Inspection on 16/07/08 for The Limes Care Home

This inspection was carried out on 16th July 2008.

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

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

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE The Limes Care Home Earlsford Road Mellis Eye Suffolk IP23 8DY Lead Inspector Julie Small Unannounced Inspection 16th July 2008 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 Care Home DS0000071661.V368511.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 Care Home DS0000071661.V368511.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Limes Care Home Address Earlsford Road Mellis Eye Suffolk IP23 8DY 01379 788114 01379 788201 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) Priory Care Limited Mrs Sandra Hutchison Care Home 26 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (26) of places The Limes Care Home DS0000071661.V368511.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Within the category of DE(E) the home can provide care and accommodation only for the three named service users as listed in application V26679 Date of last inspection Brief Description of the Service: Priory Care Limited purchased The Limes April 2008. The Limes is a Care Home for 26 older people situated in the Village of Mellis, overlooking the village green. The village amenities include a Post Office/ Newsagent and Public House. It is 3 miles from the market town of Diss and Eye, and 9 miles from Stowmarket. There is a bus service to the surrounding towns. The Home is set in large grounds, where there are eight self-contained cottages with tenants, who attend the Home for their main meal and companionship during the daytime. The Home is not registered to provide care for the tenants living in these cottages. The Home has 22 single bedrooms (8 of which are located in the home’s new extension) and 2-shared bedrooms. Communal day space consists of 2 small lounges, dining room, and lounge/kitchenette area leading into the new conservatory. Whilst there is no passenger shaft lift, a stair lift is provided for access to the first floor. At the time of the inspection the manager said that the weekly fees for the home were £415 for those living in the old build and £426 for those living in the new build. The Limes Care Home DS0000071661.V368511.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. This means the people who use this service experience adequate quality outcomes. The unannounced inspection took place on Wednesday 16th July 2008 from 10.15 to 19.20. The inspection was a key inspection, which focused on the core standards relating to older people and was undertaken by regulatory inspector Julie Small. The report has been written using accumulated evidence gained prior to and during the inspection. The registered manager was present during the inspection and they provided the requested information promptly and in an open manner. During the inspection three staff recruitment records, the care plans of three people who lived at the home and fire safety records were viewed. Further records viewed are detailed in the main body of this report. Four staff members and eleven people who lived at the home were spoken with. Prior to the inspection an Annual Quality Assurance Assessment (AQAA) and surveys were sent to the home to provide people with an opportunity to share their views about the service. One service user and one staff survey were returned to us. We had received concerns from two anonymous sources prior to the inspection, which included the manager’s attitude to people that lived at the home, the quality of food, infection control and reporting of issues regarding the safety of people that lived at the home. We looked into the issues that were raised during this key inspection and our findings can be found in the main body of this report. What the service does well: Interaction between staff and people that lived at the home was observed to be friendly and professional. People reported that staff treated them with respect and that they were caring. The home was clean, well maintained and was attractively furnished and the grounds were attractive. People reported that they were happy with the environment that they lived in. People were provided with a good activities programme that they could participate in if they chose to, which met with their interests. People were provided with a healthy and nutritious diet. The Limes Care Home DS0000071661.V368511.R01.S.doc Version 5.2 Page 6 The staff survey that was received commented ‘provides a happy, warm, friendly home from home atmosphere. Good care in all aspects’. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Limes Care Home DS0000071661.V368511.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Limes Care Home DS0000071661.V368511.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can be expected to be assessed prior to moving into the home to ensure that the home can meet their assessed needs. They cannot be assured that they will be provided with the information they need to make an informed choice about where to live and to be provided with a contract/statement of terms and conditions with the home, that reflects the current provider details. The home does not provide an intermediate care service. EVIDENCE: The Limes Retirement Home Limited had been purchased by Priory Care Limited April 2008. The registration report stated that the Statement of Purpose/Service User’s Guide document would be updated to reflect the new provider details when the sale and the registration had been completed. However, the document that was viewed during the inspection had not been The Limes Care Home DS0000071661.V368511.R01.S.doc Version 5.2 Page 9 updated and the previous provider details were still present. The document included previous details about the provider, the responsible individual, the registered company address, the organisational structure and the arrangements for making complaints. The manager stated that the document was in the process of being updated. However, people were not provided with the appropriate information that they needed to enable them to make decisions about the home. The Statement of Purpose/Service User’s Guide included information about the aims and objectives of the home, philosophy of care, fire safety, activities that were provided by the home and the details of what the fees