Inspection on 08/04/08 for The Limes

This inspection was carried out on 8th April 2008.

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 07/04/09

The Limes 08/06/06

The Limes 10/02/06

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE The Limes Glebedale Road Fenton Stoke-on-trent Staffordshire ST4 3AP Lead Inspector Amanda Hennessy Key Unannounced Inspection 8th April 2008 09:30 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 DS0000064713.V361670.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 DS0000064713.V361670.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Limes Address Glebedale Road Fenton Stoke-on-trent Staffordshire ST4 3AP 01782 844855 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) Limes Fenton Ltd vacant post Care Home 41 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (15), Learning disability (1), Old age, not falling of places within any other category (41), Physical disability (10) The Limes DS0000064713.V361670.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Two Dementia - DE - Minimum age 55 years on admission. Date of last inspection 8th June 2006 Brief Description of the Service: 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 has been operating for a number of years and was extended in 2003, bringing the number of beds available for residents up to 41. The home has recently come under a new Registered management and continues to provide care for older people within a range of current registration categories including Dementiaover 65 years of age (5), Old age, not falling within any other category (33), Physical disability (4), Physical disability over 65 years of age (10). The accommodation was of a good standard throughout, and provides 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. The service user guide was not inspected at this inspection. For information on fees the Home should be contacted directly. The Limes DS0000064713.V361670.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. The means the people who use this service experience adequate quality outcomes. One inspector Mrs Amanda Hennessy carried out the inspection between 09.30 and 19.30 The inspection assessed the homes compliance with the National Minimum Standards core standards for Older People. The home/provider did not know 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. Before the inspection three people who live at the home and eight relatives completed a survey form known as “have your say about…” telling us about their experiences of life at the home. 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, viewing their rooms and if possible talking to their relatives whenever possible and discussing their care with staff. This process is known as case tracking. We met and spoke with other people who live at the home and the home’s staff. People told us their opinion of what it is like to live and work in the home. A tour of the peoples’ rooms and communal and service areas was completed and records about safety of equipment and the building were checked. Twelve of the previous thirteen requirements have either been addressed or removed as they no longer apply or have been made good practice recommendations. The home was sent an urgent action letter following the inspection that highlighted issues that may affect peoples’ health and safety. These included a need to ensure that: hot water is maintained within safe temperatures, bedrails are used safely and are appropriately fitted in pairs, there are appropriate risk assessments in place for the use of bedrails, all staff have a fire drill, all staff to have fire training and moving and handling training, new people coming to live at the home should be weighed as soon as possible following their admission to the home, a plan of care is available for new people living at the home, people should have appropriate access to other The Limes DS0000064713.V361670.R01.S.doc Version 5.2 Page 6 healthcare professionals and are also seen timely when ill by their GP. The provider has since written to the Commission for Social Care Inspection (CSCI) and confirmed that all required actions have been undertaken. Seven new requirements were issued following this inspection and fifteen good practice recommendations were made as a result of this inspection. We would like to thank the people who live at the home, relatives, management and staff for their hospitality throughout this inspection. What the service does well: What has improved since the last inspection? The home now has a new manager who had been in post eight weeks at the time of the inspection. The manager and provider have identified an improvement plan that highlights the homes weaknesses and has identified a way forward to address these weaknesses. The Limes DS0000064713.V361670.R01.S.doc Version 5.2 Page 7 There have been some improvements in the way that medicine is stored safely within a medication fridge although there is a need for further improvement in the safe keeping and safe administration of medicines. A previous requirement that a home has a comprehensive fire risk assessment that identifies actions to be taken during emergencies has been addressed. There have also been required changes to the complaints procedure and it now details peoples’ rights to contact Commission for Social Care Inspection if they have any concerns. What they could do better: There is a need to improve care records and more fully detail changes (including improvements) to people’s health. Care records also need to show