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Inspection on 10/07/07 for The Limes Nursing Home

Also see our care home review for The Limes Nursing Home for more information

This inspection was carried out on 10th July 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

A GP visits the home every Friday to assess residents` health needs. Family and friends are encouraged to visit regularly. Residents are able to attend religious services either in the community or a minister of their chosen denomination can visit them in the home if preferred.

What has improved since the last inspection?

A system has been put into place for obtaining Criminal Record Bureau checks for staff.

What the care home could do better:

Staff`s interactions with residents were task orientated and with assistance being given with no conversation. There should be a staff training matrix to identify what training each member of staff has received and when refresher mandatory training is due.Recruitment and selection processes must be more robust to ensure the safeguarding of residents. Medication procedures need to be more robust. All staff should receive adult safeguarding awareness training. The manager should be involved in the admission of prospective residents. This should be prior to admission to make sure that the staff have the ability and skills required to meet needs. A record of complaints should be kept.

CARE HOMES FOR OLDER PEOPLE The Limes Nursing Home 816 Wilmslow Road Didsbury Manchester M20 2RN Lead Inspector Sue Jennings Unannounced Inspection 10th July 2007 10:00 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 Nursing Home DS0000021648.V345359.R02.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 Nursing Home DS0000021648.V345359.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Limes Nursing Home Address 816 Wilmslow Road Didsbury Manchester M20 2RN 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) 0161 446 2141 0161 445 9524 Britannia Care Homes Limited Mrs Ntswaki Elizabeth Moiloa Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (41), Physical disability (1) of places The Limes Nursing Home DS0000021648.V345359.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The maximum number of service users requiring nursing care shall be 41. The maximum number of service users requiring personal care only shall be 1. Minimum nursing staffing levels as set out in the Notice issued under Section 13(5) of the Care Standards Act on 15 May 2002 must be maintained. One named service user currently accommodated to receive nursing care is under pensionable age. Should this service user no longer require the accommodation offered by The Limes the service user category will revert to OP (old age). 26th March 2007 Date of last inspection Brief Description of the Service: The Limes Nursing Home is a care home providing nursing care for a maximum of 42 older people. The Limes Nursing Home is formed around an adapted and refurbished Victorian house with a modern extension set in its own grounds. Accommodation is on 4 floors all of which have lift access and are wheelchair accessible. Facilities within the home are located in two separate wings, each with a communal lounge and dining area. The kitchen and administration office is located on the lower ground floor, next to one of the dining rooms. There is a central office and separate staff room located at the main entrance to the home, which is central to the two wings. There are two treatment rooms, located in each of the two wings. In one wing there is a large lounge on the ground floor, which gives access to an enclosed conservatory providing a bright, airy view of the grounds of the home. There is a dining room on the lower ground floor. The second lounge has a French window that gives direct access to the garden and has a small dining area. There is a small kitchen next to the lounge where visitors and staff are able to make light refreshments. There are 20 single bedrooms, and 11 double rooms with en suite facilities. The gardens are laid to lawn, and well maintained with sufficient car parking available for visitors and staff. The home is located within a short walking distance of Didsbury village and all its amenities. There are two local parks The Limes Nursing Home DS0000021648.V345359.R02.S.doc Version 5.2 Page 5 within short walking distance from the home. Bus stops to Manchester and surrounding areas are within 100 yards of the home. The home’s fees for residents vary from £365 to £610 weekly. Charges for hairdressing, newspapers and chiropody are extra, but are invoiced following supply. The Limes Nursing Home DS0000021648.V345359.R02.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This visit was undertaken as part of a key inspection, which includes an analysis of any information received by the Commission for Social Care Inspection, in relation to this home, prior to the site visit. Two inspectors, Sue Jennings and Geraldine Blow, visited the home in response to a number of concerns that had been raised by the funded nursing care team regarding care practices in the home. Service user and relatives survey forms were taken and distributed by the inspectors on the day of the site visit. The visit was unannounced and took place over the course of 6.5 hours on Monday 10th July 2007. During the course of the site visit, time was spent talking to the manager, the responsible individual, 4 residents, 3 visitors and 4 members of staff to find out their views of the home. The two inspectors spent time examining care plans, records and the staff files. A tour of the building was also made. What the service does well: What has improved since the last inspection? What they could do better: Staff’s interactions with residents were task orientated and with assistance being given with no conversation. There should be a staff training matrix to identify what training each member of staff has received and when refresher mandatory training is due. The Limes Nursing Home DS0000021648.V345359.R02.S.doc Version 5.2 Page 7 Recruitment and selection processes must be more robust to ensure the safeguarding of residents. Medication procedures need to be more robust. All staff should receive adult safeguarding awareness training. The manager should be involved in the admission of prospective residents. This should be prior to admission to make sure that the staff have the ability and skills required to meet needs. A record of complaints should be kept. 