were and what was and was not included in the fees. The contact details of CSCI (Commission for Social Care Inspection) were included in the document. However, they needed updating to reflect the current contact details in the event that people chose to contact us. Page four of the document made reference to the previous inspection commission. A service user survey stated that they had not received enough information about the home that helped them to decide if it was the right place for them and that they had not received a contract. A staff member was spoken with and stated that the Statement of Purpose/Service User’s Guide was provided to newly admitted people and prospective residents of the home which did not reflect the changes of provider. The manager stated that the provider was in the process of updating the contracts/statement of terms and conditions to reflect the changes in the provider. A copy of the ‘statement of terms for service users’ was viewed and the document was an agreement between the person and the previous providers The Limes Retirement Home Limited and not the current providers Priory Care Limited. The records of three people who lived at the home were viewed, which held needs assessments that identified the support that each person needed and preferred on a daily basis. The assessments included details of support and daily care needs, continence, dietary needs, communication and medication. The records included care plans, which identified how their assessed needs were met and they were regularly updated with the people’s changing needs and preferences. The Limes Care Home DS0000071661.V368511.R01.S.doc Version 5.2 Page 10 The Limes Care Home DS0000071661.V368511.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect to have their health, personal and social care needs set out in an individual plan of care, that their health needs are met, to be treated with respect and to be protected by the home’s medication procedures. EVIDENCE: The support that people needed and preferred to meet their assessed needs were recorded in an individual care plan. The care plans of three people who lived at the home were viewed and they included details of the person’s religion, personal care, communication, mobility and dietary needs. The manager was spoken with about the need for increased detail to be included in the care plans which identified the specific individual support that people required, such as the specific support that they required when bathing which included what areas they could attend to independently, how they preferred staff to support them and with what. The manager stated that they were in the The Limes Care Home DS0000071661.V368511.R01.S.doc Version 5.2 Page 12 process of updating the care plans into the new provider’s care planning format. The records of a project that a staff member was working on were viewed, which were details about people’s individual life history and their diverse needs and preferences. The manager said that when they were completed they would be included in people’s care plans, this would provide staff with a ‘pen picture’ of each person. The care plans were updated on a monthly basis to reflect the person’s changing needs and preferences. Daily records were maintained which identified people’s well being and activities. The care plans viewed included risk assessments, which identified possible risks and methods of minimising the risks, in areas of people’s lives such as when leaving the home when unaccompanied by staff, using the stair lift and how staff should support a person which protected the person and the staff. A recent incident of a person leaving the home without staff knowledge, this had been recorded in the daily records and a risk assessment had been completed which identified methods of minimising the risks of them ‘wandering’ in the future. The service user survey stated that they were usually provided with the care and support that they needed. Ten people that were spoken with confirmed that their needs were met and that they were happy with the service that they were provided with. A staff survey stated that they were always given up to date information about the needs of the people that they supported and the ways that they passed information on about people usually worked well. Staff spoken with had a clear understanding of people’s individual needs and how their needs were met. People living at the home were provided with support that ensured that their health care needs were met. Three people’s records that were viewed included details about their individual health care needs, such as if they were diabetic and how their diabetes was controlled. Details of the health care treatment that people had received, such as from the district nurse, GP, dentist and optician, were recorded in the people’s care plans. The records of one person stated that staff were to be aware that the person might ask them to apply cream in areas that they could manage independently and advised that the staff must ensure that they protect themselves when working with the person. A health professional was observed to visit a person during the inspection, staff were observed to ensure that people were provided with privacy during their visits. The manager was observed to receive information from the health professional regarding to the person’s well being and fed the information back to staff members. The Limes Care Home DS0000071661.V368511.R01.S.doc Version 5.2 Page 13 A service user survey stated that they always received the medical support that they needed. An anonymous complaint had been received which stated that people had lost weight due to the poor quality of food and the small amounts of food that people were provided with. The provision of food is discussed in the next section of this report. Records of regular weight charts were viewed for the whole of 2008 and people’s weight was checked by staff on the day of the inspection. There had been fluctuations in people’s weight, however, none of the fluctuations were great and were not of cause for concern. Whilst two people had lost approximately one stone in weight records showed that one had since re-gained the weight and that one had been hospitalised due to an illness. It was noted during the inspection that people’s privacy was respected. Staff were observed knocking on bedroom and toilet doors and waiting to be invited