Inspection on 02/03/06 for WCS - The Limes

This inspection was carried out on 2nd March 2006.

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

Other inspections for this house

WCS - The Limes 16/06/07

WCS - The Limes 01/08/06

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

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Maple Lodge

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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 Unannounced Inspection 2nd March 2006 09:30 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 WCS - Limes, The DS0000004268.V285531.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. WCS - Limes, The DS0000004268.V285531.R01.S.doc Version 5.1 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 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.V285531.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th September 2005 Brief Description of the Service: The Limes is a home for twenty-eight older people. It was previously a Local Authority home, but was transferred in 1992, along with a number of other homes, to Warwickshire Care Services, a voluntary sector organisation. The Limes provides personal care to twenty-five permanent service users and has three rooms, which are reserved for short stays. 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. Eighteen of the bedrooms have en-suite facilities. Warwickshire Care Services plan to replace the passenger lift in 2004. 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. WCS - Limes, The DS0000004268.V285531.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 a weekday between the hours of 11.30 am and Midnight. This was the second visit for this inspection year. The Deputy Manager was present at this inspection. Staff in the home co-operated with the inspection. The inspection process involved discussions with the manager, examination of care profiles, case tracking, and discussions with staff and residents. Records related to residents, staff, the environment and operations in the home were examined. These included maintenance, servicing contracts, care profiles, accident records and policies and procedures. Details in a pre-inspection questionnaire sent to the home prior to the inspection provided factual information on the home. Comment cards sent to the home and given to residents and relatives also informed this report. Eight comment cards were received from residents and nine from relatives. Their views are detailed in the following table: Outcome of Service Users Comment Cards – 8 received Yes 7 7 7 8 4 5 5 8 8 3 4 No Sometimes 1 1 1 Comment 1 2 3 4 5 Do you like living here? Do you feel well cared for? Do the staff treat you well? Is your privacy respected? Do you wish to be more involved in decision making within the home? 6 Does the home provide suitable activities? 7 Do you like the food? 8 Do you feel safe here? 9 If you are unhappy with you care do you know who to speak to? 10 Do you or a relative or representative wish to speak to an Inspector about your life in the home? (If so tell us your name) Other comments made include: 4 2 3 1 no comment 1 “I enjoy staying at the Limes very much. The staff take very good care of me.” WCS - Limes, The DS0000004268.V285531.R01.S.doc Version 5.1 Page 6 “I have only lived at the Limes a short time. I have been made very welcome. Staff treat me well most of the time.” “…says she is satisfied with the care she is getting at the Limes and is happy with the standard of service, although she would like to be informed of any changes made within the home.” Outcome of Relatives/Visitors Comment Cards – 9 received Yes 9 9 8 7 7 8 1 4 6 9 2 1 8 3 1 No Comment 1 2 3 4 5 6 7 8 9 Do staff/owners welcome you in the home at any time? Can you visit your relative/friend in private? Are you kept informed of important matters affecting your relative/friend? If your relative/friend is not able to make decisions, are you consulted about their care? In your opinion are there always sufficient numbers of staff on duty? Are you aware of the home’s complaints procedure? Have you ever had to make a complaint? Are you made aware of forthcoming inspections? Do you have access to a copy of the inspection reports on the home? 1 usually 1 sometimes 1 n/a 1 uncertain 1 not sure 1 have not enquired 1 query 10 Are you satisfied with the overall care provided? Other comments made include: “This place (The Limes in Stratford-on-Avon) is more like a ‘4 Star’ hotel, A wonderful place.” “The staff are invariably kind and helpful.” “On the whole the home appears to be well run and caring. It appears to be hampered by difficulties in maintaining staffing levels. There are insufficient activities/outings.” “The very caring staff have made the transition from independence to total need for care, that my mother had to make during the past year, easier because of their very caring attitude. We now feel part of a bigger ‘family’. “There have been staffing problems at the Limes but the manager has been working hard to address this situation and it is much better.” WCS - Limes, The DS0000004268.V285531.R01.S.doc Version 5.1 Page 7 “We have complained about issues but the problems are resolved in a very efficient manner and we are very happy with the Limes the staff are wonderful.” What the service does well: What has improved since the last inspection? What they could do better: The areas where improvements are needed in the home include: • Ensuring care plans reflect residents’ health, personal and social care needs and staff ensure the details completed provide details for effective audit of care plan documentation. A review must be undertaken of all staffing levels within the home to ensure that at all times sufficient staff are available to meet all the needs of residents. The manager must inform the Commission of any event in the home, which has an impact on the day to day life of residents in the home. This includes significant changes in staffing levels. A review must be undertaken on the present arrangements for the keeping of cats in the manager’s office. • • WCS - Limes, The DS0000004268.V285531.R01.S.doc Version 5.1 Page 8 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. WCS - Limes, The DS0000004268.V285531.R01.S.doc Version 5.1 Page 9 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.V285531.R01.S.doc Version 