Inspection on 16/06/07 for WCS - The Limes

This inspection was carried out on 16th June 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

WCS - The Limes 01/08/06

WCS - The Limes 02/03/06

WCS - The Limes 25/09/05

WCS - The Limes 27/01/05

WCS - The Limes 02/09/04

WCS - The Limes 30/03/04

WCS - The Limes 14/01/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE WCS - Limes, The Alcester Road Stratford On Avon Warwickshire CV37 6PH Lead Inspector Yvette Delaney Key Unannounced Inspection 16th June 2007 15:15 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 WCS - Limes, The DS0000004268.V344103.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. WCS - Limes, The DS0000004268.V344103.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service WCS - Limes, The Address Alcester Road Stratford On Avon Warwickshire CV37 6PH 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) 01789 267076 01789 414627 admin@wcslimes.f9.co.uk Warwickshire Care Services Limited Miss Lesley Jane Anderson Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places WCS - Limes, The DS0000004268.V344103.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st August 2006 Brief Description of the Service: The Limes is a home for twenty-seven older people. The home is owned by Warwickshire Care Services, a voluntary sector organisation. The Limes provides personal care to twenty-four permanent service users with three additional bedrooms reserved for short stay. The home also caters on weekdays for up to sixteen-day care service users. Accommodation is on two floors. There is a lounge/dining area on the ground floor and separate lounge and dining areas on the first floor. Nineteen of the bedrooms have en-suite facilities. The home is very close to the town centre of Stratford-upon-Avon. It has parking on site and is near to the train station. The currently weekly charge for accommodation, board and personal care is £440 - £551. Additional charges are made for private chiropody, hairdressing, personal items, toiletries and newspapers/magazines. WCS - Limes, The DS0000004268.V344103.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection visit was unannounced and took place on a weekend, Saturday 16 June 2007 between the hours of 3:15 pm and 9:30 pm. Senior care staff, care staff and the care manager were present at the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for residents and their views of the service provided. This process considers the care home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. Before the inspection, questionnaires were sent to the home to be given to residents, relatives/visitors and visiting professionals to seek their independent views about the home. Completed questionnaires were received from nine relatives and ten residents. Comments received provided mixed views of praise and concerns from people about the service they are receiving. Some of the comments are included throughout this report to evidence outcomes for people who use the service. The registered person for the home completed and returned a pre-inspection questionnaire containing further information about the home as part of the inspection process. Some of the information contained within this document has been used in assessing actions taken by the home to meet the care standards. Four residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting, talking or observing them, discussing their care with staff, looking at their care files, and focusing on outcomes. Records relating to the care of the people using the service, training and health, and safety were examined. Some of the residents were able to make active contributions during the inspection visit. WCS - Limes, The DS0000004268.V344103.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The management of medication in the home must improve to ensure that residents are not exposed to the risk of harm and their well being is maintained. To ensure that people who live in the home receive appropriate care all care plans must be reviewed to clearly reflect the assessed individual and current needs of all people admitted to the home. WCS - Limes, The DS0000004268.V344103.R01.S.doc Version 5.2 Page 7 Risk assessments must be completed and updated by staff and a consistent approach to applying the criteria maintained. This will ensure that residents are not exposed to risk to their health and wellbeing. Activities and events in the home must be reviewed through consultation with people using the service. This will support person centred care and ensure that resident’s needs are met. 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. WCS - Limes, The DS0000004268.V344103.R01.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 WCS - Limes, The DS0000004268.V344103.R01.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): 1,3, 4 and 5 Quality in this outcome area is good. The preadmission process provides sufficient and suitable information for the home to ensure that the diverse needs of people admitted to home can be met. Residents have sufficient information available to help them make an informed decision about moving into the home. These judgements have been made using available evidence including a visit to this service. EVIDENCE: A Statement of Purpose and Service User Guide is available to residents and other people who use the service. These are provided by the home to ensure that current and potential residents have up to date information available to help make an informed decision as to whether the home can meet their needs. WCS - Limes, The DS0000004268.V344103.R01.S.doc Version 5.2 Page 10 The Statement of Purpose and Service User Guide have recently been reviewed and copies have been forwarded to the Commission. Two residents identified to be followed through the case tracking process and a further two resident admitted for respite, short-term care, were able to confirm