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 Nursing Home DS0000021648.V345359.R02.S.doc Version 5.2 Page 8 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 Nursing Home DS0000021648.V345359.R02.S.doc Version 5.2 Page 9 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 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home does not have appropriate systems in place to make sure that people’s needs are always assessed before admission. The written information provided to perspective residents needs to be improved. EVIDENCE: The owner said that the statement of purpose and function and the service user guide had been updated since the last inspection. This version was not available at the time of the site visit. However the owner did say that he provided information about the home verbally. The statement of purpose made available at the time of the site visit did not detail what services the home offers, criteria for admission, details about the organisational structure or staffing arrangements. The Limes Nursing Home DS0000021648.V345359.R02.S.doc Version 5.2 Page 10 When discussed with the owner of the home, he said that a pre-admission assessment was usually undertaken, but there was no paperwork to support this. The manager stated that, on occasions, people have been admitted to the home without her involvement and that some of the placements had been inappropriate. The manager should be involved in the admission of prospective residents. This should be prior to admission to make sure that the staff have the appropriate skills required to meet residents’ assessed needs. A sample of care plans was examined and it was noted some residents had a care manager’s assessment of needs. However others only contained admission assessments that were being carried out on the day of admission. This indicated that the person had already been accommodated at the home and that there had been no assessment before admission of any specialist needs they may have. Admissions should not be made unless a full needs assessment has been undertaken. The Limes Nursing Home DS0000021648.V345359.R02.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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care plans were basic and did not reflect the care being provided to meet people’s needs. Medication and infection control practices needed to be improved to reduce potential risks to residents. EVIDENCE: There were concerns that appropriate infection control measures were not in place to protect residents, as protective clothing was not readily available. Wall mounted paper towel holders and latex glove and plastic apron dispensers were found to be empty in toilets, bathrooms and corridors, apart from one situated on the ground floor. The owner requested that these were filled during the inspection visit. Plastic washbowls were provided in bedrooms for residents’ use and it was of concern that these were not individually identified in shared rooms. The Limes Nursing Home DS0000021648.V345359.R02.S.doc Version 5.2 Page 12 A sample of care plans was examined. The majority of these did not contain a pre-admission assessment completed before admission, were not signed or dated and did not contain an identifying photograph of the resident. Some care plans identified the need for bed rails but there were no risk assessments for the use of bed rails. Some care plans were contradictory giving different instructions to staff regarding residents’ needs. In different sections of one care plan it was identified that the resident transfers independently, transfers with one person and transfers alone. Consistency of care for the residents is compromised where staff are given conflicting advice in care plans. Some care needs had not been fully assessed. For example one dependency assessment stated, “requires help” with dressing, the care manager’s assessment stated “needs prompt/supervision with dressing” and “needs help with parts of dressing”. A care plan had not been developed to address this care need. To make sure the appropriate care is delivered to residents, information provided in care plans must be consistent. On one care plan there was a ‘pre-admission’ assessment, dated the day of admission to the home. When discussed with the owner it was reported that a pre-admission assessment was undertaken, however there was no paperwork to support this. Examination of one resident’s care plan, who had been admitted from hospital with a pressure area wound, found that no information had been provided from the hospital informing staff what dressings were to be used. There were no records describing the wound on admission, in particular the size, so that comparisons could be made with regard to the healing process. Residents were registered with a General Practitioner and it was reported that a GP visited the home every Friday. The drug trolley was kept in the treatment room, which was locked when not in use. There were two fridges to store medication that required cold