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Inspection on 18/04/06 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 18th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Residents` and visitors were very happy with the care given at the home. The home was seen to meet the needs of residents`. Residents stated that staff were good and respected their individual privacy and dignity and felt that they were treated as individuals The home is an appropriate building to deliver the care that residents need and it is kept maintained, clean, and tidy and found to be free of bad smells. The Pines Intermediate care unit gave an appropriate standard of care with the homes own and PCT staff combining well to the overall benefit of residents. The building is well maintained with good wheelchair access and a good range of aids and adaptations appropriate for residents with a range of disabilities. For a lot of the staff in the home English is not their first language, and to help how they are able to talk with residents classes in English as a second language are held at the home.

What has improved since the last inspection?

A lot of new carpets had been fitted since the last inspection which included both main lounges, and a good number of bed rooms. A number of bedrooms have also been redecorated.

What the care home could do better:

All residents identified needs must have care plans written so that all staff are aware the resident has a need that they must meet. All residents must have a lockable storage space in their room so they are able to store items securely. Ensure that residents and potential residents are made aware that the bedroom doors cannot be locked, as there are no locks fitted to the doors. This affects the residents` ability to maintain their own privacy dignity and independence as well as their own security if they want to. In all cases a Criminal Records Bureau check must be carried out for all staff. This is necessary so as to ensure that the staff working with vulnerable people are safe to do so.

CARE HOMES FOR OLDER PEOPLE The Limes Nursing Home 816 Wilmslow Road Didsbury Manchester M20 2RN Lead Inspector Leslie Hardy Key Unannounced Inspection 18th April 2006 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 Nursing Home DS0000021648.V292934.R01.S.doc Version 5.1 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.V292934.R01.S.doc Version 5.1 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.V292934.R01.S.doc Version 5.1 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). 5th January 2006 Date of last inspection Brief Description of the Service: The Limes Nursing Home is a care home providing nursing care for 41 older people and personal care for 1 older person. The Limes Nursing Home is formed around an adapted and refurbished Victorian house with a modern extension set in its own grounds. The home has two distinct areas. The one based in the original house is known as The Limes unit, and a newer unit in the recent extension is called The Pines unit. The Limes unit has 25 beds and is used for residents admitted for continuing care. Accommodation is on 4 floors all, which have lift access and are wheelchair accessible. There are ? single rooms and ?double rooms, none of which have on suite facilities. The Limes has a large lounge on the ground floor, which gives access to an enclosed conservatory that runs along the side of The Limes unit providing a bright, airy view of the grounds of the home. There is a dining room on the lower ground floor. The Pines unit has 16 beds and is used to provide accommodation for residents admitted for short-term care referred to as intermediate care. The cost of these beds is directly meet by South Manchester Primary Care Trust who use them to either give further rehabilitate to people discharged from hospital, or for people from the community who need a period of rehabilitation before they return to there. These beds are provided on the two floors of the Pines unit. There are ? single bed rooms and ?double rooms, of which ? are on suite. The Pines has a lift and all rooms are wheelchair accessible. The Pines has a lounge and dining room on the ground floor. The lounge has a French window The Limes Nursing Home DS0000021648.V292934.R01.S.doc Version 5.1 Page 5 that gives direct access to the garden. The gardens are laid to lawn, 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 within short walking distance from the home. Bus stops to Manchester and surrounding areas are within 100 yards of the home. There are two passenger lifts, one in each unit. The homes fees for residents vary from £475 to £525 weekly. Charges for hairdressing, newspapers and chiropody are extra, but are invoiced following supply. The Limes Nursing Home DS0000021648.V292934.R01.S.doc Version 5.1 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The report brings together information on the home gathered since the last inspection in January 2006. This inspection was unannounced and took place at the home on Tuesday 18 April 2006. This inspection started at 7 30 am and lasted for 7 hours. During the inspection, 14 residents, 3 visitors and 10 staff were spoken with. A tour of the building was also carried out. At the inspection a number of questionnaires together with reply paid envelopes for return directly to the inspector were given to service users. None of these questionnaires were returned at the time of writing this report. What the service does well: What has improved since the last inspection? A lot of new carpets had been fitted since the last inspection which included both main lounges, and a good number of bed rooms. A number of bedrooms have also been redecorated. The Limes Nursing Home DS0000021648.V292934.R01.S.doc Version 5.1 Page 7 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 Nursing Home DS0000021648.V292934.R01.S.doc Version 5.1 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.V292934.