in, before entering them. One person was observed to slam their bedroom door closed when the manager approached the room, the manager was observed to leave the situation and respect the person’s privacy. Staff were observed to be attentive to people’s needs and they were observed asking them if they would like drinks, if they wished to participate in the planned activity and if they were comfortable. The interaction between staff and people that lived at the home was observed to be caring and professional. It was noted that staff answered call bells promptly. We had received concerns from anonymous sources regarding the ways in which the manager interacted with people. However, we observed the manager’s interaction between staff, visitors to the home and people that lived at the home and they were observed to be friendly and professional. Eleven people who lived at the home that were spoken with confirmed that their privacy was respected and ten people stated that all the staff treated them with respect and were caring. One person reported that some of the staff were good and others were not so good. Medication was stored, handled and administered in a safe way, ensuring that people who lived at the home were safeguarded. The medication of some people was stored in a secured room in the home, which contained an appropriately secured controlled medicines cabinet and a fridge where medication that must be kept refrigerated was stored and records of regular temperature checks were viewed. The majority of people’s medication was stored in MDS (monitored dosage system) blister packs in a secured metal cabinet, which was attached to the wall in their bedrooms. The medication record keeping safeguarded people with regards to the administration of medication. MAR (medication administration record) charts The Limes Care Home DS0000071661.V368511.R01.S.doc Version 5.2 Page 14 were viewed and were completed appropriately to show when people had taken their medication and when they had refused it and the reasons for refusing the medication, for example if they were not in pain and did not wish to take PRN (as required) pain relief medication. People’s care plans that were viewed included a list of their prescribed medication. The controlled medication book was viewed and completed appropriately, which included the signatures of two staff to show that people had taken their medication and a running total of the administered and stored medication. The numbers of the controlled medication of one person was checked and it was found that the records accurately reflected the actual numbers of the remaining medication. The lunchtime administration of medication was observed and a staff member clearly explained the procedures for the safe handling of medicines. One person at a time was assisted with their medication, the staff member removed the MDS blister pack or other containers that did not allow MDS storage from the cabinets and taken in a secured metal box to the person. The staff member carefully checked the records to ensure that they were administering the correct medication and dosage to the correct person. The staff member explained that the MAR sheets were not signed until the person had been seen to take their medication. There had been a concern raised by a person that lived at the home regarding the times that their evening medication was administered. A staff member was spoken with and explained that previously they had administered the medication to the person and that they then took their medication when they chose to. A risk assessment was viewed which identified how this method had been assessed. However, they stated that this practice did not safeguard people and that they ensured that the person took their medication before it was signed for in the MAR charts and it was no longer left with the person to take later in the night and the risk assessment had been reviewed. Training records were viewed and evidenced that staff who were responsible for administering medication were provided with medication training. The home had a medication procedure which clearly explained the safe handling, storage and handling procedures of medication. The Limes Care Home DS0000071661.V368511.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 good. This judgement has been made using available evidence including a visit to this service. People can expect to be provided with the opportunity to participate in activities which meet with their interests, to be supported to maintain contacts, to be supported to exercise choice and control over their lives and to be provided with a nutritious and balanced diet. EVIDENCE: People were provided with a daily activity programme that met with their preferences and interests that they could participate in if they chose to. It was noted upon arrival to the home that there was a notice posted on the front door which advertised a cheese and wine evening for the Friday after the inspection. The evening was open to people that lived at the home, staff and visitors to the home. The manager was observed to invite visitors to the home to the evening during the inspection. The manager explained that they had organised a music band for the event. People’s records that were viewed identified the activities that they had participated in. The activities programme was viewed and there was an activity The Limes Care Home DS0000071661.V368511.R01.S.doc Version 5.2 Page 16 provided each day and activities included a library club, reminiscence therapy, manicure, exercise, word games, crafts and music and comedy visiting entertainers. During the inspection people were observed to be enjoying the gardens, watching television and reading newspapers. During the afternoon of the inspection a visitor to the home presented a slide show of Suffolk waters. Two people were spoken with about the activity and they said that the person showed slides of their world wide travel and that they also bought in jewellery from the countries for them to see. They said that the slides were ‘marvellous’ and that they were really looking forward to the forthcoming slide show of Antarctica. People spoken with reported that there were plenty of activities that they could enjoy that were provided at the home. A person said that they could use the summer house when the weather was good. A person said that there was religious worship provided at the