storage. The dial on one fridge indicated that the temperature was not in the safe zone and the last temperature check was done in Feb 07. There should be a daily record of fridge temperatures and this fridge must be repaired or replaced. One Medication Administration Record (MAR) stated “none supplied this month” but all medication listed had been signed as being given. On examination of the drug trolley there were blister packs of this particular The Limes Nursing Home DS0000021648.V345359.R02.S.doc Version 5.2 Page 13 medication provided, raising concerns that medication was not appropriately checked into the home. This has the potential to place residents at risk. Where information on MAR sheets provided by pharmacists is incorrect, this must be brought to the attention of the supplying pharmacy, as it is the responsibility of staff at the home to maintain an accurate record of all medicines received, administered or disposed of. Pain relief medication brought in from home for one resident had been hand written on the MAR but the quantity of tablets not signed for. Therefore it was not possible to follow an accurate audit trail. In addition, the MAR for one resident was signed as 42 tablets being received by the home although the manager said that none had actually been received. Failing to keep an accurate audit trail has the potential to place residents at risk. On examination of the drug trolley, a box of 84 tablets was seen, which had not been signed into the home. The pharmacist’s label stated “as directed by prescriber” and the MAR stated the same so there was no prescribed dosage of medication. It was of particular concern when the manager said that the nurses were giving 5 mg, even though the dose was not prescribed because “they knew that was what the dosage was”. There was no formal auditing system of the medication administration in the home to ensure that residents receive medication as prescribed by the GP. This practice has the potential to place residents at risk. Eye drops for one resident did not have a date of opening even though they had a limited life span. This posed a risk that out of date medication was being given to the resident. It was also noted that medication was being dispensed into a lid from an empty container. It is strongly recommended that medicine pots be purchased and used. During a tour of the building it was noted that footrests had been removed from wheelchairs. These were seen stored in a pile in a corner of the hallway. There was no way for staff to identify, which, footrest went with which wheelchair. This practice indicated that residents were being transferred by wheelchair without footrests being used posing a risk of injury to residents. Residents’ care plans were also seen to be on view and accessible in an office close to the main entry door which compromised confidentiality. It was also of The Limes Nursing Home DS0000021648.V345359.R02.S.doc Version 5.2 Page 14 concern that personal healthcare information relating to residents was displayed on notice boards in a lounge and the hallway and left on tables in the conservatory. This is poor practice and shows a lack of respect for the resident’s privacy and dignity. It was also concerning to note that a diary with medical information relating to residents was left next to the visitors signing in book by the entry door. In addition, stuck to some residents’ wardrobe doors, was a notice informing staff of which continence aids to use. It is acknowledged that the owner removed these at the time but this practice does not respect the privacy and dignity of residents. The Limes Nursing Home DS0000021648.V345359.R02.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 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provided a varied diet but residents were not fully supported to exercise choice and control. EVIDENCE: The lunch served on the day of the site visit was mince or a vegetarian pasty, mashed potatoes, fresh cauliflower and carrots. The sweet was melon and ice cream. Observations showed that residents were not asked what they would like to eat i.e. did they want carrots, cauliflower and mashed potatoes – the meal was just plated and given to them. When the carer serving lunch was asked if residents were given a choice at meal times she said that residents were not asked what they wanted for their meals because all the staff knew what they liked and disliked. The Limes Nursing Home DS0000021648.V345359.R02.S.doc Version 5.2 Page 16 It was strongly recommended that residents be asked what they would like to eat when they were seated at the table. Choices of what food goes onto the plate should be made available at each mealtime. Staff were observed assisting residents who required help eating. In one instance a carer was observed using the poor practice of standing over the resident feeding them. There was no conversation with residents and the process was task based. Biscuits were given with afternoon tea but residents were not asked if they wanted a biscuit, which biscuit they would like or how many they would like. Residents were just given one biscuit. A member of staff was observed bringing a resident a cup of tea and placing it on the table without speaking to them. Residents spoken to said that the staff were very nice but it was “sometimes difficult to understand what they were saying”. There was no consultation with residents regarding activities or their social interests and an activity programme was not available. A physiotherapist visited the home on the day of the site visit. It was reported that they visited on a regular basis to provide staff training, to advise on moving and handling techniques and provide some activities for residents. Visitors were seen