more fully that people have the care that they need when the need it. We highlighted a need for people to have more comprehensive risk assessments for the use of bedrails and replace any bedrails, which may put people at risk. When this is undertaken it will give people who need the bedrails increased protection from harm. Some improvements have been made to the storage of medicines but there is a need for further improvement in the safe keeping and safe administration of medicines. Required improvements will reduce the risk of medicine error and harm to those people and also ensure that people receive medicines that they have been prescribed. Staff need to know and understand their responsibilities identified by the Mental Capacity Act respecting choice and upholding peoples’ rights. Areas highlighted where the home is not meeting this include the locking of peoples’ bedroom doors and people needing to ask staff to unlock them and some people without access to any money. There are currently few activities for people who live at the home. We were told that: “People are bored to death”. We are hopeful that this will be addressed by the newly appointed Activities Organiser. Food at the home is tasty and home made. Further improvement should be made with people being offered a choice of dish at each mealtime. Staff supervision and training have been insufficient. The Managers plan to develop the home’s staff is essential to ensure that there is a knowledgeable and informed staff group who are aware of peoples’ needs and are able to keep them safe. Please contact the provider for advice of actions taken in response to this The Limes DS0000064713.V361670.R01.S.doc Version 5.2 Page 8 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Limes DS0000064713.V361670.R01.S.doc Version 5.2 Page 9 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 DS0000064713.V361670.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have their needs assessed before coming to live at the home and have comprehensive information about the home. The availability of all required information gives assurance that people can make an informed choice that the home is suitable for their needs. EVIDENCE: Pre-admission assessment of peoples’ needs are undertaken prior to individuals being admitted to the home. These assessments are essential to establish whether the home is able to meet peoples. The information gathered at assessment is transferred into the care plans. One lady recently admitted confirmed that she had visited the home and had lunch there. Staff confirmed that introductory visits are routinely undertaken and are invaluable. The Limes DS0000064713.V361670.R01.S.doc Version 5.2 Page 11 The Statement of Purpose and Service User Guide were forwarded to us in November and were considered to be comprehensive at that time. We were told that both documents are made available to people and their representatives and have been updated to reflect the changes in the home’s management. Brochures of the home are also given to existing and prospective residents. There was a written contract and statement of Terms and Conditions within each persons’ care records looked at. The home does not provide intermediate care. The Limes DS0000064713.V361670.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People receive the care that they need. Care records need improvement to ensure that people continue to receive the care that they need. Medicines are not always safely administered with increased risk of error that may cause people harm. EVIDENCE: People who live at the home generally have a plan of care, which provides staff with instructions for their needs and how they should be met. It was disappointing that although people who had recently come to live at the home had an assessment of their needs they did not have a completed plan of care, giving essential information to staff on how their care needs should be met. We have been told since the inspection that the Manager now completes a preliminary plan of care within 72 hours of the person’s admission. We found duplication in the completion of care records, which we found confusing. There was some duplication in the daily handover sheet and The Limes DS0000064713.V361670.R01.S.doc Version 5.2 Page 13 ‘exceptional events’ record. We also found that record keeping at the time of the inspection did not always detail when people’s health had improved and responded to their treatment. It is also poor practice that the daily handover sheet references all people at the home and therefore is not filed with all their care records. We have been told since the inspection that the Manager has now changed and improved the way that care is recorded. People who have lived at the home for some time are weighed regularly. The provider told us that staff, send him a record of peoples’ weights each month to enable him to monitor that appropriate actions are being undertaken. We did find though, that newly admitted people had not been weighed one of whom had lived at the home for five weeks. There is a need for people to be weighed as soon as possible after admission so to more effectively monitor can be made of their general health. When we asked people about their care within the home they answered favourably making comments such as: “They keep a careful watch over my husband and calm him when he is worried”. “ I have no complaints about the way he is cared for at the home.” People see their Doctor when they need to . We found that people’s individual records seen