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home was able to meet the assessed needs of residents, all of which had been adequately assessed prior to admission to ensure this. Residents on the Pines for intermediate care received a level of care and professional input that was focused on the aim of them returning home. EVIDENCE: All residents had appropriate assessments undertaken prior to admission. Those in the Limes had been undertaken by the referring agency, the funded nursing care team at the local Primary Care Trust (PCT) team and a senior nurse at the home. These full assessments meant that residents were only admitted if the home could meet their needs. Resident’s and visitors confirmed that they felt that needs were being met by the home. The referring NHS professionals had undertaken the assessments for residents in The Pines unit. This ensured that the resident needs could be appropriately The Limes Nursing Home DS0000021648.V292934.R01.S.doc Version 5.1 Page 10 met in the Pines unit and was confirmed by residents who felt that needs were being met by the home and also by all staff working in that unit. The Pines unit functioned as a separate unit with its own separately allocated staff. Medical input, including General Practitioner and Consultant in Elderly Medicine and also Physiotherapy and Occupational Therapy input was supplied directly by the PCT. Working relationships were confirmed to be good by PCT supplied staff which meant that the residents received care from a unified team whose main purpose was to get the resident back into the community. Care in the Pines unit was very much rehabilitation driven, which was what the residents said they wanted as they wanted to return home. Residents said they were happy to accept limits that this put on personal choice occasionally such as having to get up early to be ready for OT and physiotherapist treatments and care. The Limes Nursing Home DS0000021648.V292934.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The lack of full care plans for all residents meant that not all residents care needs were being addressed. The use of good risk assessments ensured that risks were appropriately addressed, and good regimes for the management of medication reduced the risk to residents of errors. Resident’s dignity and privacy were respected by staff. EVIDENCE: Care plans in use were normally core care plans that were personalised to a residents needs. Each of the core care plans carried a number. Care plans are written using the information from the carried out which identified how resident’s needs are to be met. Not all residents had a care plan identifying the care needs and because of this the resident’s care could suffer. Care plans in place included data from such as risk assessments, which helped to identify risks to residents. Staff recorded in writing the care they gave each day and this showed how each resident was and how their need for care changed. They also identified concerns staff had about residents and any need to refer the resident to other The Limes Nursing Home DS0000021648.V292934.R01.S.doc Version 5.1 Page 12 professionals. In a number of records the care being provided to the resident was recorded against a plan not in the patients record. This suggested that the resident had needs that had not been assessed and identified to ensure that the resident’s care needs can be appropriately met. The manager must take steps to ensure that all identified needs have plans so that all residents’ needs are met. Residents had appropriate risk assessments and like the care plans these were reviewed monthly to ensure that they still met the residents needs. Risk assessments for bed rails involved discussion with the resident or relative so that they all agreed the appropriateness of these for the resident. Appropriate procedures were in place for the handling of medication with good written records kept. Residents were treated as individuals by staff that were seen to be aware of their needs. Residents confirmed that staff knocked on their bedroom doors before coming in. A number of residents also confirmed that they were aware that they could not lock their bedroom doors as no pocks were fitted and stated that they would not lock them even if they could as they felt safer with the door unlocked and open so they could see staff and other residents as they passed. Residents were dressed in their own cloths that were appropriately laundered on the premises. Residents could expect to receive personal care or treatment in their own room, and where residents shared rooms, screens were available to ensure privacy. The Limes Nursing Home DS0000021648.V292934.R01.S.doc Version 5.1 Page 13 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, and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents are able to say how they wish to spend their day, though there are not that many arranged activities in the home. Staff interacted appropriately with residents and offered support and assistance at mealtimes. Meals were of an appropriate standard with both choice and dietary requirements being met. EVIDENCE: Residents were seen to be able to exercise choice over were they spent their day and what they did, although on the Pines unit residents were happy to accept restrictions on choice, such as the need to get up earlier than they would wish to undertake rehabilitation so they could return to the community. Formal organised activities in the Limes were undertaken by a physiotherapist twice a week so at other times there was little organised activity so residents spent time in their rooms or in the lounge talking or