to come and go throughout the course of the site visit and many of the bedrooms had a personal phone so that residents could maintain contact with family and friends. A number of visitors were spoken to and confirmed that there are no restrictions on visiting. However, they are asked to avoid mealtimes where possible. One visitor made comments about the lack of activities in the home but said that the staff were very caring. Another visitor leaving the building was overheard saying ‘there is a notice that says the next session of arts and crafts is ………., but there is nothing in it’. Another visitor said that there had been some visits from the local schools and churches. Residents are able to attend religious services either in the community or a minister of their chosen denomination can visit them in the home if preferred. The Limes Nursing Home DS0000021648.V345359.R02.S.doc Version 5.2 Page 17 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. Residents were aware of the complaints procedure. Some staffs’ understanding of adult protection procedures needed to be improved to ensure that residents were not placed at risk. EVIDENCE: Residents told us that they had no complaints but if they were concerned about anything they would talk to the manager. The owner of the home said that he had received Protection of Vulnerable Adults (POVA) training and was aware of the ‘No Secrets’ documents and policies but he was unable to accurately describe the action to be taken in the event of an allegation of abuse being made. He also indicated that he would start an investigation – depending on who had made the allegation. All allegations must be reported using the local adult safeguarding procedures regardless of who makes the allegation. The nurse in charge said that she had not received training in POVA and was unable to describe the action to be taken in the event of an allegation of abuse, stating that they would start to investigate the allegation. The Limes Nursing Home DS0000021648.V345359.R02.S.doc Version 5.2 Page 18 This lack of knowledge has the potential to put residents at risk. The recommendation made in previous report relating to staff training is made as a requirement in this report. There should be a system of logging complaints and this should include the detail of the complaint, any investigations and the outcomes. To complete the audit trail, the log should include any correspondence with the complainant. The Limes Nursing Home DS0000021648.V345359.R02.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The premises are generally safe and the home’s environment was adequately maintained both internally and externally. EVIDENCE: Generally the home was clean although some of the furniture was showing signs of general wear and tear. Some bedrooms had been personalised with items brought in from home. It was noted that wedges were used to hold a number of bedroom doors open. The owner stated that these were used for cleaning purposes. The Limes Nursing Home DS0000021648.V345359.R02.S.doc Version 5.2 Page 20 Where residents wish to have their doors held open advice must be sought from the local fire officer with regard to appropriate automatic door closure systems. The Limes Nursing Home DS0000021648.V345359.R02.S.doc Version 5.2 Page 21 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. Generally, sufficient staff were rostered on duty to meet the needs of residents. However, improvements were needed in the recruitment and training of staff. EVIDENCE: In general sufficient staff were deployed to meet the needs of residents. On the day of the inspection, a registered nurse had phoned in sick. Staff spoken to expressed concerns that failing to cover shifts places additional pressure on the remaining nurses who are solely responsible for administering medication and changing dressings. A sample of staff files was examined including the files of two new members of staff who had commenced employment that day. Both people had been recruited from India via a recruitment agency There was no evidence of an interview although the owner said that he had undertaken a telephone interview for both people. The Limes Nursing Home DS0000021648.V345359.R02.S.doc Version 5.2 Page 22 It was recommended in the last report that documentary evidence should be kept of telephone interviews. This had not been implemented. There was no evidence to show that expiry dates of PIN numbers of nurses were being checked. Up to date copies of this check should be held on file. It is recommended that the Nursing and Midwifery Council website be checked for suspension or exclusions from the register of any nurse employed to work at the home. Evidence was seen that Criminal Record Bureau (CRB) checks were now being taken up for each member of staff. However, the staff files of the two new staff that had actually started work that day did not contain CRB or POVA first checks. When this was brought to the attention of the owner he rang the recruitment agency who said that they had e-mailed the POVA first to him. It was reported that the owner was having problems with e-mail and had now requested a fax. The lack of thorough recruitment procedures has the potential to put residents at risk. A sample of staff files was examined and there was no evidence of staff training or any reference to their training and career development needs. There should be an up to date training record that identifies that staff have received appropriate training and are informed about the different health conditions that effect older people to promote the well-being of residents. The Limes Nursing Home DS0000021648.V345359.R02.