receiving copies of these documents. Residents spoken with said that the information helped them when making decisions about the suitability of the home. In the ten completed questionnaires received from resident’s all said that they had received enough information about the home so they could decide if it was the right place for them. Examination of their files demonstrates that a thorough assessment of their care needs before admission to the home had been carried out with the involvement of the residents. Pre-admission assessments carried out involved assessing a number of key areas related to individual health and social care needs. These include medical and health history, mobility, personal support and potential areas of risk. However, evidence obtained when examining the records of two residents admitted for respite care showed that up to date assessments of their care needs had not been carried out. An assessment based on the current admission would identify any changes in care needs and could be used to inform care planning. The home manager or her deputy, care manager assesses all prospective residents before they are offered a place in the home. Potential residents are also offered the opportunity, if appropriate to visit the home before making the decision to move into the home. Assessments read at the inspection and care plans provided by the referring management team i.e. social services were informative. However, the information available in assessments were not always transferred to care plans, which would identify good practice of re-assessment on admission to identify any changes in care needs. WCS - Limes, The DS0000004268.V344103.R01.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. Care plans do not detail the individual care needs of all residents living in the home. This practice does not ensure that the care delivered will be appropriate at all times. Medication practices for the safe receipt of medicines into the home are not consistently carried out to ensure the safety and welfare of residents at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four residents identified for case tracking were seen, spoken with and the interaction between them and staff were observed. Residents were comfortable with the staff as they helped them with their care needs. The home is currently in the process of changing some of the documentation used in the care planning process. Care plans contained mixed examples of both the old and new systems and therefore both were read during the WCS - Limes, The DS0000004268.V344103.R01.S.doc Version 5.2 Page 12 inspection. The process for introducing the new care plan documentation was incomplete and the benefits to be gained from changing the care plans could not be fully assessed at this inspection. The outcome identified at this inspection is that the process is complex and evidence available show that staff will need time, training and supervision to ensure that they understand the process. Examination of care plans show that they lack sufficient detail in a logical format to support staff when meeting the needs of residents in their care. Written details showed that they did not always contain clear, concise or specific information describing the range of personal and health care needs of the residents. For example, the care file for one of the resident’s case tracked identified that they had a dressing on their leg. A care plan had not been written to identify the reason why a dressing was necessary and there was no information to show if any care was to be given by care staff. In another care plan the strengths and abilities of a resident were not identified. There was a lack of information in this care plan to demonstrate the level of support needed from carers to help the resident meet both their hygiene and mobility needs. Identifying a resident’s strengths and abilities would support staff to provide more detail in residents care plan on the level of support needed from carers or other resources. Staff spoken with were knowledgeable about these residents but the lack of documented information describing their care needs means that there is a risk of inconsistent care being delivered to residents. Care plans for residents admitted for respite care were not updated to reflect their current stay in the home. For example, care plans dated September 2006 were being followed for a resident admitted in July 2007. There was no evidence that a re-assessment of their care needs had been carried out to determine whether their care needs had changed and ensure that staff delivered appropriate care. Daily statements were not consistently written by care staff to describe the day-to-day wellbeing of resident’s living in the home. A care record sheet has been introduced as part of the new documentation. The record sheets were examined in the care plans of residents followed through the case tracking process. It was noted that record sheets were also not consistently completed. The care manager explained how these should be used. Care staff are required to put their initials against events that residents have taken part in related to social activities, personal care, medical support or WCS - Limes, The DS0000004268.V344103.R01.S.doc Version 5.2 Page 13 intervention and actions taken to reduce identified risks. Care staff should then enter written details of these events into the daily record documentation for each resident. The lack of information in these documents does not demonstrate that care has been given as planned and does not allow for effective audit of care provided in the care home. Risk assessments are carried out on all residents admitted to the home these include falls, moving and handling and mobility both in and outside the home. It was not always clear from risk assessments what criteria was used and therefore what determined the scores that were made. This was