Inspection on 17/12/07 for The Limes Care Home

This inspection was carried out on 17th December 2007.

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 Care Home 09/08/06

The Limes Care Home 28/12/05

The Limes Care Home 26/10/05

The Limes Care Home 08/03/05

The Limes Care Home 08/06/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE The Limes Care Home Park Road Mansfield Woodhouse Nottinghamshire NG19 8AX Lead Inspector Jayne Hilton Unannounced Inspection 17th December 2007 07:30 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 Care Home DS0000008710.V355467.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 DS0000008710.V355467.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Limes Care Home Address Park Road Mansfield Woodhouse Nottinghamshire NG19 8AX 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) 01623 632 681 01623 622644 lantraz@btconnect.com Mr Ahmad Ally Toorabally Mrs Nazeera Toorabally Carol Ann Wilewski Care Home 40 Category(ies) of Dementia (40), Old age, not falling within any registration, with number other category (40) of places The Limes Care Home DS0000008710.V355467.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered persons may provide the following categories of service only: Care Home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - code DE The maximum number of service users who can be accommodated is 40 9th August 2006 2. Date of last inspection Brief Description of the Service: The Limes is a care home providing personal care and accommodation for 40 service users who are over 65 years of age in the category of Older People (OP). The home is owned by Mr and Mrs Toorabally who oversee the conduct of the home. The Limes is a purpose built home with bedrooms and lounges located on both floors. A passenger lift provides access to the first floor. The home is situated in well-maintained grounds in Mansfield Woodhouse close to local shops and amenities. All forty bedrooms are single and ensuite with the opportunity to utilise adjoining doors in two sets of rooms for couples where required. In addition to the ensuite facilities there are two assisted baths, two toilets and one shower on each of the two floors. All rooms have a telephone point available. Bedrooms are tastefully decorated and furnished, they can be personalised where required. Service users have access to sufficient communal space to meet their needs with a choice of lounge including one for smokers and sufficient dining space to accommodate everyone. The manager confirmed that on the day of the inspection, fees range from£290 - £350 per week, this fee does not include hairdressing, chiropody, magazines, escort duties, and personal toiletries. The Limes Care Home DS0000008710.V355467.R01.S.doc Version 5.2 Page 5 Service users have a copy of the Service User Guide in their bedroom, which informs service users that copies of inspection reports are held in the office and are available upon request. The Limes Care Home DS0000008710.V355467.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for service users and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. This inspection took place over 7 daytime hours and was unannounced. Because we are not always able to communicate with people with dementia about their experience of the service, we have used a formal way to observe people in this inspection to help us understand. We call this the ‘Short Observational Framework for Inspection’ (SOFI). This involved us observing five people who use services for 2 hours and recording their experiences at regular intervals. This included their state of well being, and how they interacted with staff members, other people who use services, and the environment. The observation took place in the dining room and lounge of the home. We also spoke to the manager, three staff members, two relatives and three people who use the service, who were not part of the observation. We looked at records and documents, including four people’s care plans. The provider had completed an Annual Quality Assurance questionnaire, which was also used as part of the inspection process. A Thematic Inspection was undertaken on 20th September 2007. A thematic inspection is a short, focused inspection that looks in detail at a specific theme. This inspection looked at the quality of care people with dementia experience when living in care homes, focussing on ‘dignity’ as an important part of people’s quality of life. The findings of the thematic inspection will be used as part of a wider focussed investigation that we are doing about the quality of care that people with dementia experience. The report will be published in 2008. Further information on this, and thematic inspections can be found on our website www.csci.org.uk. What the service does well: The Limes Care Home DS0000008710.V355467.R01.S.doc Version 5.2 Page 7 Service users live in a home, which is managed by a person who is fit to be in charge and is run in their best interests and their health and safety is promoted and protected. Service users have some information about the home and can be assured the home will meet their individual needs and preferences and are supported well to settle into their new surroundings. Service users needs are met by, staff who are appropriately trained and supervised. The home will accommodate as much as possible of a service user’s personal possessions which they wish to bring with them into the home. Observation of practice on the day of the inspection demonstrated that, service users, were treated in a way, which maintained their personal dignity, and the staff treat residents with respect. Service users confirmed the home offers three meals, together with snacks and drinks each day, special diets are catered for, for example diabetic diet, that they have a choice and reported that they enjoyed the food. Service users said staff were marvellous, hard working and do their best that felt that there were enough of them; service users spoken with also said their needs had never been unmet. Service users live in a safe, clean and well-maintained environment and have access to safe and comfortable indoor and outdoor communal facilities. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users know how to make a complaint and systems are in place to protect them from harm What has improved since the last inspection? Our overall findings were that the service promises to deliver care to service users in a way, which respects their personal dignity and right to privacy and that this is how care is now provided in practice. The Limes Care Home DS0000008710.V355467.R01.S.doc Version 5.2 Page 8 We found that there were now satisfactory levels of staff interaction with the service users and the interactions, which were seen, were mostly of good quality to enhance the quality of life of the residents who were observed. The manager has increased the numbers of staff to four on each daytime duty shift. A new door security system has been installed. What they could do better: Review the Combined Statement of Purpose and Service User Guide. Develop ‘Person Centred Care Plans’ for all service users, which include support plans for their healthcare needs and medication relating to them. Ensure care plans are implemented where service users develop pressure areas. Review the systems in place for monitoring service users healthcare needs. Ensure the systems in place for the management of medication are safe Ascertain the wishes of service users and ensure that they uphold their choices unless the care plan and risk assessment indicate that this is not appropriate. Undertake an assessment of service users’ needs and provide evidence as to how you calculate the appropriate staffing levels to meet the health, safety and welfare needs of the residents. Ensure accident records are always completed. Ensure that any events, which affect the health and well being of service users, are appropriately notified to the Commission for Social Care Inspection. Further develop the personal life history profiles and the assessment documentation. Provide confirmation in writing to the service user/representative that the home can meet the persons assessed needs. Explore and Introduce visual cues, tactile surfaces and stimulating/activity objects for service users with Dementia. The Limes Care Home DS0000008710.V355467.R01.S.doc Version 5.2 Page 9 More imaginative ways of engaging residents, particularly those with Dementia in purposeful activity need to be found to make sure they are not treated differently to other residents. Ensure that formal service user/relatives meetings are arranged and held on a regular basis. Nine requirements and twelve good practice recommendations have been made. 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 DS0000008710.V355467.R01.S.doc Version 5.2 Page 10 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 DS0000008710.V355467.R01.S.doc Version 5.2 Page 11 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 and 4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users have some information about the home and can be assured the home will meet their individual needs and preferences and are supported well to settle into their new surroundings. Further development of the homes information and assessment documentation is needed to ensure service users needs are fully met. The home does not provide an intermediate care service. EVIDENCE: The home has produced a Service Users Guide and Statement of Purpose but the manager reported that they are due to be reviewed. The Limes Care Home DS0000008710.V355467.R01.S.doc Version 5.2 Page 12 The manager acknowledged the requirement set, in respect of this, at the Thematic Inspection would not be met by the set timescale of 21/12/07 and stated that she wanted to ensure she got the contents right and not rush the document through. Four service users care plans were viewed, three of these were in detail and the other sampled for specific information. All had contracts in place, but the manager acknowledged that they had not provided confirmation in writing to the service user/representative that the home could meet the persons assessed needs. The manager carries out the needs assessment, including that of individuals who are self-funding. Social Worker assessments and reviews were viewed where appropriate and these were satisfactory. Service users are supported and encouraged to be involved, in the assessment process and evidence of signatures were seen on those files examined. The home has formal documentation in place for carrying out an, holistic needs assessment but this requires further update and development, particularly around service users diversity needs. Further development of the personal life history profiles and the assessment documentation would further embrace the individual as a whole person. One newly admitted service user told us that he was only at the home for a short stay but spoke highly about being supported to feel welcome in the home and was