CARE HOMES FOR OLDER PEOPLE
The Limes Nursing Home 816 Wilmslow Road Didsbury Manchester M20 2RN Lead Inspector
Leslie Hardy Unannounced Inspection 5th January 2006 07:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Limes Nursing Home DS0000021648.V275736.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.V275736.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.V275736.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). 4th September 2005 Date of last inspection Brief Description of the Service: The Limes is a care home providing nursing care for 41 older people and 1 for personal care. The Limes is an extended Victorian premises set in its own grounds. The home has two distinct units - The Pines and The Limes. Accommodation is provided on 2 floors in the Pines (the most recent extension) and on the 4 floors in the original house (The Limes). An enclosed conservatory runs along the side of The Limes providing a bright, airy view of the grounds of the home. 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 400 yards of the home. There are two passenger lifts, one in each unit. The Limes Nursing Home DS0000021648.V275736.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced, and took place on Thursday 5 January 2006. The Inspection started at 7 15am and lasted for 7 hours. During the inspection, 16 residents, 6 visitors and 8 staff were spoken with. A tour of the building was also carried out. A number of improvements from the previous report had been actioned, but a number had not. If the outstanding actions from previous reports are not carried out in the timescales given in this report the Commission for Social Care Inspection may have to take further action. During this inspection only a selection of key National Minimum Standards were assessed therefore to gain the full picture of how the home meets the needs of residents, this report should be read with any previous reports. What the service does well: What has improved since the last inspection?
The Manager has taken steps to prevent medication being given after being stopped by a doctor. The home has nearly completed a programme of ensuring all radiators are protected to prevent a resident being accidentally burned by one. Residents’ views are now sought on how they are cared for throughout the home.
The Limes Nursing Home DS0000021648.V275736.R01.S.doc Version 5.1 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 Nursing Home DS0000021648.V275736.R01.S.doc Version 5.1 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 Nursing Home DS0000021648.V275736.R01.S.doc Version 5.1 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): 6 Residents on the intermediate care unit were receiving appropriate care centred on the residents needs. EVIDENCE: The intermediate care unit is based in the Pines. Nursing staff from the home run this unit but are assisted by occupational therapists, physiotherapists and a specialist nurse from the local NHS Primary Care Trust that contract with the home for the service. Staff from the PCT and the home’s staff were seen to work as a cohesive team and this was confirmed by PCT staff who were confident that plans of care are continued over the 24-hour period, including weekends. Two local GP’s employed by the PCT provide daily medical sessions. A Consultant in Elderly Medicine employed by the PCT provides consultant medical cover for the unit, who was on the unit during the inspection. He was seen to have confidence in the homes staff. Residents on the intermediate care unit were very positive about the care provided and the ability of the staff to aid their rehabilitation and ensure that they were able to return either home or to a less intensive facility.
The Limes Nursing Home DS0000021648.V275736.R01.S.doc Version 5.1 Page 9 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): 9 and 10 Good medication control mechanisms are in place. Staff treated residents with respect and ensured that the way they delivered care maintained the residents dignity. EVIDENCE: The procedures for the control and giving of medication were good. The recording of medication to residents is well documented. The manager has taken action to ensure that medication that has been discontinued cannot continue to be given inadvertently. Residents were seen to be treated with respect with their dignity maintained. Staff were noted to carry out personal treatments on residents in the privacy of their own rooms. Residents confirmed that staff were respectful and maintained their dignity. This was also confirmed by a number of visitors to the home. The Limes Nursing Home DS0000021648.V275736.R01.S.doc Version 5.1 Page 10 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 Residents’ were respected as individuals with their rights maintained by staff who encouraged them to take control over as much of their life that it was possible to do so. Visiting was encouraged. Food on the whole was good but attention to how one of the meals is served will enhance the residents’ experience. EVIDENCE: Residents’ were enabled to exercise control and choice over how they spent their day. They described how they were able to go to get up and go to bed at times of their choosing and how staff respected their wishes. The need for rehabilitation to some extent dictates a more limited choice on The Pines but residents on The Limes were able to say where and how they would like to spend their day. One visitor described how, out of choice, his mother normally spent her day in her room, but did attend the regular religious services in the home, which staff, from their knowledge of her, realised that she would wish to attend. A physiotherapist is employed on The Limes for 2 days a week to encourage physical and mental activities. She reviewed and assisted residents to mobilise and arranged craft activities. On the day of the inspection there were no activities on offer, and though the television was on in one lounge this was not
The Limes Nursing Home DS0000021648.V275736.R01.S.doc Version 5.1 Page 11 dominant. Some residents had their own newspapers and magazines purchased through the home. Visitors were encouraged to visit at any time and felt positive about the way they were treated by staff. Visitors were enabled to take part in care tasks if they wished and with the approval of the resident. Residents in The Limes were positive about the food. Two main choices were on offer at lunchtime and other food was available if residents requested this. The kitchen was part of The Limes and the cook was seen to be engaging with residents and was aware of their likes and dislikes. Residents on The Pines felt that there was no choice of main course and observed that the main course of an evening frequently consisted of cold meat and chips, which were also always cold. It is recommended that the registered person review how the evening meal is served. Staff were seen to enable and encourage residents to eat and if assistance was required this was given appropriately. The Limes Nursing Home DS0000021648.V275736.R01.S.doc Version 5.1 Page 12 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 The home treats complaints seriously and tries to learn from them. The lack of staff knowledge on the recognition and reporting of adult abuse could put residents at risk. EVIDENCE: The home maintained records of complaints. Since the last inspection the Commission has investigated 2 complaints and as a result of one of these complaints, changes to how staff recorded the residents day was required. Complaints made directly to the home are recorded, investigated and action taken documented. Staff spoken to seemed unsure of what action to take in the event of adult abuse being observed. It is recommended that the manager undertakes updating training on the recognition and reporting of adult abuse and the further training is made available to care staff to ensure that if adult abuse ever occurred it would be recognised and appropriate action could be taken. The Limes Nursing Home DS0000021648.V275736.R01.S.doc Version 5.1 Page 13 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): 24, 25 and 26 Resident’s choice regarding their privacy and dignity is restricted by the lack of lockable facilities. The home needs to ensure out of hours availability of hand towels in what is a clean and tidy home. EVIDENCE: Many of the residents at the home do not have a secure storage space in their bedroom. This along with the fact that no bedrooms have locks on the doors which could be used by residents if they wished restricted choice and could place residents at risk of their privacy and dignity not being maintained. As required in previous reports action is required to remedy this. The home was kept clean, tidy and free from offensive odours. At the start of the inspection one toilet did not have any hand towels. The proprietor stated that dispensers were filled each day. Staff should be informed of the required action if a dispenser is found to be empty at other times as the lack of hand towels could lead to practices which encourage cross infection and put residents at risk.
