Inspection on 03/10/05 for The Limes

This inspection was carried out on 3rd October 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 29/10/08

The Limes 09/06/08

The Limes 03/07/07

The Limes 27/04/06

The Limes 03/02/06

The Limes 07/02/05

The Limes 01/09/04

Similar services:

Claremont House

Chesham House

Oak Ridge

Argyll House

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

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

CARE HOMES FOR OLDER PEOPLE The Limes High Street Henlow Bedfordshire SG16 6AB Lead Inspector Linda Lilley Unannounced Inspection 3rd October 2005 12:00 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.V254376.R01.S.doc Version 5.0 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.V254376.R01.S.doc Version 5.0 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 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.V254376.R01.S.doc Version 5.0 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) accomodated within the home. No person aged under 45 years of age who falls within the category of DE may be admitted to the home. 7th February 2005 4. Date of last inspection Brief Description of the Service: The Limes is a privately owned residential care home, providing care for 22 residents over 65 years of age with physical and mental disorders. The property is situated in Henlow, High street. It was built in 1840 and had 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. The Limes DS0000014929.V254376.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit took place in the afternoon and evening of October 3rd 2005. This visit followed a three hour period of review and preparation that included reviewing previous reports, reviewing information from other stakeholders, and documentation received in support of the process and preparing an inspection plan. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for Service Users and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provisions that need further development. The primary method of inspection used was ‘case tracking’ which involved selecting two Service Users and tracking the care they receive through review of their records, discussion with them, the care staff and observation of care practices. Six Service Users, Five members of staff and two visitors were spoken to during the inspection visit. A partial tour of the premises was also completed and a review of the documentation and records required to be kept in a care home was also undertaken. This inspection report additionally addresses specific areas where requirements and/or recommendations were identified at the previous inspection. What the service does well: There is an open and friendly atmosphere, seen by the family of Service Users as efficient but informal, with good access to the Manager for any queries. The assessment process prior to a Service Users admission is good in terms of their mental health needs. This provides clear information for carers regarding the observation required to identify any potentially challenging behaviours and clear interventions to meet the needs of the Service User. The Service Users are treated with respect and their dignity preserved. There is active encouragement for Service Users visitors and friends to visit the home, in accordance with the Service Users wishes. The communal areas and the bedrooms within the home have good standards of décor and contained appropriate furnishings and individual personal possessions to provide the Service Users with a homely place to live. The Limes DS0000014929.V254376.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Revise the homes Statement of Purpose and Service User Guide to provide sufficient information for prospective Service Users to be clear about the services the home does or does not provide. In particular the statement “The home does not provide nursing care” should be added. Ensure the process for assessment of the Service Users physical health, personal and social needs is as robust as that for their mental health needs. Revise the documentation system for providing a clear and consistent care planning system, to enable care staff to have the information they need in one document, to ensure Service Users healthcare needs are met. Provide supervision and support to ensure the training carried out for the Administration of Medicines is implemented in practice. Revise the Adult Protection Policy to contain information regarding the procedure for referral to the Service User’s General practitioner if needed and a statement highlighting the need to clarify the Service User’s consent for the reporting of allegations of abuse to statutory authorities. Provide support and supervision to ensure the training carried out for safe moving and handling of Service Users is implemented in practice. The Limes DS0000014929.V254376.R01.S.doc Version 5.0 Page 7 Ensure the results of the Quality Assurance questionnaires are collated, shared with Service Users and staff and an appropriate action plan produced to implement any changes. 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.V254376.R01.S.doc Version 5.0 Page 8 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.V254376.R01.S.doc Version 5.0 Page 9 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. 4. The homes Statement of Purpose and Service User Guide is inadequate and does not provide sufficient information for prospective Service Users to be clear about the services the home does or does not provide. The assessment process prior to a Service Users admission is good in terms of the mental health needs of the Service User, thus ensuring these can be met in the home, however the process is not as robust for assessment of the Service Users other aspects of health, personal and social needs, therefore there is no assurance that these needs will be met. Each Service User has a contract stating the room to be occupied and the terms and conditions, enabling Service Users and families to be clear about the rights and obligations of the Service User and registered proprietor. EVIDENCE: The homes statement of purpose does not state the home does not provide nursing care, and there are references to nursing throughout the home for example, signs regarding “cleaning the nurses station”, documents labelled “nursing care plan”. The Limes DS0000014929.V254376.R01.S.doc Version 5.0 Page 10 Within two Service Users files there was evidence of a good documentation of the Service Users mental health needs to ensure that new Service Users are properly assessed and planned for. These records did not have full assessment details regarding the other health, personal, and social care needs of