire, gas and electrical equipment. Servicing of equipment had been undertaken by approved contractors and regular maintenance checks had been undertaken by the homes personnel. Staff and their training records confirmed that they had attended training in fire safety, food hygiene, moving and handling and risk assessment. Observations showed staff carrying out safe practices throughout the inspection, for example maintaining hygiene through the use of protective clothing. Records seen relating to income and expenditure of residents monies managed by the home were noted to be satisfactory. Balances were seen to be correct and an ongoing written record is maintained. However the home must include the reason and details of why a resident’s money is being managed within their care plan and this was discussed with the manager at the time of the inspection. The Limes DS0000014929.V290185.R01.S.doc Version 5.1 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 2 X X 3 The Limes DS0000014929.V290185.R01.S.doc Version 5.1 Page 21 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 14.2 15.2 (b) Requirement There must be a robust system in place for assessing and planning the resident’s needs in relation to their physical health, personal and social needs. (Previous requirement timescale of 31/12/05 not met) Evidence must be available for inspection to demonstrate that a Criminal Records Bureau check has been undertaken on staff employed at the home. The reasons and details for the home managing residents monies must be entered within the individual care plans and signed by the resident or their representative. The Registered Manager must implement and record formal staff supervision sessions at least 6 times per year, to ensure the provision of support for staff and the implementation of safe practice. (Previous requirement timescale of 31/01/06 not met) Timescale for action 30/04/06 2. OP29 12(1)(a), 18 & 19. 30/06/06 3. OP35 17(2) schedule 4 31/05/06 7. OP36 18.2 30/06/06 The Limes DS0000014929.V290185.R01.S.doc 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. Refer to Standard Good Practice Recommendations The Limes DS0000014929.V290185.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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