Inspection on 05/07/06 for The Limes

This inspection was carried out on 5th July 2006.

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 30/06/07

The Limes 18/01/06

The Limes 19/08/05

The Limes 31/01/05

The Limes 23/08/04

The Limes 02/03/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE The Limes 16a Drayton Wood Road Hellesdon Norwich Norfolk NR6 5BY Lead Inspector Hilary Shephard Unannounced Inspection 5th July 2006 10:15 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 DS0000027285.V303526.R01.S.doc Version 5.2 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 DS0000027285.V303526.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Limes Address 16a Drayton Wood Road Hellesdon Norwich Norfolk NR6 5BY 01603 427424 01603 429003 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) Mr Michael Christophi Mrs Christina Dawn Laffey Care Home 41 Category(ies) of Dementia (41), Old age, not falling within any registration, with number other category (11) of places The Limes DS0000027285.V303526.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Eleven (11) Older People of either sex and forty-one (41) people of either sex with dementia may be accommodated. The total number not to exceed 41. 18th January 2006 Date of last inspection Brief Description of the Service: The Limes is a care home providing care for 41 older people with dementia, which includes the facility to accommodate 11 older people who do not have dementia. All accommodation, including a choice of lounges, is on the ground floor, and there are secure gardens, which are accessible to all residents. Car parking is provided at the front of the home. The home informed CSCI in April 2006 that the fees are between £366 and £425 per week and residents are expected to pay for hairdressing, toiletries, magazines, papers, confectionary, chiropody and transport to events. The Limes DS0000027285.V303526.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Care services are judged against outcome groups which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out by using information from previous inspections, information from the providers, the residents and their relatives, as well as others who work in the home. This has included a recent unannounced visit to the home. This report gives a brief overview of the service and the current judgments for each outcome group. At the end of the unannounced visit feedback was given to the Manager. A total of 7 requirements, 3 of which are repeated from previous inspections and 2 recommendations were made as a result of this inspection. What the service does well: The home is well managed by a competent and qualified manager who has a good understanding of the residents care needs. Quality is monitored and the manager recognises when improvements are required. The home has been developed with the needs of the residents in mind so they benefit from an environment that compensates for their loss of abilities. Residents are cared for in a respectful way, staff are good at helping them to make choices in their daily lives and residents were generally happy and satisfied with the service provided. Most staff have a good understanding of how to help residents express their concerns and these are managed well. Safe recruitment practices are followed which means that the home is protecting residents from harm. Residents generally enjoy their lifestyle and the food provided and like the way they are cared for by staff. Prospective residents are seen by the manager before admission and she provides them with information to help them decide if they want to live in the home. The Limes DS0000027285.V303526.R01.S.doc Version 5.2 Page 6 Staff are provided with good induction and training relevant to the needs of the residents. The home is also good at ensuring staff undertake statutory training in health and safety. With some minor improvement needed regarding recording, the home manages medication safely. What has improved since the last inspection? What they could do better: Care planning needs to be improved further as they do not all reflect the information gathered about residents regarding their hobbies and interests. Staff need to be aware of other ways they can offer residents a choice of meal or drink because some people with dementia are unable to make verbal choices. Nutritional screening and pressure area assessments need to be completed for all residents and reflected in their care plans. Some care plans do not contain information that assists care staff to provide the care required because the way some plans are written is poor. More staff need to undergo NVQ training as the home does not yet meet the minimum standard of 50 of staff trained to NVQ2 or above. Staffing levels in afternoons need reviewing, as they are not always sufficient to meet the needs of all residents. The telephone bell is loud and intrusive and one bedroom smelled strongly of urine. However, the home has not had a problem with bad odours for the past year. The proprietor needs to ensure he completes formal quality monitoring visits to the home on a monthly basis. He also needs to formally supervise the manager. The Limes DS0000027285.V303526.R01.S.doc Version 5.2 Page 7 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 DS0000027285.V303526.R01.S.doc Version 5.2 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 DS0000027285.V303526.R01.S.doc Version 5.2 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): 3 Quality in this outcome area is good. Residents are provided with information before admission and their needs are assessed prior to admission. The home is careful not to admit anyone whose needs they cannot meet. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The way information is gathered about residents before their admission has not changed since the previous visit. Two residents were case tracked but because of their dementia they were unable to confirm they had been involved in their assessment and pre-admission planning. Care plans are completed by care staff in conjunction with the residents families where this is possible. The Limes DS0000027285.V303526.R01.S.doc Version 5.2 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 adequate. The outcome of this group of standards could be good if recording in the care plans were consistent, had better detail about residents individual needs and used information gathered about the residents to meet their social and emotional needs. Care plans are not consistent and do not always identify residents needs clearly nor do they all provide clear guidelines in how the resident wants their needs addressed. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The last two full inspection visits (August 2005 and January 2006) set requirements for care plans to be clear, specific, updated, amended, to contain detail about residents social & emotional needs and to complete nutritional assessments for all. The Limes DS0000027285.V303526.R01.S.doc Version 5.2 Page 11 The visit of 5th July 2006 indicated that care plans had improved considerably in the way residents’ needs are being identified and met. Care plans are also being regularly updated, however those looked at omitted nutritional screening and pressure area assessments. A requirement has been repeated for the second time regarding this. Some information recorded was good with plenty of detail regarding the residents preferred way of being cared for, however some information was not recorded very well making it difficult to understand what the residents needs were and how they should be looked after. It is not clear how residents are involved in their care planning, but there was some evidence that their relatives had been asked for information regarding their life history. Recording of residents’ social and emotional needs has improved in part, but information gathered in the life histories is not always being referred to in the planning of care and guidelines regarding residents’ perceived “aggressive behaviour” were poor. A requirement has been made regarding care plans. The last two full inspection visits (August 2005 and January 2006) set a recommendation for the home to develop a person centred ethos. The care plans show that the home has started to develop a person centred ethos and staff are making an effort to provide individualised care rather than being focussed on physical care tasks. Medication continues to be managed well with some minor improvement needed to the recording of medication received in addition to the monthly order. Comment cards received from residents indicated that 95 felt their privacy was respected and staff were observed treating residents respectfully. Care plans showed residents’ health care needs were addressed promptly and residents looked well cared for. The Limes DS0000027285.V303526.R01.S.doc Version 5.2 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. The outcome of this group of standards could be better if the care plans consistently focussed on residents’ individual needs and used information gathered about their hobbies and interests. It could be better if the staff understood how to enable residents to express their choices about food and drink in ways other than verbally. Care planning regarding social and emotional needs is sporadic and inconsistent and does not reflect information gathered about residents social needs. Residents generally enjoy their lifestyle and the food provided but are not offered choices in a way they can understand. This judgement has been made using available evidence including a visit to the service. The Limes DS0000027285.V303526.R01.S.doc Version 5.2 Page 13 EVIDENCE: Entries in daily records indicated that care staff are not being consistent with the way they are recording and addressing residents need for occupation and stimulation. Residents hobbies and interests have been identified in a life history but the information gathered from this is not always reflected in the care plans and where it is, daily records show little or no evidence that these needs are being met. A requirement has been made regarding care plans. The home has a designated activities coordinator who arranges and assists with different types of activities. Improved staffing levels enabling better interaction between staff and residents followed a requirement made at the visit in November 2005. During the morning of the July 2006 visit residents in the smaller lounge were clearly enjoying the interaction with one of the care staff. Residents were seen to be offered