watching TV. Staff did engage in conversations and some one to one and group activities with residents such as cards and board games took place. Religious services were held on a regular basis and some residents did go out to worship. Residents also went out with relatives and friends. The Limes Nursing Home DS0000021648.V292934.R01.S.doc Version 5.1 Page 14 Residents were able to bring in personal possessions, larger items of furniture were seen in rooms in the Limes, but all residents had pictures and photographs in there rooms. Details of an advocacy service were available in the home and some residents were visited by advocates who helped residents express their views and any concerns to staff . The home operates an open visiting policy and visitors spoke positively about the home and how “they could visit when they wished”. Visitors were also positive about staff and the “care the person they were visiting was receiving”. Residents stated that the food was of a good quality. Hot meals were served hot and choice was available. The chef reported that dietary needs of residents’ are catered for. This included diabetic diets and vegetarian diets etc. The chef said that he used the same basic menu each week, which would provide a very repetitive diet, although he said he did make some changes. The main choices of meals served on the day of the inspection differed from that on the menu. These meals were of satisfactory quality, hot, and attractively served. The chef was seen in discussion with residents about food choices and care staff were seen to be unobtrusively encouraging and assisting residents with meals. The Limes Nursing Home DS0000021648.V292934.R01.S.doc Version 5.1 Page 15 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 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home has good internal mechanisms in place for investigating complaints. Staff’s knowledge of adult abuse and its reporting needs updating to ensure they have a clear grasp of this important subject and residents are not put at risk. EVIDENCE: The home keeps a record of complaints made directly to them that record the investigation, action taken and the response. The records showed that since the last inspection in January 2006 one complaint had been received by the home by a friend of a resident, investigated and an appropriate response sent. Residents were aware of how to complain but said they would talk first to the manager or the proprietor. The home had an Adult Abuse Procedure and Manchester City Councils Local procedure was available. Staff, with some prompting, showed that they were aware of what constituted adult abuse and some idea about what they should do if they thought it had occurred in the home. As staff where not obviously clear what to do the recommendation in the last report that the manager should undergo refresher training and update staff is made a requirement in this report. The Limes Nursing Home DS0000021648.V292934.R01.S.doc Version 5.1 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, 24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home was well maintained and odour free, and provides a good environment for residents, but the lack of a lockable space in some rooms and the lack of locks on bedroom doors could affect resident’s need for privacy, dignity and security. Infection control systems in place should protect residents. EVIDENCE: The home is well maintained and found to be clean and free of offensive odours. The whole building is wheelchair accessible. The grounds are well kept and residents are able to go outside and make use of the provided garden furniture in good weather. The Limes also has a conservatory area. The home recently had a workplace inspection by the local fire service and reported that the small amount of work required to be undertaken as a result of that visit had been completed. The Limes Nursing Home DS0000021648.V292934.R01.S.doc Version 5.1 Page 17 Not all residents had lockable storage space and this had been the subject of a requirement in previous reports. The proprietor stated that he was ordering new bedroom chests which would have a lockable space which would ensure that all residents had a lockable space to store valuables and other items. This has been a requirement in a number of previous reports and the provider must ensure that his proposed action occurs and emables this requirement to be met in the required timescale. Bedrooms did not have lockable doors .Bedroom doors should have locks fitted for privacy, dignity and security reasons. The proprietor believes that residents do not want this, and a number of residents spoken to during the inspection said that they would not lock the doors at night even if locks were fitted. But residents should be given the choice and not fitting locks takes this choice away. Resident’s who do not want to lock the room when they are in it, may want to lock it when they are not. The home must clearly spell out in the Service User guide that locks are not fitted and the potential disadvantages of this. Bedpans and urinals in the home are cleaned and disinfected by hand but the regime in place has not caused any infection control problems. Clinical waste and dirty linen was disposed of appropriately. Hand towels and soap were available throughout the home during the inspection and staff were aware of where supplies were kept so they could refill containers if they were found to be empty. This means that the correct supplies are always available to staff so that residents are not put st risk from infection spread by unwashed and dried hands. The Limes Nursing Home DS0000021648.V292934.R01.S.doc Version 5.1 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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home was staffed