Inspection on 07/04/09 for The Limes

This inspection was carried out on 7th April 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Limes 08/04/08

The Limes 08/06/06

The Limes 10/02/06

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

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Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Limes Glebedale Road Fenton Stoke-on-trent Staffordshire ST4 3AP     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Amanda Hennessy     Date: 0 7 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 24 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: The Limes Glebedale Road Fenton Stoke-on-trent Staffordshire ST4 3AP 01782844855 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Limes Fenton Ltd Name of registered manager (if applicable) Mrs Terrina Ann Willshaw Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 41 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 17 Old age, not falling within any other category (OP) 41 Physical disability (PD) 10 Date of last inspection Brief description of the care home The Limes residential home is located in Fenton, Stoke-on-Trent, close to local facilities and in walking distance of shops and the local library. The Home provides care and accommodation for up to 41 older people some of whom may have dementia or a physical disability. Care Homes for Older People Page 4 of 24 17 0 10 Over 65 0 41 0 care home 41 Brief description of the care home The home has both single en-suite and double bedrooms. The communal areas included a very pleasant conservatory and a number of lounge/seating areas on both the ground and first floors. The Home had a main dining room and other mixed sitting and dining areas. The car park is situated to the rear of the property and has adequate parking space for staff and visitors. There is a small area of garden to the rear of the property. Care Homes for Older People Page 5 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection was carried out between 11.15 and 19.15. The inspection assessed the homes compliance with the National Minimum Standards for Older People. The inspection was unannounced and so neither the home nor provider knew we were coming. The manager was present during the majority of the inspection. The inspection included a review of information supplied by the Proprietor called An Annual Quality Assurance Assessment (AQAA) which provided information about the establishment, policies and procedures at the home, information about people who live at the home and its staff. During the inspection we followed the experiences of living at the home for five people, including looking at their care records, when possible conversations with them or observing how they interacted with staff, viewing their rooms and also discussing their Care Homes for Older People Page 6 of 24 care with staff. This process is known as case tracking. Tracking people s care helps us understand the experience of people who use the service, how they spend their time and whether the service promotes their privacy and dignity. We also looked at the arrangements for storing and administering medication. We met and spoke with other people who live at the home and the homes staff. People told us their opinion of what it is like to live and work in the home. We also looked at staff files including how they are recruitment and trained. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 24 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is sufficient information for people to make an informed choice that the home will be suitable for them. Evidence: Information is made available for people about the home and the service that they offer. The statement of purpose and service user guide are both available in the reception area of the home for people to refer to. People have an assessment of their needs carried out by a senior member of staff, to enable a decision to be made that the home would be suitable to meet their needs. A copy of the Social Worker s assessment is also available for staff to refer to and gain additional information about peoples needs, interests and difficulties that they have been experiencing. Whenever possible people are invited to visit the home and have a meal there to gain an insight to whether the home would be suitable for them and they would like to come to live there. Care Homes for Older People Page 10 of 24 Evidence: The home is registered to provide care for older people with dementia. The majority of staff have had training in dementia care, new staff we spoke to said that arrangements were in place for them also to attend this training. We do have reservations about the sufficiency of activities that take place that will both occupy people with dementia and limit their memory deterioration and also the sufficiency of staff to enable these activities to take place, this will be discussed further within the Daily Life and Social Opportunities and Staffingsection of this report. The home needs to address our reservations before further admissions to the home are made to give ongoing confidence that peoples needs will continue to be met by the home. The home does not provide intermediate care. Care Homes for Older People Page 11 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Ongoing improvements to care planning and medication practices will give greater assurance that peoples health and personal care needs will be met. Evidence: All people living at The Limes have an assessment of their needs from which a plan of their care is developed. We found that care plans and care records generally have improved since our previous inspection, although we did find that further improvement is required. We found care plans did not fully identify all the persons care needs particularly when peoples health had deteriorated and also despite care plan being reviewed during this time (although not as regularly as required) these changes had not been included within their plan of care. We looked at the care records of people who the manager told us we are struggling to meet their needs due to their increasing aggression, these peoples care plans did not identify that they had challenging behaviour and did not give staff instructions how they should manage this behavior. We asked staff about people who they found to have the most challenging