Inspection on 09/08/06 for The Limes Care Home

This inspection was carried out on 9th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Limes Care Home 17/12/07

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 Rob Cooper Key Unannounced Inspection 10:00 9th August 2006 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.V302669.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.V302669.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 Mr Ahmad Ally Toorabally Mrs Nazeera Toorabally Carol Ann Wilewski Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places The Limes Care Home DS0000008710.V302669.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 28th December 2005 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. Fees: range from £277 - £319 per week The Limes Care Home DS0000008710.V302669.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place through the middle of the day with one Inspector present, and lasted approximately four hours. The Registered manager was away on holiday, so the Responsible Individual/owner facilitated the inspection. The method of inspection used was to visually inspect parts of the premises, talk with four residents, and case track three residents. Case tracking involves looking at a range of care records, and making a judgement about the quality of care that residents are receiving. Unfortunately it was not possible to speak to any relatives as none were visiting The Limes during the time of the inspection. In addition to case tracking three members of staff were spoken with about care practice at the Limes and how resident’s needs are met. On the day of the inspection there were thirty-three residents in residence, with two more in hospital. What the service does well: What has improved since the last inspection? All of the requirements set at the last inspection and the majority of the recommendations have been met. Redecoration of some of the bedrooms has been carried out. The Limes Care Home DS0000008710.V302669.R01.S.doc Version 5.2 Page 6 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 Limes Care Home DS0000008710.V302669.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 DS0000008710.V302669.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1235&6 The quality outcome in this area is good. This judgement has been made using the available evidence including a visit to this service. Prospective residents at the Limes have the information they need to make an informed choice about where to live. Each resident has a written contract/ statement of terms and conditions with the Limes. No resident moves into the Limes without having had their needs assessed, and been assured that these will be met. Prospective residents and their relatives have an opportunity to visit and assess the quality of facilities and the suitability of the Limes. Intermediate care is not offered at the Limes. EVIDENCE: The Statement of purpose and Service User Guide for the Limes were both seen. A requirement had been set at the previous inspection to update the Statement of Purpose so that it meets the requirements of Care homes regulations, and this has now been done. Copies of the Service User Guide were seen in resident’s bedrooms, and two residents when asked said that they had a copy. In addition copies of the terms and conditions were also seen The Limes Care Home DS0000008710.V302669.R01.S.doc Version 5.2 Page 9 in resident’s bedrooms, and evidence was seen that every resident has a copy. Three resident’s files were seen as part of the case tracking process, and all three case files contained an assessment completed by a Social worker before the resident was admitted. Requirements set at the last inspection regarding internal assessments of needs were found to have been met. However a recommendation relating to the wording ‘mental state’ within the assessment tool remains, and this should be changed. Evidence was seen that showed residents and their families visited the Limes before they moved in, and staff said that often the families would come alone if the resident was particularly frail. Two residents were asked about visiting the Limes before they moved in, and both said they had visited. One said: “I came for tea.” While the other said they had visited with members of their family. The Limes does not offer Intermediate Care. The Limes Care Home DS0000008710.V302669.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 & 10 The quality outcome in this area is good. This judgement has been made using the available evidence including a visit to this service. Resident’s health, personal and social needs are recorded and met. Resident’s health care needs are fully met. Residents at the Limes are protected by the policies and procedures in place for dealing with medicines. Residents at the Limes feel they are treated with respect and their right to privacy is respected. Residents are assured that at the time of their death, staff at the Limes will treat them and their family with care, sensitivity and respect. EVIDENCE: Three resident’s files were seen as part of the case tracking process. Each of these files contained a clear plan of care with care plans laid out in a logical order covering health, personal and social care needs. All three files contained care plans relating to health care, and two residents were asked about health care at the Limes. One said that if they needed a doctor: “the staff would get one” for them, while the other said: “the staff are very good, if I’m not well they will look after me, and call the doctor if I need one.” Two recommendations were set at the last inspection relating to record keeping in The Limes Care Home DS0000008710.V302669.R01.S.doc Version 5.2 Page 11 respect of health care. Both of these recommendations were found to have been met. The Limes use a Nomad system for their medication from Lloyds Pharmacy. A Nomad system is a monitored dosage system for medication dispensed by the local chemist. Storage and administration of the medication was seen during the inspection, together with the Medication Administration Records (MAR sheets) all of these were found to be correct and complete. Two residents selfmedicate, and both of these residents had care plans and risk assessments to support their self-medication. Three residents were asked about medication, none of the three self-medicated, but all said they were quite happy with the arrangements, and one said: “It’s good that I don’t have to worry about it.” Staff members were observed interacting with residents throughout the inspection, and this was seen to be done in a respectful and polite manner. Some staff members were seen enjoying a joke with residents, but this was a fun experience for all concerned, and not done at the resident’s expense. Staff were seen to be knocking on bedroom doors before they entered and three residents were asked about how they felt they were treated by the staff. “They are marvellous, I couldn’t fault them.” “They do a fantastic job, very good.” And “They are very kind, and they speak to you in a very nice friendly way.” Were some of the comments made by residents. The Limes Care Home DS0000008710.V302669.