home on some Sundays, which people could go to if they chose to, that a hairdresser visited the home and that the home had a shop where they could buy personal items if they did not wish to go out shopping. A service user survey stated that there were always activities in the home that they could take part in. Care plans that were viewed included information about contacts with family members and friends that people maintained. People spoken with said that their family and friends were welcomed into the home when they visited. One person said that their family had recently visited and they were particularly impressed with the cleanliness of the home and the meals that people were provided with. During the inspection people were observed to receive visitors from family members and friends and one person went out shopping with a family member. The interaction between staff and visitors was friendly and professional. People spoken with said that the staff at the home listened to them, that they always chose their own clothes and that they could choose what they wanted to do each day. A service user survey stated that the staff always listened to them and acted on what they said. The minutes of a residents meeting that had taken place in February 2008 were viewed and showed that people were provided with the opportunity to discuss the support that they were provided with in the home. During the inspection it was noted that people were provided with choices such as their meal and drink choices, what they wanted to do during the day and if they wished to participate in activities. As mentioned earlier we had been advised about a concern that the quality and quantity of food had deteriorated since the new providers had bought the home. However, people spoken with said that the quality and the quantity of food was very good, that they were provided with choices of alternatives if they did not wish to have the meals that were on the menu and that they had The Limes Care Home DS0000071661.V368511.R01.S.doc Version 5.2 Page 17 not noticed a change in the food provision since the home had changed providers. Two people said that they were provided with too much food. One person said that they supplemented their meals by ensuring that they kept snacks in their room. A service user survey stated that they sometimes enjoyed the meals at the home and commented ‘some dinners could be bigger, a jacket potato on a Saturday is not really sufficient’. People who lived at the home were provided with a diet which was appealing and nutritious. The menu was viewed and it was noted that the planned meals were balanced and nutritious. On the day of the inspection the main meal was chilli con carne or minced beef, new potatoes and vegetable and desert was fresh raspberries and fresh cream. People said that they enjoyed their meal and comments included ‘lovely’ and ‘you could not get better food anywhere else’. People were provided with drinks regularly throughout the day and people said that they could ask for a drink at any time. Tables in the attractively furnished dining room were laid with cutlery, napkins, the menu for the day and salt and pepper. People’s care plans that were viewed clearly identified people’s specific dietary requirements, food allergies and the support that people required. The manager reported that they purchased their fresh vegetable, fresh fruit and fresh meat from local suppliers. The Limes Care Home DS0000071661.V368511.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, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect to be protected from abuse and to have their complaints listened to and acted upon. EVIDENCE: People were provided with the information that they needed to enable them to make a complaint about the service that they were provided with. The home had a complaints procedure, which had recently been updated by the manager to reflect that complaints could be forwarded to the new responsible individual. However, the Statement of Purpose/Service User Guide needed to be updated to reflect the change in ownership if the home and contact details for CSCI to ensure that people were provided with the details that they needed to raise concerns and make complaints as well as the complaints procedure. The complaints book was viewed and there were no complaints made since the last inspection. The manager stated that they had not received any complaints since the last inspection. We had received complaints from a person that lived at the home, which had been acted upon when the home was advised of the areas of support that they required. We had received complaints from anonymous sources regarding a range of areas as identified in the summary The Limes Care Home DS0000071661.V368511.R01.S.doc Version 5.2 Page 19 section of this report. The issues were looked at within the inspection process and the findings are identified throughout this report. A staff survey said that they knew what to do if a resident, relative, advocate or friend had concerns about the home. A service user survey stated that they always knew who to speak to if they were not happy and that they knew how to make a complaint. People spoken with stated that they were aware of how to make a complaint if they were not happy with the service that they were provided with. Several thank you letters and cards were viewed, which were from family members of people that had lived at the home and they thanked the staff for the support that they had provided to the people during their stay. Staff were informed of their responsibilities in safeguarding adults who lived at the home by attending adult safeguarding training and the home’s safeguarding policy and procedure. Staff spoken with were aware of their responsibilities in the protection of people who lived at the home. There had been two safeguarding referrals made by CSCI since the new providers had taken over the home, following allegations made from anonymous sources. One issue was not investigated by social care safeguarding due to a decision made by the safeguarding manager and one issue was under investigation by social care safeguarding at the time of the inspection. The Limes Care Home DS0000071661.V368511.