behavior and if they knew how to manage this behavior they told us that they went Care Homes for Older People Page 12 of 24 Evidence: into them in twos but had no other awareness of how they may try to calm them and told us that they had not had any training in the management of challenging behavior, although there is a plan for them to undertake Dementia awareness training. Another person whose records we looked at also had an eye infection and a pressure sore and yet these needs were not identified within their plan of care, We found another person had been seen by a Dietitian following concerns about a deterioration in their general health. The Dietitian gave staff prescriptive information how to fortify their diet with additional calories, the care plan had not been updated to reflect these changes although staff had recorded that they had reviewed the plan of care since the visit by the Dietitian. There are care risk assessments in place for a potential for poor nutritional, pressure sores, falls and the use of bed rails. We found that care risk assessments are regularly reviewed and they were not always dated meaning it was not always clear which instructions were the most up to date. There was no record that one persons moving and handling risk assessments had not been reviewed since 18/10/2008, this persons condition had deteriorated and we were told that staff had recently started to hoist them, however there was no record of any changes that had also resulted in a decrease in their mobility. We were able to see that people are seen by other health professionals such as doctors, dentists, chiropodists, opticians, district nurses and Community Psychiatric nurses when clinically indicated. We did find that for two people one of whom had ongoing diarrhea the other person had had a fall staff should have ensured that they were seen more promptly for further review. It is positive that staff check peoples weight weekly and ensure that they are seen promptly if staff have any concerns about any concerns about their weight. We visited the home in September 08 and found that medication practices were much improved and that medication storage and administration was safe. Medications storage remain safe although at this visit we did find that there were gaps in the medication administration records, this means that people may not have had the medication that they are prescribed for, we were not able to check all the gaps as the home does not have suitable equipment to enable either us or the manager to count the tablets there and therefore check tablets- we had also advised the manager at the previous inspection to purchase equipment to enable her to check the balance of medicines but this has not been undertaken. Care Homes for Older People Page 13 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the opportunity to make choices about their life in the home and maintain relationships with friends and families, although would also benefit from more activities for them to take part in. Evidence: Peoples interests and choices are recorded in their care records. People told us that they can get up and go to bed when they choose and spend their day where they choose to. Since our last inspection the home have employed an Activity Organiser who works three days a week. Unfortunately she was not on duty on the day of our visit so we were unable to ascertain what activities she arranges. Staff told us that the Activity Organiser had been making Easter bonnets the week before and that she arranges social events. The Directors have told us that there are now: a wide range of both therapeutic and social activities for all capabilities, we have also been told that there is now a mobile snoozelum- this provides sensory such as light and sound stimulation for people with dementia. We sat in one lounge throughout the majority of the day of the visit. During this time we saw little interaction between staff and people in this lounge and for the majority of time there was no staff member Care Homes for Older People Page 14 of 24 Evidence: present. The television was on in this lounge for most of the morning but constantly jumped yet it was not until the afternoon staff came on duty that this was resolved. We were told that care staff had arranged a game of hoopla which people in another lounge which they throughly enjoyed. Staff we spoke to said: the only thing that could be improved is the amount of activities that take place, Id like to sit and chat or take them for a walk outside but we just dont get a minute. Visitors are able to visit the home at any reasonable time of day. Local clergy visit giving people the opportunity to take communion if they wish to. The home have told us that they would support people from other religious denominations to worship according to their faith if required. We were told that usually people have a choice of meal available. Unfortunately on the day of the inspection the cook had to leave suddenly and as a result only one main meal was available. Everyone we spoke said that they had thoroughly enjoyed their lunch and that meals at the Limes are always really nice. A relative told us; Mum never complains about her meals she says that the food is always excellent. Care Homes for Older People Page 15 of 24 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to express concerns and required actions are usually undertaken to address these concerns and keep people safe. Evidence: The complaints procedures is displayed in the reception area of the home. The home have told us that they have had three complaints in the last year, we have received one complaint about the home. We found that the home usually fully investigates any concerns, although we did find concerns in care records that were not available within the complaints log. Visitors we spoke to said that they could discuss any concerns with staff and they felt that they would be resolved. There has been one safeguarding referral about someone who previously lived at the home, although this was not undertaken by the home. Staff we spoke told us that they had received training in Adult Protection and know what constitutes abuse, although records seen show that not all staff have had this training. Staff said that they would highlight any concerns to whoever is in charge of the shift or the manager. It