the Service User. One Service User spoken to did not feel the staff were fully aware of their physical care needs in terms of mobility and dietary preferences. One visitor spoken to did not know of the changes to the Services Users physical needs since admission. The Limes DS0000014929.V254376.R01.S.doc Version 5.0 Page 11 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. There are some shortfalls in providing a clear and consistent care planning system, to provide care staff with the information they need to ensure Service Users healthcare needs are met. These shortfalls have the potential of placing the Service Users and the staff at risk. There has been some progress on improving the homes procedures for dealing with medicines, however this is not applied consistently by all staff and results in some practices that may compromise the safety and welfare of the Service Users. There was evidence that the Service Users are treated with respect and their dignity preserved. EVIDENCE: Individual plans of care are available for each Service User. Two sets of plans were reviewed. In general they provided clear information for carers regarding the observation required to identify Service Users potentially challenging behaviours and clear interventions to meet the mental health needs of the Service Users. However they did not always reflect the current physical health, personal or social care needs of the Service User. This was particularly evident The Limes DS0000014929.V254376.R01.S.doc Version 5.0 Page 12 for one Service User who is being supported and treated by a District Nurse for pressure ulcers, there was no reference on the Service Users plan of care to the District Nurses care plan which is kept in the Service Users room, or any specific measures to be taken. Discussion with the staff indicated this information is communicated verbally. This Service Users individual plan had not been update and reviewed effectively, for example since June 2005 statements written in the plan indicated “all aspects of plan not appropriate” and from that date the letters “TLC” had been written in the plan of care. Staff spoken to indicated this meant “Tender Loving Care”. There was no indication what actual care needs this term constituted and staff spoken to described a variety of care needs for the Service User. There are a number of documents in use, (Key worker file, day/night book and a Kardex system) to make up the Service Users individual plan. Not all of these documents are stored in the same place, or written or accessed by the same people. The Key worker file contains polices for guidance, for example the record keeping policy, the “nursing” plan of care, and some risk assessments. The day/night book records events /incidents relating to the Service User, and is not always completed, and the Kardex system is a card written by the home Manager for each Service User, highlighting any changes and interventions. This Kardex system does not form part of the plan of care. This approach relies on good verbal communication systems and is dependent on staff memory. There is a risk that some Service Users will not have their needs met if these informal systems break down. A number of staff have undertaken training in the safe administration of Medicines, in March 2005, and observation of a carer dispensing medicines indicated safe practice. New Administration of Medicines records have been introduced on the advice of the pharmacist, however review of two Service Users Medicines Administration Records highlighted errors in recording, for example the chart was not signed as evidence that one dose of a prescribed drug had been given and no record had been made of the reason or action taken if omitted . Another Services User record indicated they had not been given a prescribed drug for 5 days, however on investigation from the pharmacist it was found that the drug had been discontinued by the Doctor and therefore not supplied, however this was not evident from the records. A new system for storage of medicines has been introduced which is robust; however on reviewing the contents of the medicine trolley a tube of eye ointment was found to be outside of its use by date. There are no written guidelines for the administration of “when required”` (P.R.N) medicines. This was made a requirement from the previous inspection. A number of Service Users and visitors were spoken to and everyone who commented on the staff said they felt the staff treated them with respect and respected their privacy. Staff were seen knocking on doors prior to entering, covering Service Users to maintain dignity and addressing Service Users by their preferred title. The Limes DS0000014929.V254376.R01.S.doc Version 5.0 Page 13 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): 13 The home actively encourages Service Users visitors and friends to visit the home, in accordance with the Service Users wishes, these links are important and enrich the Service Users lives. EVIDENCE: Two visitors were spoken to and said they had been encouraged to visit as often as they wished. Service Users spoken to indicated they could say whom they wanted to visit. One visitor highlighted they had been fully informed with decisions regarding the Service User and had found the home to be “Efficient but informal” and that the Manager was easily available for consultation. Two Service Users records indicated they were involved in the local community, attending church services and going to the local pub. The Limes DS0000014929.V254376.R01.S.doc Version 5.0 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): 18 There has been little progress in updating the homes procedure to ensure a proper response to any suspicion or allegation of abuse. EVIDENCE: The home has an Adult Protection Policy but does not contain information regarding the procedure for referral to the Service Users General practitioner if needed or a statement highlighting the need to clarify the Service Users consent for the reporting of allegations of abuse to statutory authorities. This was made a requirement from the previous inspection in February 2005. The Manager has obtained a copy of the local authorities adult protection policy and advice was given as to the appropriate sections to review and include in the homes procedure. Staff spoken to knew the whereabouts of the Adult Protection folder. The Limes DS0000014929.V254376.R01.S.doc Version 5.0 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 24 The communal areas of the home visited showed a good standard of décor providing Service Users with a homely place to live. Bedrooms visited contained appropriate furnishings and individual personal possessions, to meet the needs of the Service User. EVIDENCE: There was evidence of ongoing decoration work during the inspection. A partial tour of the home showed the communal areas in the original part of the building to be bright and cheerful, with appropriate dinning room and lounge furnishings. Visits to Service Users bedrooms and talking to Service Users and Visitors indicated they were happy with the comfort and privacy their bedrooms. The furniture within the rooms was of a good standard. Service Users files indicated a risk assessment had been carried out to identify if the Service User could be provided with a key. The Limes DS0000014929.V254376.R01.S.doc Version 5.0 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): 28. 