5.1 Page 10 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): 1, 2, 3, 4 and 5 Residents have the information needed to help them and their families make an informed choice about where they live. The contract/statement of terms and conditions in use promotes and upholds residents’ rights. All residents are assessed prior to moving into the home and given assurances that their needs can be met by the home and the services offered. Residents and or their families have the opportunity to visit the home in order to decide on the suitability, quality and the facilities of the home. EVIDENCE: The home’s Statement of Purpose and Service Users’ Guide have been produced and are informative. The Statement of Purpose is accessible to ensure that potential and current residents have the information they need available to them, which could support them in making informed choices about day-to-day life in the home. WCS - Limes, The DS0000004268.V285531.R01.S.doc Version 5.1 Page 11 Written contracts/statement of terms and conditions are issued to residents or their relatives. Contracts for three residents were seen and examined, the document provides residents with the terms and conditions for moving into the home, and outlines their rights under the contract. Four residents profiles were examined good pre-admission assessments were available and these were completed with the resident and their relative at their place of residence. Residents or a nominated relative are encouraged to be involved in the pre-admission process and confirmation of their involvement is demonstrated by signing the pre-admission assessment. Relatives and residents are invited to visit the home prior to admission and two residents spoken with stated that they had visited and made the final decision for admission. WCS - Limes, The DS0000004268.V285531.R01.S.doc Version 5.1 Page 12 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 and 9 Residents’ health, personal and social care needs were not consistently described in care plans, which could result in the oversight of care. Medicines are generally safely managed within the home. The inspection showed that some more attention to detail is needed to demonstrate that all the medicines are administered as prescribed. EVIDENCE: The care planning system is part of the overall quality assurance system used by Warwickshire Care Services. Four care plans were examined these demonstrate that improvement had been made in the way they had been completed. Information, which identifies individual residents health, personal and social care needs is available with the action to be taken by staff to meet these needs. The documentation of daily statements had improved but was not consistently maintained by all staff. Spaces were left between one entry and another, entries continue to be made in different coloured inks, and entries were not all dated, timed and signed with a signature. Good record keeping is important when auditing care plan profiles or if carrying out an investigation. WCS - Limes, The DS0000004268.V285531.R01.S.doc Version 5.1 Page 13 A new medication policy/procedure has been written. The document provides clear guidance to support staff in the safe administration of medicines. There are some areas, which need attention. Staff are crossing out their initials following signing the Medication Administration Records (MAR) chart, which once signed indicates that the medicine has been taken by the resident. The Controlled Drugs register had been poorly maintained on some pages. Written information demonstrated the introduction of poor practices when recording the receipt of controlled drugs. Controlled drugs received Medicines had been removed from their original pharmacy labelled box. This is considered very poor practice as this may increase the risk of errors in the home. WCS - Limes, The DS0000004268.V285531.R01.S.doc Version 5.1 Page 14 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): 14 Residents are able to exercise informed choices about their day to day activities and care in the home. EVIDENCE: Residents were seen to be relaxed, smiling and happy to be living in the home. Time was taken to talk with two residents in their bedrooms, who were happy to express their views on living in the home. One resident enjoyed painting, learning French and the computer. Residents are encouraged to maintain their independence and maintain their contact with the community and are able to leave the home as they wish. WCS - Limes, The DS0000004268.V285531.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): 18 Policies and procedures concerning the protection of vulnerable people are adequate to ensure that residents are protected from abuse. EVIDENCE: A policy/procedure for responding to allegations of abuse is available. The document provides clear guidance for staff to follow and would therefore support staff to suitably deal with an allegation or evidence of abuse. Staff spoken with were able to confirm that they had attended to support them in effectively dealing with concerns over potential abuse. WCS - Limes, The DS0000004268.V285531.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): 26 The keeping of cats in the manager’s office does not promote good health and hygiene practice. EVIDENCE: Cats living in the home were seen to live in the manager’s office. This did not present as hygienic. There are two litter trays and six cat bowls in the office as the cats are fed in this area. The cats did not socialise with the residents during the time of the inspection and it was apparent that the cats are encouraged to live in this area, jumping on the desks and sleeping on chairs in the office. WCS - Limes, The DS0000004268.V285531.R01.S.doc Version 5.1 Page 17 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 and 29 The impact of night staff undertaking significant housekeeping duties could lead to inappropriate care provision and omission of care. The skill mix of staff on duty on the day of inspection meets residents’ needs, ongoing training is needed to ensure that this level is maintained at all times. The procedures for the recruitment of staff are robust to ensure that all safeguards are accessed to offer protection to residents living in the home. EVIDENCE: Information received during the course of the inspection identified that