during the inspection did not always show that they are regularly seen by other health professionals such as dentists, opticians and chiropodists. The home have supplied additional information since the inspection evidencing visits by health professionals although this information should be included in peoples own records to enable staff to ensure that people are seen at the frequency needed to maintain their quality of life, their health and well being. We saw that risk assessments are in place for some people regarding poor nutritional, pressure sores and falls. There are also risk assessments in place for the use of bedrails, although they fail to identify potential risk of gaps etc. We saw bedrails on peoples’ beds that did have excessive gaps that would place people at risk of entrapment and serious injury. There have been improvements to the safe keeping of medicines since the previous inspection, although further improvement is needed. Improvements are also needed to ensure that medicines are safely administered and the risk of medicine error and harm to people is minimised. We found that the receipt of medicines is not recorded making it impossible to audit and be confident that people are receiving their correct medicine. A requirement from the previous inspection that the home has a locked medication fridge is now met. We were concerned however that the room where medicines are stored is also the hairdressing room which is neither safe The Limes DS0000064713.V361670.R01.S.doc Version 5.2 Page 14 or appropriate as on occasions this room will get too hot making it unsafe to store the majority of medicines. Staff do record when medicines are given. We did see that staff frequently use “f” when a medicine is not required, when we discussed this with the manager we found it to be inappropriate. Staff must also record why they are not giving a medicine to be certain that there is an ongoing need or not for this medicine. We saw handwritten medicine records without signed confirmation of the accuracy of the entry. The failure to confirm the accuracy of records had resulted in entries for a very strong painkiller that stated: “Co- codymol 2x prn”. This is unsafe practice and increases the risk of error as it suggests that 2 of the co-codymol tablets may be given at any time. There was no record of the minimum amount of time between doses or a reason why it should be given. We also found another handwritten entry for another person stating: “Immodium 2 prn”. Again it was not evident the minimum frequency that these tablets should be given and why they were to be given. In addition we were unable to find any of these tablets prescribed for this person and when discussed with the manager she agreed it was probable that staff had used another person’s medicine. Again this is both unsafe practice and is also misuse of this person’s medicine. We did find that there are safe and appropriate practices in place for the storage and administration of controlled drugs. Staff record the receipt of all controlled drugs and check that the balance of the medicine is correct. People said that are treated with dignity and respect, and that they are encouraged to be as independent as possible. We saw did see staff knocking on peoples’ doors before entering their rooms. We were told that all peoples’ rooms are locked. We heard people who live at the home asking staff to open their room doors, which we felt, was belittling to them. Some risk assessments had been undertaken and agreement made that some individual’s rooms should be locked but this was not consistent. We discussed this restrictive practice with the new Manager who immediately unlocked all doors. The manager also said that she would ensure risk assessments were in place so those people who wished to, could keep their own bedroom door key. The Limes DS0000064713.V361670.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A need to develop activities at the home has been identified to ensure that leisure opportunities meets peoples’ interests, choices and capabilities. Food is tasty and homemade but a lack of choice may mean that people do not always enjoy it. People are able to keep in contact with friends and families. EVIDENCE: The home currently has little in the way of activities. Staff told us that the hairdresser visits weekly and also undertakes hand and foot massage which people enjoy. There was also a trip to the theatre at Christmas and last summer visits to Trentham gardens and the monkey sanctuary were arranged. Relatives told us that people who live at the home are“bored to death, and they end up falling out as they have nothing else to do,” and “our only concern is the lack of activities, we brought jigsaws in but we haven’t seen them since”. The Limes DS0000064713.V361670.R01.S.doc Version 5.2 Page 16 The manager told us that a new activity coordinator is due to start work at the home soon when all pre-employment checks have been undertaken. The manager said that the new Activity Organiser is very enthusiastic and will be sure that there are more social opportunities for people who live at the Limes. We have been told since the previous inspection that the Activity Organiser has started employment and has a weekly plan of activities. Concerns were highlighted at the previous inspection and since by complaints made to CSCI about the lack of activities/ stimulation for people with dementia. This remains the situation, as there are very few activities available. The Deputy Manager told me that she hoped to