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, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect to be provided with a clean, hygienic, safe and well maintained environment to live in. EVIDENCE: People were provided with a clean, safe, well maintained and attractive environment to live in. At the time of the inspection it was noted that the home was clean and tidy. A tour of the building was undertaken and it was noted that the communal areas were clean and attractively furnished. People spoken with were complimentary about the environment that they lived in and they reported that the home was always clean and tidy. A service user survey stated that the home was always fresh and clean. The Limes Care Home DS0000071661.V368511.R01.S.doc Version 5.2 Page 21 The communal areas to the home were attractively decorated and furnished. The large communal lounge was light and airy, with sufficient comfortable seating for people to use and people reported that there had been a new television that was recently purchased which they liked. One person said that they had a swollen ankle and they had been provided with a foot stool to rest their leg. The dining areas provided sufficient seating and tables for people to use to enjoy their meals. There were various pieces of art work that were displayed in the communal areas of the home that people had created during their crafts activities. The gardens of the home were attractive and well maintained. There was seating provided for people to use if they chose to and there was a summer house in the grounds that people could use. People spoken with said that they enjoyed the grounds and often sat outside when the weather was good. The laundry area was clean and contained washing and drying machines and hand washing facilities, including liquid soap and disposable paper towels. Communal toilets and bathrooms provided hand wash liquid and disposable paper towels, which reduced the risks of cross infection. Staff were observed using good infection control procedures during the inspection, which included washing their hands and wearing protective clothing when working with food and issues of personal care, which protected people from cross infection. Staff spoken with had knowledge of infection control procedures. There were no unpleasant odours in the home during the inspection. We had received concerns that stated that the infection control practices in the home were inadequate and that the cleaning materials that were purchased had deteriorated since the new providers had taken on the home. The manager reported that there had been no change in the cleaning materials apart from that they had previously been purchased from a local supermarket and they were currently purchased from a contracted provider. There was no evidence to suggest seen during the inspection to show that the home’s infection practices were not adequate. The Limes Care Home DS0000071661.V368511.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, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can expect to be supported and have their needs met by staff that are trained and competent to do their jobs. They cannot be assured to be protected by the home’s recruitment procedures. EVIDENCE: During the inspection there were three care staff, domestic staff, the cook, maintenance person, a volunteer and the manager on duty. Staff were observed to meet the needs of people, they responded to call bells promptly and they were attentive to people’s needs. The staff rota was viewed and it was noted that the home was staffed throughout the twenty four hour period. The manager reported that the home was fully staffed and two newly appointed staff members were awaiting their recruitment checks before they started working at the home. A staff survey stated that there were always enough staff to meet the individual needs of the people who lived at the home. Staff spoken with reported that they felt that there were sufficient staff on duty at all times to meet the needs of people. A service user survey stated that staff were always available when they needed them. People that lived at the home that were The Limes Care Home DS0000071661.V368511.R01.S.doc Version 5.2 Page 23 spoken with reported that there was adequate numbers of staff that worked at the home and that staff were available when they were needed them. Three staff recruitment records were viewed and two held all the required documents that were required to ensure that people were safeguarded by the home’s recruitment procedures. The recruitment records included CRB (criminal records bureau) checks, work history and two written references. One staff recruitment record of a person that was recently employed at the home that was viewed only contained one written reference. A staff member was spoken with regarding the lack of a second reference and they stated that they would chase the reference up immediately to ensure that people were safeguarded. Staff training records viewed evidenced that newly appointed staff were provided with an induction, which included the Skills for Care Common Induction Standards and an in house induction which advised people about the internal expectations of their work role. A staff survey stated that their induction covered everything that they needed to know to do the job when they started. Staff spoken with confirmed that they were provided with an induction when they started working at the home which provided them with the information that they needed to meet the needs of people. Staff were provided information about how to meet people’s needs and safeguard people who lived at the home by the provision of training courses. Staff training records were viewed, included some training certificates and a list of training that staff had attended. Training provided to staff included manual handling, fire safety, health and safety, food hygiene, safeguarding adults, medication, infection control and dementia. The manager was working on a palliative care distance learning course and reported that staff members were also working on the certificated course. The manager and two staff members that were spoken with confirmed that they had also completed distance learning courses on health and safety and dementia, which they reported were helpful in meeting the needs of people. Staff spoken with stated that they received appropriate training to support them in meeting people’s needs. A staff survey said that they were provided with training which was relevant to their role, helped them to understand and meet the individual needs of people and kept them