The Limes Nursing Home DS0000021648.V275736.R01.S.doc Version 5.1 Page 14 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, 28and 29 The home is staffed to at least the minimum required levels, by staff who are appropriately recruited to ensure residents are not placed at risk from unsuitable people being employed in the home. EVIDENCE: The home is staffed to meet at least the minimum requirements in the current staffing notice. Since the last inspection, the trained staffing level of one registered nurse between 5pm and 8pm has been reviewed by the proprietor who has concluded that this is still adequate. The national Minimum Standards requires all homes to have a minimum of 50 of the carers with NVQ level 2 (excluding Registered Nurses) by 2005. The home only have 2 carers with NVQ level 2 so falls short of the requirement. However there were 5 carers working at the home who are qualified nurses who trained overseas undertaking the adaptation training to register here as registered nurses. To include these in the NVQ level 2 figures the proprietor must demonstrate that the social care element of their previous training is equivalent to the required social care elements of NVQ level 2. Each member of staff has a personal file, which is securely kept and contains all the information required in Schedule 2 of the Care Home Regulations 2000, which ensures that the homes recruitment procedures are appropriate. The Limes Nursing Home DS0000021648.V275736.R01.S.doc Version 5.1 Page 15 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 and 35 The home is currently managed by a nurse who is unable to verify management training to the required level. Systems in place safeguard residents’ financial interests. EVIDENCE: Nurses who were existing managers of care homes were required by the end of 2005 to have a NVQ level 4 in management or equivalent. The manager believes that part of her degree course in nursing would be equivalent and has been trying to establish this. Having contacted her university she believes she will be shortly able to do this. It is important that this is undertaken urgently. The home has implemented in The Limes the quality assurance tool that was used previously only in The Pines Unit to ensure that feedback about the service is obtained. The Limes Nursing Home DS0000021648.V275736.R01.S.doc Version 5.1 Page 16 The home is currently not responsible for the financial affairs of any residents. They also do not keep any residents’ monies and any items supplied through the home such as hairdressing is invoiced monthly. The Limes Nursing Home DS0000021648.V275736.R01.S.doc Version 5.1 Page 17 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 X X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 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 3 X X X X X 2 3 2 STAFFING Standard No Score 27 3 28 2 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 X The Limes Nursing Home DS0000021648.V275736.R01.S.doc Version 5.1 Page 18 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 OP24 Regulation 23 Requirement 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. (Previous timescales of 01/07/05 and 01/12/05 only partially met). All bedrooms doors must be fitted with locks suited to residents capabilities and assessable to staff in an emergency. (Previous timescales of 01/07/05 and 01/12/05 not met). The proprietor must provide a sluicing disinfector to meet the required standard. (Previous timescale of 01/07/05 and 01/12/05 not met). Timescale for action 01/05/06 2 OP24 12, 23 01/05/06 3 OP26 26 01/05/06 The Limes Nursing Home DS0000021648.V275736.R01.S.doc Version 5.1 Page 19 4 OP28 18 5 OP30 9 The home must meet the minimum requirements for carers with NVQ level 2. The social care element of the training undertaken by trained nurses undergoing adaptation training must be reviewed to confirm it meet NVQ 2 social care requirements if these nurses are to be included in the number of staff with this training or equivalent. The manager must either confirm that she has received management training to NVQ level 4 standard or undertake further training to obtain this. 01/05/06 01/05/06 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 OP15 OP18 Good Practice Recommendations The Registered Manager should review how the evening meal is served in the Pines. The Registered Manager should undertake refresher training in adult abuse recognition and reporting and training in this area should be made available to other staff. Staff should be aware of how to replenish hand towel dispensers overnight. 3 OP26 The Limes Nursing Home DS0000021648.V275736.R01.S.doc Version 5.1 Page 20 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
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