appropriately. The home’s recruitments systems did not fully protect residents. EVIDENCE: The home was staffed to at least the levels required by the current staffing notice and this appeared adequate to met residents needs. During the inspection it was noted that when the nurse call was used the longest it took staff to respond, was 75 seconds. Staff had a good knowledge of residents and an observed handover between day and night staff showed that staff were aware of residents, their needs and plan of care in place, and also reported on how residents had been overnight. Registered nurses maintain their knowledge of current practice by attending external training so that they are able to meet residents needs. Only 2 members of the care have achieved NVQ level 2 but at the time of the inspection, 7 nurses who were qualified staff from overseas were either undertaking or waiting to commence adaptation training to be accepted as a qualified nurse in England. These nurses use their knowledge from their previous training to the benefit of residents. Residents spoken to said that the staff had the skills to meet their needs. The Limes Nursing Home DS0000021648.V292934.R01.S.doc Version 5.1 Page 19 The home operates an appropriate recruitment procedure which recognises equal opportunities. Staff recruited to the adaptation programme were recruited via an agency that undertook appropriate checks and obtained references which were available on the member of staffs file. Because the staff members were recruited direct from overseas the agency provided Police checks from that country. The proprietor was reminded that he must ensure Criminal Record Bureau checks are carried out and to include the Protection of Vulnerable Adults register, to ensure that residents are protected from staff who should not be working with older people. The home only had a short induction programme, as all new carers were already trained nurses. In-service training included English as a second language to assist those staff whose first language is not English to develop fluency in spoken English. The Limes Nursing Home DS0000021648.V292934.R01.S.doc Version 5.1 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 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The homes current audit tool does not give the information required to ensure residents views are heard. Regular equipment and installation servicing ensures that equipment in use should not put residents at risk. EVIDENCE: Residents and staff, including PCT and medical staff had a positive view of the manager who was a registered nurse who had many years experience working with older people. She had qualified in South Africa and her training to degree level included management. The proprietor spends five days each week in the home and is readily accessible to residents and visitors. The Limes Nursing Home DS0000021648.V292934.R01.S.doc Version 5.1 Page 21 The home currently obtain views of residents using a PCT monitoring tool, but discussion with the proprietor showed that he was not certain that this form gave him the information and feedback that he felt he needed and was currently designing a new form which should increase the homes awareness of residents views on their care. It is important that any information obtained from residents is both acted upon and feedback to them. At the time of the inspection the home did not control any of the residents monies. Any payments for extra services such as newspapers and hairdressing were invoiced to either the resident or the person controlling their finances. The homes Policies and Procedures had been reviewed recently. The home had maintenance and service agreements in place for facilities and equipment in the home and a random check of paperwork showed that required work had been undertaken. This ensures that all equipment used with residents is in safe working order and could not put them at risk. A record was kept of all accidents that occurred in the home. This was reviewed by the inspector and found not to show any concerns or patterns that would put residents at risk. The Limes Nursing Home DS0000021648.V292934.R01.S.doc Version 5.1 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 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X 2 X 3 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 3 X 3 X X 3 The Limes Nursing Home DS0000021648.V292934.R01.S.doc Version 5.1 Page 23 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. 2. Standard OP7 OP18 Regulation 15 18 Requirement All residents must have care plans, and plans must reflect all the residents needs Staff in the home including the Registered Manager must undertake refresher training in adult abuse recognition and reporting. The registered person must provide suitable lockable storage facilities for those residents who have not yet had a lock fitted, for medication, money or valuables. Keys must be provided for this facility. The registered person must explain in the service user guide why bedroom doors are not lockable and the potential problems this may cause. (Previous timescales of 01/07/05, 01/12/05 and 01/05/06 only partially met). Timescale for action 01/08/06 01/08/06 3. OP24 23 01/08/06 The Limes Nursing Home DS0000021648.V292934.R01.S.doc Version 5.1 Page 24 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 OP1 OP33 Good Practice Recommendations The home should amend the Service User Guide to state that bedrooms are not lockable. The proprietor should complete the review of the homes quality monitoring tool. The Limes Nursing Home DS0000021648.V292934.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ 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 Nursing Home DS0000021648.V292934.R01.S.doc Version 5.1 Page 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!