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 & 15 The quality outcome in this area is excellent. This judgement has been made using the available evidence including a visit to this service. Residents find that the lifestyle experienced at the Limes matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Residents at the Limes maintain contact with family/ friends and representatives and the local community as they wish. Residents are helped to exercise choice and control over their lives. Residents receive a wholesome appealing balanced diet in pleasing surroundings at times that are convenient to them. EVIDENCE: Three residents were asked about activities at the Limes. One resident talked about bingo and ball games, and said that the activity co-ordinator had left, and that things had not been as good since then. However they heard that the activities person would be returning, and so were hopeful that activities would return to their previous level. Another resident talked about outings, and said they had been down to Trent Bridge in Nottingham and had afternoon tea. The third resident said that they were: “quite happy, and they thought there was plenty going on.” The Limes is well equipped with a number of lounges, and one lounge is equipped as a library/activity area. No relatives were seen The Limes Care Home DS0000008710.V302669.R01.S.doc Version 5.2 Page 13 visiting during the inspection, although two residents were asked about family visits, and both said they tended to get visitors at the weekends. The residents said that the staff always made their visitors welcome, and they either saw their family in their bedroom, or in one of the lounges. With one resident saying: “There is always a quiet spot somewhere.” Three residents were asked about choice. One resident said: “ There’s always a choice of lunch, but you can see the cook if you don’t like it, and they will get you something else.” One resident said that they spent a lot of time in their bedroom watching television, as they are not as “active as I used to be.” This particular resident likes sport and has a large screen television in their bedroom to watch, they said it was their choice, and “the staff were very good, popping in and out to check I’m OK.” All three residents said they thought there was plenty of choice at the Limes, and that the residents were regularly consulted. During the inspection the kitchen was visited and found to be clean and well organised. A range of records relating to food storage, and cooking were seen, and all found to be complete and correct. The main meal being prepared was Stew and vegetables, but there were a number of alternatives available. Three residents were asked about the food, and their comments ranged from: “lunch was very good, very nice.” “The food is excellent – plenty of choice, and big portions too.” “No complaints – the food is very good, very tasty.” The Limes Care Home DS0000008710.V302669.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The quality outcome in this area is good. This judgement has been made using the available evidence including a visit to this service. Residents and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon at the Limes. Residents at the Limes are potentially at risk of abuse due to lack of staff training. EVIDENCE: The complaints procedure was prominently displayed around the building and forms part of the Service User Guide, which every resident has a copy of. Two residents were asked about complaints, both said that they had never made a complaint, but both also said that if they needed to they would speak to the manager or Mr Toorabally the owner. The records of complaints were seen, and all found to be correct, and having been dealt with in line with the Limes’ complaints procedures. Staff training records show that not all members of staff have had training in safeguarding adults and the protection of vulnerable adults. Three members of staff were spoken with, and one said they had covered issues of abuse in other training (National Vocational Qualification level II) but had not had any specific training in issues of abuse. The other two members of staff said that they had not received any training related to these issues. It is important for staff to receive relevant training around abuse and safeguarding adults, so that they The Limes Care Home DS0000008710.V302669.R01.S.doc Version 5.2 Page 15 might recognise abusive behaviours, and know what procedures to follow in reporting them. The Limes Care Home DS0000008710.V302669.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 & 26 The quality outcome in this area is excellent. This judgement has been made using the available evidence including a visit to this service. Residents at the Limes live in a safe, well-maintained environment. Residents have access to safe and comfortable indoor and outdoor communal facilities. Residents at the Limes live in safe, comfortable bedrooms with their own possessions around them. Residents live in safe, comfortable surroundings. The Limes is clean, pleasant and hygienic. 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, and two residents talked about ‘the handyman.’ One resident said: “The handyman decorated my bedroom, while I was in hospital, and I’m very pleased with it.” Further discussion showed that the resident has chosen the colours, and that the redecoration had been planned and arranged to take place during the hospital admission, as the room The Limes Care Home DS0000008710.V302669.R01.S.doc Version 5.2 Page 17 would be empty for a week, and this would cause the least disruption. The Limes has a number of pleasant lounge areas, and residents are able to choose which lounge or lounges they spend time in. 