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home does not have a quality assurance system that fully involves people in the process of reviewing and developing the service. EVIDENCE: The registered manager was responsible for the clinical management of the home. All accidents are recorded however completed reports were retained in the book. Completed accident reports should be filed within the residents’/staff individual files in accordance with data protection. The Limes Nursing Home DS0000021648.V345359.R02.S.doc Version 5.2 Page 24 Fixed Gas and Electrical appliances had been maintained at regular intervals. Fire drills are carried out as required and a record kept. The home’s certificate of registration and the certificate of public liability insurance were publicly displayed. Residents’ relatives assisted with managing financial affairs. The administrator managed a small budget for day-to-day items. There was no formal supervision system in place, although the manager stated that staff received on the job supervision. There was evidence on the notice board of thank you letters and cards from relatives. However, there were no formal systems in place to gain the residents’ views on how the home could improve. An effective Quality Assurance monitoring system should be developed and used. The Limes Nursing Home DS0000021648.V345359.R02.S.doc Version 5.2 Page 25 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 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 X 3 The Limes Nursing Home DS0000021648.V345359.R02.S.doc Version 5.2 Page 26 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 OP3 Regulation 14 (1) (a) Requirement Prospective residents must not be admitted without a full assessment of need. A care plan for each resident must identify how the residents’ needs in respect of health and welfare are to be met. This must include any specialised care relating to infection control. Where bedrails are provided a risk assessment must be carried out to show that measures have been put in place to prevent residents being placed at risk of harm. There must be a method of auditing the medication administration systems in the home to ensure that residents receive medication as prescribed by the GP. The method of measuring the temperature in the refrigerator used to store medication must be reviewed. Timescale for action 13/08/07 2. OP7 15 (1) 09/08/07 3. OP7 13 (4)(c) 31/07/07 4. OP9 13 (2) 24/08/07 5. OP9 13 (2) 13/08/07 The Limes Nursing Home DS0000021648.V345359.R02.S.doc Version 5.2 Page 27 6. OP18 13 (6) 7. OP26 13 (3)(4) There must be a system in place 13/08/07 to ensure that residents are protected from harm or the risk of harm or abuse and arrangements must be made for staff to receive training relating to the Protection of Vulnerable Adults. There must be suitable 01/08/07 arrangements in place to prevent infection and to reduce the risk of cross infection. To ensure residents are not placed at risk new staff must have at least a POVA first check before they start work. This requirement is outstanding from the previous report and is reiterated. 20/10/07 8. OP29 19 (4)(c) Schedule 2 (7) (b) 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 OP1 Good Practice Recommendations It is strongly recommended that the Statement of Purpose and Function and the Service User Guide be dated to identify that they were being reviewed. Medication should not be dispensed into the lids from other bottles of medication. It is strongly recommended that medicine pots be obtained from the pharmacist. The temperature of the refrigerator used to store medication should be recorded on a daily basis. It is strongly recommended that the Medication Administration Records cross reference to where there is an accurate record of thickened fluids given. DS0000021648.V345359.R02.S.doc Version 5.2 Page 28 2. OP9 3. 4. OP9 OP9 The Limes Nursing Home 5. OP10 There should be arrangements in place to ensure that resident’s privacy and dignity is respected. Information should be stored confidentially. There should be evidence of consultation with residents regarding activities or their social interests. It is strongly recommended that residents are asked what they would like to eat and choices be available at each mealtime. Where residents need assistance with eating meals carers should not stand over the resident but should offer assistance discreetly and sensitively. There should be a record of all complaints made by residents or their representatives and the action taken by the owner in respect of any complaint, kept independently of residents’ files. It is strongly recommended that the expiry date of PIN numbers of nurses be checked and up to date copies of this check held on file. It is also recommended that the Nursing and Midwifery Council website be checked for suspension or exclusions from the register of any nurse employed to work at the home. A staff training and development plan should be developed that is kept up to date and reviewed on a regular basis in order to be able to evidence the staff have the skills to meet residents’ needs. The home should develop a quality assurance system and monitoring tool to seek the views of residents and visitors. A staff supervision system needs to be developed and implemented, to ensure staff receive regular 1:1, documented supervision and periodic performance appraisals. It is strongly recommended that completed accident reports be stored in line with the requirements of the DATA Protection Act 1998. 6. 7. OP12 OP14 8. OP15 9. OP16 10. OP29 11. OP30 12. 13. OP33 OP36 14. OP38 The Limes Nursing Home DS0000021648.V345359.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 Nursing Home DS0000021648.V345359.R02.S.doc Version 5.2 Page 30 - 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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