particularly evident in risk assessment related to falls, where outcomes and scores varied from staff to staff and therefore did not clearly identify the level of risk and how the risk would be managed for individual residents. Carrying out risk assessments will ensure residents take managed risks with support as required and protect them from potential harm. Entries in residents’ health records and comments by staff confirmed that people are supported to gain access to relevant health professionals where required, such as the GP, Optician, District Nurses, Dentist and Chiropodist. Conversations were held with the residents in the home they were very receptive and liked to talk about the care they received. Observations made during the visit showed that residents were relaxed in the house and integrated well with staff and other residents. People living in the home were well groomed and dressed. Residents felt that care staff showed them respect and helped them to maintain their privacy and dignity when helping them to meet their personal care needs. Care staff were observed speaking to residents politely and in a friendly manner. Responses in questionnaires received to the question “Do you receive the care and support you need?” was mixed some residents said always, some said usually and others said sometimes. Comments made include: “It depends on who the carer is, some of the carers are understanding.” “So far very helpful.” “Do help me at night.” Family members also made comments in questionnaires received about the care their relatives receive in the home, these include: WCS - Limes, The DS0000004268.V344103.R01.S.doc Version 5.2 Page 14 “My …is kept informed by the staff of everything they are doing for …and is kept clean…includes bed and room.” Management of medicines had improved at the last inspection carried out in August 2006. At this visit evidence showed that not all staff consistently follow procedures set by the company for the safe ordering and receipt of medicines into the home. One example of this was following the receipt of a box of Fentanyl patches (medication used to help control pain). The dose of the Fentanyl patches in the box were 25mcg, the error at this stage was due to staff at the Chemist used by the home dispensing the incorrect dose. The dose written on the label of the medication box and instructions on the Medication Administration Record (MAR) Chart showed that the resident had been prescribed 12.5 micrograms (mcg). However, staff receiving the medication into the home did not return the drugs to the Chemist when they noted the error but changed the dose on the MAR chart and on the label of the box containing the drugs to 25mcg. Carrying out this action could have resulted in a resident receiving twice the prescribed dose. Fortunately, staff on duty on the day of inspection noted the error and arranged for the medication to be returned to the Chemist. WCS - Limes, The DS0000004268.V344103.R01.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. Activities in the home are not varied or planned to provide appropriate stimulation for all residents living in the home. Visitors are encouraged to be involved in their relatives’ life and encouragement is given to help people living in the home to live ordinary lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents said that activities take place in the day centre on the days when day care is provided and that they have a choice whether they join in these sessions if there is space available. On the day of inspection, some residents choose to be in communal areas of the home which includes the lounge with other residents, and others were seen to like being in their own bedroom enjoying their own company or their visitors. Records regarding activities undertaken were not sufficiently maintained. Care files seen contained details of activities but these were not completed on a WCS - Limes, The DS0000004268.V344103.R01.S.doc Version 5.2 Page 16 regular basis and were not up to date. Comments made by residents to the question in questionnaires sent out “Are there activities arranged by the home that you can take part in?” were more negative than positive and include: “Boredom is sometimes a problem.” “Always” “Unfortunately I do not take part in these as I feel very hot in the room that they take place in i.e. no windows open.” “I don’t know.” “Sometimes, needs more, needs trips outside to relieve boredom. “Within staffing limits it would be nice to perhaps sit outside in the fresh air occasionally. Boredom is always a problem for the physically less able.” Life histories in care plan documentation were not completed to determine people’s hobbies and life experiences which would help staff to support residents to continue with their interests or could be used to inform activities and events which take place in the home and encourage resident participation in areas that interest them. Relatives, friends and other visitors are encouraged to visit throughout the day and maintain contact and involvement in the care of their relative. Visitors were observed to visit the home at the time of inspection. Residents spoken with said that they were free to come and go from the home as they pleased. Residents said that they made visits out to the shops, visited friends or family or other event in the community on their own if they are able or with the support of their relative or a member of staff. All residents praised the staff saying that they are friendly and kind. Residents religious needs are met by visiting clergy, residents are also able to visit a local church if they prefer. Residents were observed eating their meal at teatime. This time was observed to be a social occasion with residents choosing to have their meal in the dining room. Residents spoken with said that they had enjoyed their meal. One resident said that the choice of food available was very good. WCS - Limes, The DS0000004268.V344103.R01.