there have been significant staff shortages for some months particularly in relation to housekeeping staff. Care staff doing extra duties has managed the shortage and covered housekeeping duties. It is not clear whether this has had an impact on night care staff in the home as housekeeping duties carried out by staff. Evidence available indicates that these are not light housekeeping duties. Before leaving the home night care staff were seen carrying mops, brooms and other cleaning products. This is not good practice and these additional duties were not identified as extra or separate hours on night duty rotas to care hours identified. The pre-inspection questionnaire demonstrates that there are currently 10 of 25 (40 ) care staff with an NVQ qualification. WCS - Limes, The DS0000004268.V285531.R01.S.doc Version 5.1 Page 18 Two staff files examined demonstrated that procedures for recruiting and appointing new staff members would support the protection of residents living in the home. Examination of the files showed that required security checks had been carried out. There were two relevant and appropriate references on file and identification information was available. WCS - Limes, The DS0000004268.V285531.R01.S.doc Version 5.1 Page 19 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, 32, 34, 35, 36, 37 and 38 There are areas related to the homes professional environment and operation, which need to be improved to ensure the home is professionally managed. Accounting and financial procedures maintained in the home are suitably managed thereby safeguarding the residents’ stay in the home. Procedures are in place to manage residents’ monies and valuables so that their interests are safeguarded. Supervision procedures have been implemented to monitor care practices delivered by staff, which supports ensuring that residents’ health, safety and welfare is maintained at all times. Records are organised, accessible and securely stored, which should safeguard residents’ rights and best interests. Some practices in the home need to be reviewed to ensure that the health, safety and welfare of residents are promoted and protected. WCS - Limes, The DS0000004268.V285531.R01.S.doc Version 5.1 Page 20 EVIDENCE: The Care Manager who is also the deputy manager for the home was present for this inspection and was knowledgeable about residents in her care. The professional environment within the home was dampened by the presence of two cats that are accommodated in the registered manager’s office. The atmosphere in the home is relaxed and relationships between residents were positive. Residents were observed to be sociable, hold conversations with each other and had an awareness and knowledge of day-to-day activities in the home. Meetings are held for residents and relatives and minutes are written to detail the outcome of the meeting. The administrator manages accounting and financial procedures in the home appropriately. The insurance liability certificate on display had expired in October 2005; a copy of the current copy was faxed to the home during the inspection. The administrator manages small amounts of resident’s personal monies. Records were examined which demonstrated that information related to all transactions is available, and receipts are kept to indicate money spent. All monies are maintained individually and kept in a suitable locked facility. It was established through discussion with the manager and examination of staff files, that a formal system of supervision and appraisal of staff has been implemented in the home. Individual residents records and other personal confidential information related to staff and residents are secured in locked cabinets, in the manager’s office. Computers in the home are password protected. Records related to maintenance, contracts and servicing were examined with the manager responsible for supporting operations in the home. The manger is effective and aware of her responsibilities. At the time of inspection a fault developed with the lift prompt action was taken to appropriately address the problem. Documentation examined includes servicing of electrical equipment, clinical waste and all other services supplied to the home. Residents’ aids and equipment have also been serviced, this includes hoists and baths and maintenance work is up to date. Fire records and electrical tests are up to date. WCS - Limes, The DS0000004268.V285531.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 3 3 3 3 2 WCS - Limes, The DS0000004268.V285531.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Timescale for action Daily statements made about the 31/05/06 residents day must be dated, timed and signed with a signature to ensure information is available provides an audit trial. Spaces must not be left between each statement. All gaps on MAR charts must be investigated and appropriate action taken. The maximum, minimum and current temperatures of the medicine refrigerator must be recorded to ensure all medicines requiring refrigeration are stored within their product licences. The MAR chart must be referred to before the administration of medicines and signed or the reason for non-administration recorded immediately afterwards. 31/05/06 31/05/06 Requirement 2 3 OP9 OP9 13(2) 13(2) 5 OP9 13(2) 31/05/06 6 OP26OP31 OP38 13(3)(4), 16 The registered manager must 31/05/06 review the present arrangements for keeping the cats in the office. WCS - Limes, The DS0000004268.V285531.R01.S.doc Version 5.1 Page 23 9 OP27 18(1)(a), 3(a)(b) 10 OP28 18(1)(a) (c) The numbers and skill mix of staff must be appropriate at all times to meet the health and welfare needs of service users. Any extra non-care duties must be clearly identified on duty rotas and separate to care hours provided. The registered provider must ensure that a minimum of 50 of care staff on duty have a National Vocational Qualification in care. 31/05/06 31/05/06 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. Refer to Standard OP7 Good Practice Recommendations The completion of care plan documentation in different coloured inks should be discouraged. WCS - Limes, The DS0000004268.V285531.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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 WCS - Limes, The DS0000004268.V285531.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!