observed informing the staff members and manager as he left the home. Policies and procedures are in place for equality and diversity, and on the whole are promoted and incorporated into what they do. But the Equality and Diversity Agenda in the home needs to be further developed. The manager told us that she is keen for this to happen and is providing training for all staff on the topic, one training session being the day after the inspection for some staff. Through the observation process many positive interactions between service users and staff were demonstrated including warmth, holding, a relaxed pace and atmosphere, acknowledgement, genuiness, facilitation, enabling and belonging, which provided comfort, identity, attachment, occupation and inclusion, resulting in positive outcomes for people with dementia. The Limes Care Home DS0000008710.V355467.R01.S.doc Version 5.2 Page 13 The Limes Care Home DS0000008710.V355467.R01.S.doc Version 5.2 Page 14 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. Care plans are in place but are not person centred, or fully up to date. Systems in place for management of medication also require improvement to ensure service users are not placed at risk of harm. However service users are treated with respect and their right to privacy upheld. EVIDENCE: As at the previous inspection we found the care plans to be about tasks, rather than about providing care which centres on the person with Dementia, their past life, personality, strengths and wishes. The manager told us that she is looking at changing the format of the care plan documentation, but in the meantime will look at prioritising service users with Dementia, documentation to develop a more person centred approach and added that she is seeking out training in person centred care planning. The Limes Care Home DS0000008710.V355467.R01.S.doc Version 5.2 Page 15 The care plans examined did address some aspects of Dementia Care and were reviewed monthly but the requirement set at the previous inspection is not yet met. Care plans must be developed in consultation with residents so they are clear about how staff intend to help them. The care plans must provide clearer instructions to care staff on how the service is to be provided for each person with Dementia to make sure the care provided is in line with the philosophy of care at the service. Care staff confirmed that are trained in giving choice to service users and in ways in which to facilitate users to make decisions, for example, what to wear and service users spoken with endorsed this. Risk assessments were in place to identify those at risk of pressure damage, but one service user case tracked had no care plan in place for noted pressure ulcers. However, notes did contain details of District Nurse visits and these records evidenced appropriate intervention and treatment and what action was being taken to reduce risk, for example pressure relieving equipment, which was also observed being practiced by staff. Service user’s dietary needs and weight are monitored regularly and bowel charts in place for use, however one persons bowel chart had not been completed for 18 days. It was established by speaking with staff that this person was not at risk of a serious health problem and that the records were in fact inaccurate. The system in place for monitoring service users bowel movements, therefore requires review to ensure service users health is not placed at risk. Records of relatives consultation confirms that they feel that staff are competent to meet their health and personal care needs and service users spoken with stated they were happy, that their healthcare was looked after well. The home has a policy for the receipt, storage and handling, administration and disposal of medication, however observation of a medicines round evidenced that on some occasions staff do not fully observe that the medication is taken before signing the medication record. [On at least four occcasions service users were left with medication on the breakfact table] Details of service users medication was recorded within their care files, but where these had been reviewed they were not updated on every occasion. Observation of practice on the day of the inspection demonstrated that service users were treated in a way, which maintained their personal dignity, and the staff treat residents with respect. The Limes Care Home DS0000008710.V355467.R01.S.doc Version 5.2 Page 16 The Limes Care Home DS0000008710.V355467.R01.S.doc Version 5.2 Page 17 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 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The lifestyle experiences of service users and the promotion of their rights could be much improved; the routines of daily living and activities need to be more flexible and varied to suit individual service users needs, preferences and capacities. EVIDENCE: The Statement of Purpose and Service User guide contains conflicting information about visiting restrictions, however the manager reported that the documentation is to be reviewed and visitors we spoke with said they were always made welcome and that staff always respected their privacy. The home will accommodate as much as possible of a service user’s personal possessions which they wish to bring with them into the home. The Limes Care Home DS0000008710.V355467.R01.S.doc Version 5.2 Page 18 Service users confirmed the home offers three meals, together with snacks and drinks each day, special diets are catered for, for example