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 good. Complaints are investigated and training for staff related to adult protection increases safety and quality of life for people who use the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Policies and procedures are in place to support staff in managing any complaints received by the home. Speaking with residents demonstrate that they are aware whom they should speak to if they have a complaint. Residents spoken with said that they had no complaints about the home. There has been no complaint reported to the Commission. Staff spoken with were aware of the complaint procedure and was able to comment on the action they would take if they received a complaint. A policy and procedure detailing the action to be taken by staff to ensure the protection of vulnerable adults was examined. Training records show that staff had attended training related to the protection of vulnerable adults in the last year. Discussions with two members of staff demonstrated that they are aware of their role and responsibility in reporting any suspicion of, or actual harm to residents. WCS - Limes, The DS0000004268.V344103.R01.S.doc Version 5.2 Page 18 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, 20, 22, 23, 24 and 26 Quality in this outcome area is good. The environment is maintained and adapted to support residents in having a positive experience of living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A brief tour of the home showed that the home presents as a homely environment. There were no malodours noted in the home and the home was fresh and clean. Bedrooms are located on the ground and first floor of the home. Most of the bedrooms have been personalised by residents and relatives with their own possessions. The bedrooms of the residents followed through the case tracking process were observed to be individual, homely and WCS - Limes, The DS0000004268.V344103.R01.S.doc Version 5.2 Page 19 residents looked comfortable. Residents and relatives spoken with felt that the home was clean, well maintained and they were happy with their bedrooms. Lounge/dining areas are available on both floors. Residents were sitting in the ground floor lounge in suitable chairs that they felt comfortable in. Some of the female residents said that they enjoy sitting on the walkway between the old and new building. Residents know this area as the ‘bridge’ and all were observed to be sitting comfortably and chatting with each other. Time was taken by the inspector to have a conversation with the residents sitting in this area. The home provides equipment necessary to assist residents to maintain their mobility and independent access around the home. Grab rails are positioned throughout the home. Zimmer frames were seen in use and residents moved around the home safely. The kitchen is clean and standards of hygiene maintained. Cleaning procedures have been maintained consistently in the kitchen area and records were examined to confirm this. Temperature checks are maintained of the fridges and freezers foods received in the home and cooked meals served to residents. WCS - Limes, The DS0000004268.V344103.R01.S.doc Version 5.2 Page 20 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. The lack of review and assessment of the dependency levels of people who use the service does not ensure that staffing levels and skill mix are appropriate to meet the changing needs of residents safely at all times. Information related to the training and recruitment of staff ensures that skilled staff are available to support meeting the health and personal care needs of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the inspection, the home was short of one member of staff due to sickness. To support the staff and provide adequate cover for the home the Care Manager did an evening shift to cover the home and carry out the evening medication round. Comments received from residents about staff were mainly positive with responses of: “Very attentive.” WCS - Limes, The DS0000004268.V344103.R01.S.doc Version 5.2 Page 21 “I have nothing to complain about.” There were concerns that there was insufficient staff when residents needed support with care needs, especially where more than one carer was needed. Comments made include: “…Needs to use the hoist to go to the toilet. Two people have to be available. Problems with this…cannot take …when two aren’t available…cannot take …when giving drugs…cannot take…during handover…cannot take …during meals and preparation time. The above together with evidence mentioned previously related to the absence of assessments to determine the current care needs of people admitted to the home could mean that the level of support required by residents is not determined on an ongoing basis. Obtaining this information would ensure sufficient staff are on duty at all times, which should include times of peak activity. This will ensure that the care needs of people who use the service will be met in a timely manner. New staff have an induction period, which involves a basic introduction to the home and is linked to the ‘Skills for Care’ induction programme. A new member of staff spoken with on the day of inspection was able to confirm that they had begun their induction programme with the support of a mentor. The induction pack demonstrates that it is linked to a rolling programme of assessment of care staff towards an NVQ (National Vocational Qualification) Level 2. The care manager confirmed that there are 74 of care staff with a recognised NVQ qualification in care. The files of four staff were examined and these show that safe recruitment procedures are followed to ensure that residents are protected. Criminal Records Bureau checks are carried out and appropriate references obtained for all potential new staff before staff are employed in the home. Training