arrange a trip to Blackpool again as previously this had been very popular with everybody. Records showed us that staff make decisions for people who live at the home such as the locking of bedrooms doors and staff members holding the keys. The Manager told us that she had received training in the Mental Capacity Act but staff have not. When we spoke to staff they had a lack of understanding about the Mental Capacity Act and their responsibilities within in it. We recommended that the Manager obtain a copy of the Department of Health guidance on the Mental Capacity Act that she can also use this as a training resource for the staff. Visitors visited the home throughout the day and are welcomed by staff. The Manager told us that she has recently changed access to the home with all visitors requested to use the front door where people can sign in. The new arrangements have made the home more secure. Other visitors told us of other ways that people are helped to keep in contact with friends and family; “he is helped to use the telephone and made happy by regularly chatting to me, which makes me feel in touch”. At lunchtime, people ate in the main dining room and two other dining areas. The main meal is served at lunchtime and consists of three courses; a menu board displays the day’s menu in the hallway. On the day of the inspection, the meal prepared was soup, meat pie with potatoes and vegetables and rhubarb crumble with cream. We found that the food served was tasty but only one choice was available. There was a note on the menu (although in very small writing) if you do not like the main dish of the day ask for an alternative. When we asked people about what they would do if they didn’t like the meal: “I have what I am given.” “ I never know what we are having until it is put in front of me”. Staff when dishing up the meals commented: “ they don’t want big portions it puts them off”. Staff were seen to assist people where necessary and mealtime was not rushed. Comments regarding the food included: The Limes DS0000064713.V361670.R01.S.doc Version 5.2 Page 17 ‘The meals are nice’, ‘I would like larger portions’, and ‘You can have what you want to eat’. Staff reported that people can have snacks or soft diet if required. A cold drink was served with the meal. The Limes DS0000064713.V361670.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are able to highlight concerns and are assured that they will be listened to and their concerns responded to. Not all staff have a sufficient knowledge and understanding about safeguarding meaning that appropriate actions may not be undertaken to consistently safeguard people. EVIDENCE: The complaints procedure is displayed in the hall of the home and also included within the service user guide. There have been three complaints made directly to the home, which includes two that were made direct to the Commission for Social Care Inspection (CSCI). We found that complaints are appropriately responded to within required timescales although there is sometimes a need for some concerns to be explored more fully. One complaint raised concern that people not being able to go to their room or bed when they wished. Whilst is not always possible to take everyone to bed at the same time as the Managers response concluded, we did feel that elements of the concerns centred around the practice of peoples’ bedrooms being locked- see daily life and social activities section of this report for further information . We did however feel that the home does put strategies in place to “learn from” concerns raised. One positive thing that the new manager has implemented has been visitors’ accessing the home by just the front door and signing in as they come into the home. The Limes DS0000064713.V361670.R01.S.doc Version 5.2 Page 19 There have been two adult protection investigations. We have found that the home have acted appropriately to work with other agencies to investigate the concerns and put systems in place to reduce the risk of further similar incidents. The Home informed us that they have required adult protection policies and procedures and are place to provide staff with required adult protection training. There is a need for more staff to have adult protection training as just six out of twenty staff had had this training. We spoke to some staff about adult protection and not all were aware of what actions they needed to do to keep people safe. We also highlighted within Section two of this report-health and personal care a need for appropriate risk assessments for the use of bedrails. The Limes DS0000064713.V361670.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is very well maintained and provides a pleasant and comfortable homely place to live. EVIDENCE: The home is clean and tastefully decorated to provide a homely and safe and comfortable environment for people who live there. 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. There are both single en-suite and double rooms All bedrooms contained a good level of equipment and facilities and were of a good size. Individuals were able to accommodate larger rooms where additional mobility equipment The Limes DS0000064713.V361670.R01.S.doc Version 5.2 Page 21 was required. Individual rooms had been personalised with items of furniture and personal items. All bedrooms were locked on the day of the visit. People asked members of staff to open their room. There is a need for appropriate risk assessments to enable peoples’ independence to handle their own key when ever possible. Adequate toilet and bathing facilities were provided with appropriate aids and equipment available to assist manual handling and individual mobility requirements. The laundry area is situated on the ground floor and contained appropriate equipment, including sluice facilities, to meet peoples needs. There are sufficient supplies of protective clothing and equipment such as gloves and aprons to reduce the risk of cross infection at the home. The Limes DS0000064713.V361670.