30 The staff have undergone specific training to enable them to deliver a good standard of care, however there is inconsistency in putting this training into practice that results in risk to the Service Users and staff. EVIDENCE: Although records show the staff have undergone training in safe moving and handling techniques it was observed on two occasions that these were not being put into practice. A Service User was seen to be lifted from the chair using an underarm draglift on two occasions by the same two staff, a carer and senior carer. This is potentially dangerous to the Service Users, causing damage to the arms, and to the staff in relation to the potential for back injury. Records also indicate staff have undergone training in administration of medicines, there are inconsistencies in putting this training into practice, see standard 9). Evidence was seen of efforts to ensure the carers had effective communication skills through completion of NVQ`in care level 2 programmes and attendance at an English language course in a local Further Education College. Service Users and visitors spoken to said the staff were kind and caring and respond to any call bell quickly. During the inspection the staff were seen to be undergoing Fire training. The Limes DS0000014929.V254376.R01.S.doc Version 5.0 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 36 38 There was evidence of the views of Service User and family being sought to monitoring the quality of the care provided but there was little evidence to suggest these views are reported or acted upon. There was limited formal staff supervision sessions held to ensure the implementation of safe practice, this results in inconsistencies and potential risk to Service Users and Staff. There was evidence that accident records are being monitored on a more regular basis and further risk assessments undertaken. This results in effective action to reduce the risk of accidents. EVIDENCE: A detailed questionnaire had been sent to Service Users and families in January 2005, 17 responses were received. On examination of these it was found they indicated a generally good level of satisfaction with the service The Limes DS0000014929.V254376.R01.S.doc Version 5.0 Page 18 provided. There was no evidence that the results had been collated, shared with staff and Service Users or any action plan produced to identify how suggestions were going to be taken forward. There was evidence of an annual appraisal type interviews having taken place between the staff and the Manager, to identify performance and training needs, however there are no formal supervision sessions held at least 6 times per year with individual members of staff to support staff and ensure that polices and procedures are being implemented effectively. Accident records are now filed in individual case records and there was evidence of review by the Manager and updating of the risk assessments for the Service Users. There was evidence of risk assessments having been carried out for all Service Users who may need to use a wheelchair, indicating if they could have the footrest plates in place. The Limes DS0000014929.V254376.R01.S.doc Version 5.0 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 2 3 2 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 2 3 x x x x 3 x x STAFFING Standard No Score 27 x 28 2 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 2 x x 1 x 3 The Limes DS0000014929.V254376.R01.S.doc Version 5.0 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 OP1 Regulation 4 Requirement Timescale for action The registered person must ensure that the Statement of 31/12/05 Purpose and the Service Users Guide contain all the details as required in schedule 1 of the Care Standards, including the arrangements for service users inclusion in running the home, the admission assessment criteria, and the latest Inspection report in Service Users Guide. The registered person must produce written guidance for 01/12/05 staff that administer medications, to identify the circumstances under which medications for administration as required (PRN) are to be given. These instructions must be in place for each individual medicine. The Registered Manager must 01/12/05 revise the home’s protection procedures to include the circumstances under which urgent referral would be made to a service user’s GP. and the Service Users consent. DS0000014929.V254376.R01.S.doc Version 5.0 Page 21 2 OP9 13(2) 3 OP18 13(6) The Limes 4 OP7 15.1 5 OP8 14.2 15.2(b) 6 OP9 13.2 The Registered Manager must 05/01/06 revise the documentation system for providing a clear and consistent care planning system, to enable care staff to have the with the information they need, to ensure Service Users healthcare needs are met. The Registered Manager must ensure there is a robust system 31/12/05 in place for assessing and planning the Service Users needs in relation to their physical health, personal and social needs The Registered Manger must provide supervision and support 01/12/05 to ensure the training carried out for the Administration of Medicines is implemented in practice. The Registered Manager must provide support and supervision to ensure the training carried out for safe moving and handling of Service Users is implemented in practice. The Registered Manager must implement formal staff supervision sessions at least 6 times per year, to ensure the provision of support for staff and the implementation of safe practice. 01/12/05 7 OP38 18.1(a.c) 8 OP36 18.2 31/01/06 The Limes DS0000014929.V254376.R01.S.doc Version 5.0 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 Refer to Standard OP33 Good Practice Recommendations The Registered Manager must ensure the results of the Quality Assurance questionnaires are collated, shared with Service Users and staff and an appropriate action plan produced to implement any changes. 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