records examined at this inspection and speaking with care staff confirmed training received. Staff confirmed that they had received training in fire safety, infection control and Moving and Handling. Staff also spoke about other training they had attended related to the care of residents in the home. Topics covered include person-centred care, medication, diabetes and Parkinson’s. Ensuring that staff attend ongoing training means that they should have the appropriate skills and up to date knowledge to be able to carry out their role when meeting the care needs of people living in the home. WCS - Limes, The DS0000004268.V344103.R01.S.doc Version 5.2 Page 22 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): 38 Quality in this outcome area is adequate. There is a positive approach to the running of the home, which encourages and involves residents in improving the quality of their life whilst living in the home. Areas related to health and safety in the home are not consistently maintained to ensure the safety of residents and staff at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Senior care staff, care staff and the care manager were present at this inspection. All staff were knowledgeable about the residents living in the home. Visitors to the home stated that they found the managers and other care staff approachable. Observations at the inspection demonstrate that WCS - Limes, The DS0000004268.V344103.R01.S.doc Version 5.2 Page 23 there is good interaction and rapport between staff, residents and family members. A list on the notice board provided dates of planned resident and relatives meetings. The care manager said that these are usually well attended and give residents and relatives to have a say about the running of the home. Residents spoken with confirmed that regular meetings take place. One of the practises observed at the inspection that could compromise the health and safety of residents and staff. Residents smoking on the patio area at the back of the home were observed to put out their cigarette ends after smoking and then put the cigarette ends into their bag. Speaking to the resident’s they said they did this because ashtrays were not provided and the cigarette ashbin attached to a wall was not easily accessible to residents, particularly if they had poor mobility. This issue was discussed with the care staff on duty and a suitable container was provided for residents to dispose of their cigarette ends. Other issues that could compromise the health and safety of residents have been mentioned in this report. These are related to poor medication practices and poor maintenance of care plans. These areas have been discussed under the Health and personal care section of this report. Pre-inspection information received shows that maintenance of fire fighting equipment, electrical appliances and hoists takes place on a regular basis. Fire safety management includes regular testing of fire alarms, emergency lighting, and all records relating to fire safety management were up-to-date and in good order. A record is maintained in the home of any accident or incident that happens to a resident. Records show that appropriate decisions have been made for the management and treatment of these accidents and incidents. WCS - Limes, The DS0000004268.V344103.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 3 3 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 X X X X X 2 WCS - Limes, The DS0000004268.V344103.R01.S.doc Version 5.2 Page 25 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 OP7 Regulation 15(1) Requirement Timescale for action 31/07/07 2 OP7 15 3 OP8 13(4) 4 OP9 13(2) All persons using the service must have an up to date detailed care plan this will ensure that they receive person centred support which meets their needs. Entries in daily records should be 31/07/07 linked to care plans and demonstrate the actions taken by staff to deliver the prescribed care. This will allow the home to monitor that residents receive care, which meets their individual needs. Any identified risk to a persons 31/07/07 health and wellbeing must be recorded, assessed, monitored and appropriate care and support provided. This will ensure that all people using the service have their individual needs met. All medicines received into the 31/07/07 home must be checked against prescription charts to ensure that the current dose and medication has been received for the right resident. This will ensure that people are not put at risk of harm. DS0000004268.V344103.R01.S.doc Version 5.2 Page 26 WCS - Limes, The 6 OP27 18(1) 7 OP38 13(4) The number and skill mix of staff working in the home must be continuously reviewed to ensure that sufficient number of staff are working in the home at all times. This will ensure that people who live in the home are in safe hands at all times. The conditions and facilities available for residents who wish to smoke whilst living in the home must be reviewed to ensure that this can be done safely and without risk. This will ensure the safety of all people using the service. 31/08/07 31/07/07 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 OP12 Good Practice Recommendations All people using the service should be consulted about their social interests to help maintain links with community life. This will ensure that they receive person centred care that meets their needs. The views of people who use the service should be sought when making decisions about activities that take place in the home. This will ensure that their needs are met. The manager should ensure that food hygiene training is up to date for all staff. 2 3 OP12 OP38 WCS - Limes, The DS0000004268.V344103.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 WCS - Limes, The DS0000004268.V344103.R01.S.doc Version 5.2 Page 28 - 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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