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has sufficient numbers of staff, but staff do not always understand people or their needs. Recruitment processes are to a good standard and protect vulnerable people. EVIDENCE: The home is usually staffed with appropriate numbers of staff to meet people’s needs. People who live at the home are generally happy with the care that they are given. People told us: “staff are very obliging and helpful,” and ”staff sometimes seem tied up and I have a long time to wait”. Staff told us that they liked working at the home and caring for the people who live there.” We found that the majority of staff we spoke to were knowledgeable about peoples needs, although some did lack understanding about care needs and their role in safeguarding people who live at the home. Some professionals we spoke to raised concern about the comprehension of some overseas staff: “They struggle to understand me, I am not confident that they will understand the people who live at the home”. The Manager told us that the home has a ratio of 60/40 of overseas staff and agreed that this had caused problems. The Limes DS0000064713.V361670.R01.S.doc Version 5.2 Page 23 The Manager also told us that she had had to address some staff that were identified as having: “ a poor attitude.”, The fact that some staff had a poor attitude was also a concern highlighted to the Commission for Social Care and Inspection. The Manager told us that there has previously been problems accessing training at the home and she is addressing this. The care home has an appropriately qualified workforce with at least 50 of staff delivering personal care holding or working towards an NVQ level 2 or above. Staff recruitment is completed to the required standard. All staff files seen contained appropriate checks such as criminal records checks, references and health declaration. We did not see any records to confirm that staff have undertaken induction training. The Manager told us that the new staff she was appointing would have induction training that meets “Skills for Care” standards. The Limes DS0000064713.V361670.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management arrangements need to be strengthened to give confidence that there is effective leadership and management to give additional confidence that residents are safeguarded and receive the care and attention that they need. EVIDENCE: The home has a new manager who had been in post approximately eight weeks at the time of the inspection. The Manager is a registered nurse and has also held previous management posts for four years. The provider said that an application for the manager to be registered with CSCI will be forwarded to us shortly. The Manager and the Directors have identified their improvement plan The Limes DS0000064713.V361670.R01.S.doc Version 5.2 Page 25 highlighting some of the weaknesses of the home and actions to be taken to improve them, which was positive to see. The home did return their Annual Quality Assurance Assessment (AQAA) when required. The AQAA was comprehensively completed, although some of the actions identified have been difficult to undertake as the home has been without a Manager for several weeks. We felt that the AQAA did identify a positive way forward for the improvement of the home and it is now time for this to be undertaken. There is a comprehensive quality assurance system for the home that includes the survey of residents and other stake holders. We saw surveys that had been returned and although were generally positive one did identify lack of access for sight and hearing tests. The Directors have told us that they will continue with elements of the existing quality assurance alongside the completion of the Annual Quality Assurance Assessment AQAA. It was positive to see that some practices have changed following concerns highlighted. There is a need to further develop the homes quality assurance addressing some of the failures identified during this inspection 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 did find one person who had just £1 since the 24/11/07 and no receipts for hairdressing since 1/8/07. Staff told us that this person had had their hair cut but were unsure how payment had been made. This means that people may not have any money. There is a need to ensure that the home acts proactively as peoples advocates, ensuring that they have sufficient money available to them at all times. We were told that the Deputy Care Manager has been undertaking the staff supervision. We saw good records of staff supervision till October 2007, after which time there were no records. The Deputy Manager confirmed that she had been doing the supervision regularly but as she found this difficult since December 2007. It is imperative that the staff supervision sessions continue so that good practice can be reinforced and some of the poor practices identified during the inspection are addressed. Maintenance contracts for the home were spot checked and were found to be up to date. Hot water testing was undertaken