diabetic diet, that they have a choice and reported that they enjoyed the food. The lunchtime meal on the day was meat pie or cheese salad and staff were observed asking service users for their choice options. There is no activities co-ordinator currently and recruitment for the post had not been successful, but the manager stated she hopes to recruit a member of the care staff in this role, once further care staff, are recruited. The dining room is on the first floor and therefore, most service users need to be assisted in the lift back to the lounge on the ground floor after meals. One service user did not co-operate with the staff members approach at first, but was approached in a different way later and was happy to be assisted back to the lounge. Staff members spoken with were not sure what they should do in circumstances where service users wished to remain in the dining room and therefore this is an area, which the home needs to look at in respect of upholding service users choices and wishes and meeting their individual needs. Records of participation and refusal by service users of activities, needs to be kept. We saw a board game activity during our visit but the activities on offer seemed to be aimed at the more able service users, (for example dominoes, cards and bingo. The manager told us that she was in the process of ordering some new activity materials for example to provide a memory box and a cuddle box which would be suitable for people with Dementia. Introduction of visual cues, tactile surfaces and stimulating/activity objects should be explored for service users with Dementia, as this could enhance their quality of life. One service user said they felt that more in the line of stimulative occupation would be a good idea for those people not interested in bingo and cards etc and maybe a film club afternoon would be a good idea. Staff spoken with talked about sitting with service users and talking to them about their lives, wishes and feelings, but there was no other evidence available to support that this takes place. Service users and staff spoken with confirmed that service users are able to go to bed and get up at their preferred times. The Limes Care Home DS0000008710.V355467.R01.S.doc Version 5.2 Page 19 The Limes Care Home DS0000008710.V355467.R01.S.doc Version 5.2 Page 20 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. Service users know how to make a complaint and systems are in place to protect them from harm, however the home failed to notify CSCI [Commission for Social Care Inspection] about an incident, which is required by regulation. EVIDENCE: The Service User Guide has clear guidelines on how to make a complaint and the complaint procedure is displayed within the home. Service users and staff spoken with confirmed they knew how to make a complaint and added that they were confident they would be listened to. Examination of the complaints procedure confirmed that it details how the complaint will be dealt with and the expected response time. Two complaints had been recorded since the previous key inspection, one in respect of staff conduct and one about heating in a service users room. One was upheld and one not upheld. One other complaint was recorded confidentially about staff conduct, but this was not cross referenced in the complaints log. The Limes Care Home DS0000008710.V355467.R01.S.doc Version 5.2 Page 21 The home has obtained the new procedures and guidance on safegaurding adults. Staff training records and staff spoken with confirmed that staff have been trained in safeguarding issues, however not all staff spoken with knew about the whistleblowing policy. Through discussion with the manager it was established that there had been a safeguarding incident at the home recently, but although a referral had been made to the Adult Social Care and Health team, the manager had not notified the Commission for Social Care Inspection as required by Regulation 37. The outcome of the referral was that no further action is to be taken and the manager agreed to send the backdated notification to the Commission after the inspection. Staff also confirmed that they are trained to deal with challenging behaviours. It is recommended that the manager undertake training in referral and reporting of safeguarding issues. The Limes Care Home DS0000008710.V355467.R01.S.doc Version 5.2 Page 22 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): 19,24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a safe, clean and well-maintained environment and have access to safe and comfortable indoor and outdoor communal facilities. Service users live in safe, comfortable bedrooms with their own possessions around them. Further development of the environment is needed however, to meet the needs of people with Dementia. EVIDENCE: A partial inspection of the building showed it to be well maintained and decorated to a high quality throughout. Maintenance records show that routine maintenance is carried out. One service user asked the handyman to replace a light bulb in her bedroom, which was promptly done. The Limes Care Home DS0000008710.V355467.R01.S.doc Version 5.2 Page 23 As the home now provides a service to people with Dementia it is recommended that the lay out of the building be reviewed alongside staffing numbers and deployment of staff to ensure the service is tailored to meet the specific needs of service users. Care plans contain declarations about key holding and one service user confirmed that they had a key for