is positive that since our previous inspection there are now much improved risk assessments in place for the safe use of bed rails. Care Homes for Older People Page 16 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is a clean and pleasant place to live and provides aids and adaptations for dependent people. Evidence: The home is clean and pleasantly decorated to provide a homely and comfortable place for people to live. There are a number of lounge/seating areas on both the ground and first floors for people to choose where they would like to spend their day. There is a garden and patio area to the rear of the building and a large private car park, although neither are secure for people to wander in. The home has both single en-suite and double bedrooms. Bedrooms have been personalised with items of furniture and other personal items and can be locked should people want to lock their bedroom door. There are adequate toilets and bathing facilities around the home which also have appropriate aids and equipment available to assist people with mobility difficulties. The home has its own in house laundry that provides modern washing machines and tumble driers that meet the required guidelines for washing of soiled laundry. Care Homes for Older People Page 17 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A review of the sufficiency of staff is needed to give confidence that peoples needs will be met in a timely fashion. Evidence: There are usually five care staff on duty during the day and three care staff on duty at night for thirty eight people living at the home. Our findings of this inspection is that staffing levels are insufficient to meet the needs of people living at the home. There are insufficient staff to provide regular stimulation, activities or take people out which is important for people with dementia. Staff told us ; Id like to do more with the residents but we just dont stop. We also found that staffing levels resulted in minimal interaction between people in the bottom lounge (where we spent the majority of our day) and staff. It is positive that since our inspection the provider has told us that they have revied the use of this lounge and will now be a dining/ activity room, this means that staff will be more readily available. It is also positive that they are planning to increase the Activity Coordinator hours. Staff we spoke to told us that had good training opportunities and even new staff told us about courses they were about to start. The home has eleven of its twenty care staff with a care qualification (minimum of national Vocational level 2). We found that staff files were disorganised and did not always contain required information. The manager was able to find some of the missing information but was Care Homes for Older People Page 18 of 24 Evidence: unable to demonstrate that one of the four new member of staff had two written references. There was evidence that a criminal records check and protection of vulnerable adults check had been undertaken before staff started working at the home, although we did advise that a risk assessment is undertaken when staff are employed with a POVA first check. The Manager told us that she does check and validate references and employment history which is good practice. New staff told us that they have already commenced their induction training. The Manager confirmed that that induction training meets the Skills for Care standards. Care Homes for Older People Page 19 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Ongoing improvements are being undertaken and give greater confidence that the home will have appropriate arrangements in place to keep people safe and promote their health and wellbeing. Evidence: The Homes Manager is a registered nurse and has over six years care home management experience and attends regular training to update her knowledge. The home did return their Annual Quality Assurance Assessment (AQAA) when we asked them to. The AQAA gave us a reasonable account of the home although could have provided us with more information such as about activities that take place and how they can be confident that care plans and other records provide the required information and are up to date. The home has a quality assurance system that includes the survey of people who live at the home and other stake holders and audits the homes procedures and other aspects such as peoples weight. The Directors have told us that they also monitor Care Homes for Older People Page 20 of 24 Evidence: their performance against our Key Lines of Regulatory activity. It is evident that the home has made improvements in the last twelve months although there remain shortfalls in areas such as the recruitment of staff, care and medication records there is a need for more effective systems to be in place to identify these shortfalls to enable the home to more quickly take required actions. The home has appropriate arrangements in place for the safekeeping of peoples money. We checked the records and found receipts available for transactions. Balances were also checked and were found to be accurate. We were told that no member of the homes staff are agents for peoples money as required. Maintenance contracts and fire safety recordsfor the home were spot checked and were found to be up to date. Water testing is undertaken by the home and they have also sought further guidance on how their monitoring of hot water can be further improved to reduce the risk of infection. Care Homes for Older People Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 12 People must have all their health and personal care needs identified within their plan of care. This will give assurance that their health and personal care needs will be met. 05/05/2009 2 9 13 There must be a record of all 05/05/2009 medicines that are given and if medicines are not given the reason for this must be recorded. This will give assurance that people receive the medicines that they are prescribed for. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 Systems should be robust to enable medicine audits to take place, this should also include a need for equipment to be available to enable this. Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 24 of 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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