choices during the visit of 5th July 2006, but most had difficulty actually making verbal choices because of their dementia. Staff were not aware of any other ways to offer residents choices of meals or drinks apart from verbally asking them, but one said they offer residents a visual choice of dessert. A recommendation has been made regarding choice. The food provided is nicely prepared and 90 of residents comment cards (19 of 21) indicated they like the food and 85 said they thought the activities were suitable. At lunch time residents said they enjoyed their meal. The Limes DS0000027285.V303526.R01.S.doc Version 5.2 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. The home manages concerns and complaints well and makes every effort to protect residents from harm. This judgement has been made using available evidence including a visit to the service. EVIDENCE: One concern was received recently by the manager and was managed appropriately and to the persons satisfaction. Relatives are aware of the homes complaints procedure (100 of relatives comment cards (3 of 3) indicated this), which is provided in the service user guide and displayed in the home. Staff have received training in adult protection and would refer issues to a senior member of staff. The Limes DS0000027285.V303526.R01.S.doc Version 5.2 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, 25 Quality in this outcome area is good. The outcome of this group of standards could be excellent if the home continued to develop the internal and external environment to meet the specific needs of people with dementia and if the home was kept odour free and the noise levels were reduced. Residents benefit from an enabling environment and will continue to benefit from the well designed gardens once completed. The smell of urine in one of the bedrooms creates an unpleasant environment for the person living there and the volume of the telephone bell is loud and intrusive. This judgement has been made using available evidence including a visit to the service. The Limes DS0000027285.V303526.R01.S.doc Version 5.2 Page 16 EVIDENCE: The manager has researched and developed an environment that aims to assist residents with dementia to find their way around. The signage is good and residents’ bedrooms contain personal items of their choosing. Residents’ benefit from having lots of outdoor space all around the home with good access to the gardens. At the visit of 5th July 2006, residents spoke of enjoying the garden and staff said they had worked together planting up some flower tubs. A lot of work has been undertaken in the gardens (including the courtyard garden in the centre) since August 2005 when a recommendation was made for the gardens to be improved. The visit of 5th July 2006 showed the gardens still being developed but the home has made a very good start and the manager has worked considerably hard to design a garden suitable for the needs of people with dementia. No odours have been noted at previous visits, however the visit of 5th July 2006 found one bedroom to smell strongly of urine. The home was clean throughout, but some carpets are now looking stained and worn, particularly those in the lounges and dining room. At the visit in August 2005, the proprietor said he was to replace these but has not done so yet. The telephone bell was noted to be very loud at the July visit and was causing some irritation to residents who didn’t like the noisy intrusion it created. A requirement has been made regarding odour and a recommendation about the noisy telephone. The Limes DS0000027285.V303526.R01.S.doc Version 5.2 Page 17 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 area is adequate. The outcome of this group of standards could be good if the home showed they continually monitored and adjusted staffing levels to meet residents changing needs and at least 50 of care staff were trained to NVQ2 or above. This should result in better outcomes for people using the service. Residents are satisfied that the care they receive meets their needs, but there are some times when no-one is available to immediately help them. The home recognises the importance of training and tries to deliver a programme that meets statutory requirements but is failing to get enough care staff trained to NVQ2 or above. The home protects residents by following safe recruitment procedures. This judgement has been made using available evidence including a visit to the service. The Limes DS0000027285.V303526.R01.S.doc Version 5.2 Page 18 EVIDENCE: At the visit of 5th July 2006, there were sufficient numbers of care staff on duty during the morning to meet the needs of the current residents. In the afternoon there were 4 care staff, but some residents were left unattended for short periods of time. One resident needed immediate assistance and had to wait as staff were busy. A requirement has been made regarding staffing levels. One visit made in November 2005 identified low staffing levels in afternoons, which were improved following a requirement and the manager has recently increased the night staffing to 3. A requirement was set at the visit in January 2006 for at least 50 of care staff to have or to be working towards NVQ2 by 31/07/06. At the visit of 5th July 2006, the manager