last on the 14/2/08. Records identified that one shower was recorded as 50oc and water in five peoples rooms was also too hot and put people at risk of scalding. There was only cold water in another person’s room. The home was informed with a need for immediate action to ensure that people are not put at risk of scalding. The Provider has since written to CSCI and confirmed that required actions have been undertaken. The Limes DS0000064713.V361670.R01.S.doc Version 5.2 Page 26 The Manager told us that staff training at the home has been identified as a weakness and has identified a plan to address this. Records we saw confirmed that staff had received insufficient mandatory training. We told the Provider that there was an urgent need for all staff to have fire training and moving and handling training as the lack of required training was putting people at risk. As identified within the health and personal care section of this report we found that the use of bedrails was unsafe and was putting people at risk. We told the provider of an urgent need to replace some bedrails and ensure that all people requiring bedrails had an appropriate risk assessment. The provider has written to us and confirmed that all requirements have been undertaken. The Limes DS0000064713.V361670.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 2 2 x 2 The Limes DS0000064713.V361670.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 (1) Requirement Care plans to be reviewed to include specific information relating to individuals and support required. Previous timescale of 28/02/07 was not met as care plans were not available for new people living at the home. There must be appropriate risk assessments in place when people need bedrails to highlight and address the potential risk of harm to residents. There must be adequate arrangements in place to ensure that people have appropriate access to health care professionals. Medicines should be safely stored and administered to protect people from harm and the risk of preventable drug error. People who live at the home must be supported whenever possible to make decisions in respect of their health and DS0000064713.V361670.R01.S.doc Timescale for action 06/05/08 2 OP7 13(4) 15/04/08 3 OP8 12(1) 15/04/08 4 OP9 13(2) 15/04/08 5 OP14 12(3) 06/05/08 The Limes Version 5.2 Page 29 6 OP27 18(1)(a) 7 OP38 18(1)(a) 8 OP38 13(4), welfare. The home should have competent and well trained staff. This will ensure that staff are aware of, understand and can meet peoples’ needs. The provider must demonstrate that there is a programme in place to ensure that staff receive all mandatory training. This will give confidence that staff are aware of appropriate actions to take to protect residents health and safety. Hot water within the home must be kept within safe temperatures. If checks identify that hot water does not meet required temperatures there should be a record of action undertaken. These actions will reduce the risk of scalding and also ensure that people have sufficient hot water available. 06/05/08 06/05/08 15/04/08 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 OP8 Good Practice Recommendations People should be weighed within forty-eight hours coming to live at the home. This will provide an essential bench mark to peoples’ weight and enable staff to more effectively monitor their health Staff should countersign all hand written medication details to confirm its accuracy and reduce the risk of error. Medicines should be stored safely and preferable not in the hairdressing room. The appropriate code should be used when medicines are not administered. To ensure that people receive the medicines when they need them. There should be a record of all medicines that are received DS0000064713.V361670.R01.S.doc Version 5.2 Page 30 2 3 4 5 The Limes OP9 OP9 OP9 OP9 6 7 8 9 10 OP12 OP14 OP14 OP15 OP18 11. 12 13. OP24 OP31 OP36 14 15 OP37 OP38 into the home. This will enable staff to check that the amounts of medicines are correct and provide better systems to monitor that people are getting the medicines that they need. Specific therapeutic activities to be provided for all people who live at the home including people with dementia Staff should have training to highlight their and the homes responsibilities under the Mental Capacity Act to respect peoples’ whenever possible. The use of advocacy services within the home should be explored. So people have support to voice their choice when required. The menu should be revised to ensure that there is a choice available at every mealtime. Staff should have training in the awareness of safeguarding procedures. This will give greater assurance that they know what to do to protect people who live at the home. Assessment of risk and consent required for locking of bedroom doors An application is sent to CSCI for the Manager to be registered as a fit and responsible person to manage the home. Staff are to receive 6 sessions of individual supervision during a 12-month period, and these to be documented. This was a good practice recommendation of the previous inspection and was not met. The way that staff record care that has been both given and is required is reviewed so that there is good continuity of records. There is a record of all staff attending fire drills. The Limes DS0000064713.V361670.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 DS0000064713.V361670.R01.S.doc Version 5.2 Page 32 - 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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