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. One lounge has been turned into a library, with a selection of books and videos for the resident’s use. Two residents were asked about the building, 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 Limes was found to be clean and tidy, members of the domestic staff were spoken with about cleaning regimes and schedules, and cleaning rotas were seen. An inspection of the cleaning cupboard showed it to be well stocked with a range of good quality cleaning materials. The Limes Care Home DS0000008710.V302669.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 & 30 The quality outcome in this area is good. This judgement has been made using the available evidence including a visit to this service. The numbers and skill mix of staff at the Limes meets the residents’ needs. Residents are in safe hands at all times. Residents are supported and protected by the Limes’ recruitment policy and practices. Staff are trained and competent to do their job. EVIDENCE: The staff rota was seen, and this showed a good mix of staff and sufficient numbers on duty to meet the resident’s needs. Two residents when asked about the staff, said that they thought there were enough staff on duty, and that those staff were “very good at their job.” Clarification of this showed that they thought the staff had the skills to do the job, and do it well. Observations of the staff during the inspection supported this view. Staff training records show that there is an ongoing training programme, and that staff are being supported to gain their National Vocational Qualification (NVQ) level II. Discussions with three members of staff showed that two had completed their NVQ training, while the third was currently studying for the qualification. Two staff files were seen, and both contained application forms, two written references and Criminal Records Bureau checks (CRB’s). Three members of staff were asked about their recruitment and all three said that they had applied, and been formally interviewed. In addition they said that they did not The Limes Care Home DS0000008710.V302669.R01.S.doc Version 5.2 Page 19 start working at the Limes until their references had been returned, and the CRB’s had cleared. This shows that the Limes are taking staff recruitment seriously, and are taking steps to ensure residents are protected by recruitment policies and procedures. A review of staff training records showed that there was a staff training plan, and that staff are receiving mandatory training, and training relevant to the roles they are performing at the Limes. This was set as a recommendation at the last inspection. Discussions with three members of staff about their training needs and training provided by the Limes provided further evidence that the staff are being trained at the Limes. The Limes Care Home DS0000008710.V302669.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 36 & 38 The quality outcome in this area is good. This judgement has been made using the available evidence including a visit to this service. Residents at the Limes 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 her responsibilities fully. The Limes is run in the best interests of its residents. Resident’s financial interests are safeguarded. Staff at the Limes are appropriately supervised. The health, safety and welfare of residents and staff at the Limes are promoted and protected. EVIDENCE: On the day of the inspection the Registered manager was away on holiday, however discussions with the Limes Registered provider, and a review of the manager’s training records, showed that she is a suitably qualified and experienced person to be running the Limes. The Limes does have resident’s The Limes Care Home DS0000008710.V302669.R01.S.doc Version 5.2 Page 21 meetings, although two residents said they do not happen very regularly. A review of the minutes of residents meetings supported this view, and it is strongly recommended that formal resident’s meetings are held regularly. There is a quality assurance system in place at the Limes, and this takes the form of questionnaires for residents and for relatives, thereby getting two separate views. Resident’s finances at the Limes are mostly managed by the residents themselves or by family members. Small amounts of money are held on resident’s behalf, and records were seen which showed a clear audit trail. Two residents were asked about money, and both said that they could get their money whenever they wanted it. Records relating to staff supervision were seen, and three members of staff said, when asked that they have a formal supervision sessions approximately every 6-8 weeks. A range of health & safety records were seen including fire records, Control of Substances Hazardous to Health (COSHH), and water testing records. All of these were found to be complete and records were completed on time. The Limes Care Home DS0000008710.V302669.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 4 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 4 3 X X X X X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 4 3 X 3 The Limes Care Home DS0000008710.V302669.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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 OP18 Regulation Requirement Timescale for action 31/03/07 Regulation The Registered person must 18 ensure that all members of staff receive training in abuse, safeguarding adults and the protection of vulnerable adults. 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. 2. Refer to Standard OP3 OP33 Good Practice Recommendations The Registered person should review the wording regarding mental state in the initial assessment The Registered person should ensure that formal resident’s meetings are arranged and held on a regular basis. A minimum of monthly would be seen as good practice. The Limes Care Home DS0000008710.V302669.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Limes Care Home DS0000008710.V302669.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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