up to date with new ways of working and that they felt that they had the right support, experience and knowledge to meet the different needs of people. The home had met the target of 50 staff to have achieved a minimum of NVQ (National Vocational Qualification) level 2 by 2005, which was identified in the National Minimum Standards relating to older people, which showed that staff had been assessed as competent in their job in meeting people needs. The manager reported that there were fourteen people that worked at the home and six had achieved a minimum of NVQ level 2 in care, one was The Limes Care Home DS0000071661.V368511.R01.S.doc Version 5.2 Page 24 working on a health and social care degree and two were working towards their NVQ level 2 care. The Limes Care Home DS0000071661.V368511.R01.S.doc Version 5.2 Page 25 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, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can expect to live in a home that is managed by a person that is fit to be in charge, to have their financial interests safeguarded and to have their health and safety promoted and protected. They cannot be assured that the home is monitored appropriately by the home’s providers. EVIDENCE: The home was managed by a person that was fit to be in charge, who had been assessed as fit by the CSCI registered manager application process and who had achieved their RMA (registered manager’s award). The manager had an understanding of their role and responsibilities. The manager had updated their knowledge and was working on a distance learning for palliative care and The Limes Care Home DS0000071661.V368511.R01.S.doc Version 5.2 Page 26 had completed distance learning courses on health and safety and dementia care. There were no Regulation 26 reports available in the home which had been undertaken by the new providers to show that the running of the home was monitored on a regular basis. The manager stated that there had been visits from the responsible individual and that they had viewed care plans and spoken with people that lived at the home during their visits. There had been no satisfaction questionnaires completed since the new providers had taken over at the home. However, questionnaires were viewed, which had been undertaken in 2007. The outcomes to the questionnaires were positive apart from one which responded ‘no comment’ to the question ‘are you satisfied with the care that you received?’ The minutes from a resident’s meeting in February 2008 was viewed and showed that people were provided with the opportunity to discuss their views of the home. There was a suggestion box in the home where people could make suggestions about the running of the home. The home’s procedures for safeguarding people’s finances were viewed and it was noted that they were detailed and provided sufficient information to staff who supported people with their spending monies. A staff member explained the processes for safeguarding people’s finances and they stated that there were several methods of enabling people to maintain their finances, which included keeping their own bank accounts and billing their representatives for the services that they had used in the home, which included the home’s shop and hairdressing facility. One person kept an amount of money in the office for safekeeping and the records were viewed which showed the running total of their money and receipts for their spending. The person had signed all transactions. People’s health and safety was promoted and protected in the home. Health and safety records were viewed and it was noted that regular safety checks were routinely made, such as water temperature, fridge and freezer temperatures and electrical appliance safety. The maintenance worker was spoken with and provided us with the health and safety monitoring records that they maintained. Fire safety records were viewed and regular checks were undertaken of fire safety equipment. The home had a fire risk assessment. It was noted that fire doors were closed in line with fire safety practice during the inspection. The maintenance book was viewed which showed where repairs had been identified and when they had been completed in a timely manner. Staff training records viewed and discussions with staff evidenced that they were provided with health and safety related training such as food hygiene, The Limes Care Home DS0000071661.V368511.R01.S.doc Version 5.2 Page 27 manual handling and infection control to ensure that staff had been notified of safe working practices. The home’s policies and procedures were viewed and included food hygiene, manual handling, fire safety, health and safety and the COSHH (control of substances hazardous to health) which were available for staff reference to ensure that people were supported in a safe manner. The Limes Care Home DS0000071661.V368511.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 The Limes Care Home DS0000071661.V368511.R01.S.doc Version 5.2 Page 29 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4, 5, schedule 1 Requirement The Statement of Purpose/Service User Guide must be updated to show the current provider details to provide people with the information that they need about the home to make decisions and if they wish to contact the provider People’s contracts/statement of terms and conditions must be provided by the new providers to ensure that people are aware of the terms and conditions of living at the home Two written references must be received by the home prior to a staff member commencing work at the home to ensure that people are safeguarded Monthly Regulation 26 visits must be undertaken and the reports must be available in the home for inspection to ensure that the running of the home is appropriately monitored Timescale for action 30/08/08 2 OP2 5 30/08/08 3 OP29 19, Schedule 4 26, schedule 4 20/07/08 4 OP33 30/08/08 The Limes Care Home DS0000071661.V368511.R01.S.doc Version 5.2 Page 30 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 OP7 Good Practice Recommendations It is recommended that people’s care plans be updated to show the ‘specific’ individual support that people need and prefer to meet their needs The Limes Care Home DS0000071661.V368511.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Care Home DS0000071661.V368511.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. 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