their room and for their lockable facility. The Limes has two bedrooms which can be used by couples – they have the ability to be turned into bed sitting rooms, and can be used as either a bedroom and sitting room, or two interconnected bedrooms. Two service users were asked about the environment, and both said it was very comfortable, and they liked it very much. Outside much of the garden is laid to lawn, with sitting areas, and shade from trees. During the tour of the building no obvious health and safety risks were seen. The home was found to be clean and tidy, members of the domestic staff were observed and the cleaning trolley well stocked with a range of good quality cleaning materials. Staff were observed to follow good hygiene practice and a good supply of gloves and aprons were viewed in the home. A new door security system has been installed. The Limes Care Home DS0000008710.V355467.R01.S.doc Version 5.2 Page 24 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. Service users needs are met by staff, who are trained and supervised, however further review of staffing levels/deployment and extra diligence when recruiting new staff would ensure service users lifestyle and safety is not compromised. EVIDENCE: The staffing rota was examined and the manager stated that she had increased the numbers of staff to four on daytime duties and two staff are deployed at night, however although she reported that she had taken service users dependency levels into account, there was no written evidence to support this. The requirement made at the previous inspection is therefore only partly met. [See also comments re the deployment of staff in Standard 15 and 19.] Service users said staff were marvellous, hard working and do their best that felt that there were enough of them; service users spoken with also said their needs had never been unmet. The Limes Care Home DS0000008710.V355467.R01.S.doc Version 5.2 Page 25 The home undertakes satisfactory recruitment process and carry out various checks on possible employees, for example, CRB, [Criminal Records Bureau] checks and references, however it is recommended that extra diligence is applied on individuals employment history and the person providing employment references. Staff records showed staff, receive induction training and regular updates and staff spoken with confirmed that they have regular supervision/appraisal on a one to one basis. The care home has an appropriately qualified workforce with at least 50 of staff delivering personal care holding an NVQ level 2 or above. All staff working within the home complete mandatory annual training, applicable to their role within the company, for example, manual handling, health and safety, food hygiene, first aid and fire safety. Staff who administer medication have undertaken training in safe handling of medicines. Some staff have recently undertaken training in Dementia Care. A staff member said the training consisted of four units but the staff member was not able to inform the inspector of the course contents. The staff member stated that they thought the course had provided staff with better skills and that the approach of staff was now much improved. She added that the course had opened her eyes and that she now had a better understanding of what is important for people with Dementia and is more positive about things. Our overall findings were that the service promises to deliver care to service users in a way, which respects their personal dignity and right to privacy and that this is how care is now provided in practice. We found that there were satisfactory levels of staff interaction with the service users and the interactions, which were seen, were mostly of good quality to enhance the quality of life of the service users who were observed. . . The Limes Care Home DS0000008710.V355467.R01.S.doc Version 5.2 Page 26 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, 37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a home, which is managed by a person who is fit to be in charge and is run in their best interests and their health and safety is promoted and protected. EVIDENCE: The Registered manager has been employed at the home for a number of years and confirmed that she has completed the Registered Managers Award; she is a suitably qualified and experienced person to be running the Limes. The Limes Care Home DS0000008710.V355467.R01.S.doc Version 5.2 Page 27 The manager confirmed the home does have service user meetings, although the last minutes viewed were February 2006, it is strongly recommended that formal service user/relative meetings are held regularly. There is a quality assurance system in place at the Limes, and this takes the form of questionnaires for service users and for relatives, thereby getting two separate views, however there was no evidence of how the outcome of these were managed or fed back to service users or relatives. Service user’s finances are mostly managed by the residents themselves or by family members. Small amounts of money are held on service users behalf, and records were seen which showed a clear audit trail. A range of health & safety records were seen including fire records, lift servicing and water testing records. All of these were found to be complete and records were completed on time. The Environmental Health Officer visited the home in January and February 2007. Recommendations were made in respect of some food safety issues and a requirement issued in respect of no Legionella Controls in the home. The manager confirmed that a follow up visit was made and the home viewed as having necessary systems and protection now in place. The accident records were viewed. The ‘case tracking’ process highlighted that one service user had received an accidental skin tear injury, which care notes showed had been treated appropriately and had been referred to the District Nurse team for treatment, however there was no entry in respect of this in the accident records, which is not satisfactory practice. The Limes Care Home DS0000008710.V355467.