confirmed that out of 27 care staff, 3 staff have NVQ2, 4 are waiting to start NVQ2 and 4 waiting to start NVQ3. The home has recently employed 4 care staff who have been qualified nurses abroad. This means that the home has not achieved the minimum standard of having at least 50 of care staff trained to NVQ 2 or above. A requirement regarding NVQ training has been repeated from the visit of 18th January 2006. New staff spoken with at this visit said they were undergoing induction training with the senior care staff and the deputy manager. Previous visits to the home have identified a good induction programme is in place and training is provided relevant to the needs of residents. Staff confirmed this and good interaction was observed between staff and residents throughout the day. Comment cards (21) received from residents in May 2006 indicate that 100 feel well cared for and 95 felt staff treated them well. 100 of relatives who responded (3) were satisfied with overall care. Files of new staff seen at this visit confirmed the home continues to follow safe recruitment practices. The Limes DS0000027285.V303526.R01.S.doc Version 5.2 Page 19 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): 31, 33, 35, 38 Quality in this outcome area is good. The outcome of this group of standards could be excellent if the home could show that staff clearly understand and follow policies and procedures relating to care planning, that staff have a commitment to NVQ training and that staff work with the manager to deliver good quality dementia care. Residents’ benefit from living in a home that is well managed, well maintained and safe. Quality is monitored and the manager recognises when improvements are required, however, the proprietor needs to complete formal quality monitoring. This judgement has been made using available evidence including a visit to the service. The Limes DS0000027285.V303526.R01.S.doc Version 5.2 Page 20 EVIDENCE: The manager completed the Registered Managers award in June 2006 and manages the home well. The last full inspection showed that residents’ finances were being managed safely and the visit of 5th July 2006 showed no change to the homes process. The most recent quality survey was undertaken in April 2006 and showed a positive response from relatives and the manager provided feedback to residents, relatives and staff. The proprietor makes weekly visits to the home but does not undertake any formal quality monitoring when he is there and this needs to be done at least on a monthly basis. The proprietor does not offer the manager formal supervision. A requirement has been made regarding this. Staff files seen at the July visit showed that formal appraisals and supervision sessions are being carried out which has improved since the visit made in August 2005. With the exception of the carpets and part of the garden, the home is wellmaintained and safe. Decoration is carried out as required and the preinspection information indicates that improvements have been made to two bedrooms, the shower room and the kitchen. The Limes DS0000027285.V303526.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 The Limes DS0000027285.V303526.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Three 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 Requirement Timescale for action 31/10/06 12, 13, 15 The Registered person must ensure that all care plans contain clear and specific guidelines for staff to follow relating to residents individual needs including social and emotional needs and are written in a way that focuses on residents strengths and abilities. Repeated for 2nd time, most recent deadline of 30/04/06 not met. 3. OP8 13 The Registered person must ensure that nutritional assessments are undertaken for each resident and the findings are reflected in a plan of care. Repeated for 2nd time, most recent deadline of 30/04/06 not met. 31/10/06 4. OP19 16 The Registered person must ensure the home is kept free from offensive odours at all times. 31/07/06 The Limes DS0000027285.V303526.R01.S.doc Version 5.2 Page 23 5. OP27 18 6. OP28 18 The Registered person must review the staffing levels and ensure staff are provided in sufficient quantities to meet the needs of the residents. The Registered person must ensure that at least 50 of care staff, excluding the manager have or are working towards NVQ level 2 (minimum). 31/08/06 31/10/06 7. OP33 26 Repeated, deadline of 31/07/06 not met. The Registered person must 31/08/06 ensure formal quality monitoring visits are carried out monthly as per Regulation 26 of the Care Homes Regulations 2001. A report following these visits must be supplied to the Commission. 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 OP14 Good Practice Recommendations It is recommended that all residents are routinely offered choices regarding meals and drinks in a way they understand and that staff encourage residents to make choices other than having to verbalise themselves. It is recommended that the noise levels caused by the telephone are reduced throughout the home. 2. OP19 The Limes DS0000027285.V303526.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 DS0000027285.V303526.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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