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 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X 3 X 3 STAFFING Standard No Score 27 2 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 2 3 The Limes Care Home DS0000008710.V355467.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 Requirement The statement of purpose must be reviewed to make sure it reflects the service provided to the service users with Dementia which should be based on person centred care to make sure an appropriate service is provided which meets the service users needs. Care plans must be developed in consultation with service users so they are clear about how staff intend to help them. The care plans must provide clearer instructions to care staff on how the service is to be provided for each person with Dementia to make sure the care provided is in line with the philosophy of care at the service. Partly met. 3 OP7 OP8 12[1] 14,15 Ensure care plans are implemented for the management of pressures areas. To make sure an appropriate service is provided which meets The Limes Care Home DS0000008710.V355467.R01.S.doc Version 5.2 Page 30 Timescale for action 21/12/07 2. OP7 15 21/02/08 21/02/08 4 OP7 OP8 OP9 12[1], 14, 15 the service users healthcare needs. Review the systems in place for monitoring service users healthcare needs, to ensure an accurate and up to date record is held at all times, that care plans are developed to include support plans for all service users healthcare needs and the medicines relating to them. Staff must follow these plans to ensure that residents’ healthcare needs are met. and so that service users receive any treatment they need in respect of their healthcare needs. 21/02/08 5 OP9 13[2] 6. OP14 12(2 & 3) Ensure the systems in place for 21/02/08 the management of medication are safe and protect service users from harm The staff must ascertain the 28/02/08 wishes of service users and ensure that they uphold their choices unless the care plan and risk assessment indicate that this is not appropriate. Previous timescale of 30/10/07 7 OP18 37 8. OP27 18(1)(a) Ensure that any events, which affect the health and well being of service users, are appropriately notified to the Commission for Social Care Inspection under Regulation 37. You are required to carry out an assessment of service users’ needs and provide evidence as to how you calculate the appropriate staffing levels to meet the health, safety and welfare needs of the residents. 30/01/08 02/02/08 The Limes Care Home DS0000008710.V355467.R01.S.doc Version 5.2 Page 31 Previous timescale of 02/10/07 Partly met. 9 OP8 OP37 OP38 17 Accident records must be completed as required by regulation, to ensure appropriate monitoring and reporting of accidents/injuries to service users occurring in the home. 30/01/08 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 OP3 Good Practice Recommendations Provide confirmation in writing to the service user/representative that the home can meet the persons assessed needs. The Registered person should review the wording regarding mental state in the initial assessment Further update and development, particularly around service users diversity needs. Further development of the personal life history profiles and the assessment documentation would further embrace the individual as a whole person. The care plans for service users with Dementia should be based on delivering person centred care. Records of participation and refusal by service users, of activities need to be kept. Introduction of visual cues, tactile surfaces and stimulating/activity objects should be explored for service users with Dementia. 2 3 OP3 OP3 OP4 OP12 4 5 6 OP7 OP12 OP17 OP4 OP14 OP19 OP12 OP12 7 More imaginative ways of engaging service users, particularly those with Dementia in purposeful activity DS0000008710.V355467.R01.S.doc Version 5.2 Page 32 The Limes Care Home 8 9 10 OP16 OP18 OP19 OP27 11 12 OP29 OP33 need to be found to make sure they are not treated differently to other service users. The complaints records must include reference to all complaints [even if the confidential details are stored securely] The manager should undertake training in reporting and referring safeguarding incidents As the home now provides a service to people with Dementia it is recommended that the lay out of the building be reviewed alongside staffing numbers and deployment of staff to ensure the service is tailored to meet the specific needs of service users. Ensure extra diligence is applied on individual’s employment history and the person providing employment references. The Registered person should ensure that formal service user/relative meetings are arranged and held on a regular basis. A minimum of monthly meetings would be seen as good practice. The Limes Care Home DS0000008710.V355467.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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. 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