Care Home: Glenside Manor - Lime Tree Wing

What the care home does well Lime Tree has a comprehensive assessment system for prospective residents. This ensures that the home can meet the person`s needs and that the admission process is made as easy as possible for all people involved, particularly the resident and their relative. Staff work hard to preserve the privacy and dignity or residents, particularly when they are not able to ensure such needs are met themselves. A very wide range of equipment, which is correctly used, is available to meet residents` disability needs.The home has a thorough recruitment system, which ensures that prospective staff are only given employment after a rigorous recruitment process has been carried out. One relative commented "I am amazed by the patience and care and attention which is given to even the most difficult residents. Also by the care taken to ensure that the staff themselves are properly looked after." Another relative reported "It is a very organised and happy place to visit" and another "I`ve already booked my place!" Observations of residents and staff made during the inspection showed that no staff interactions with resident were assessed as poor and nearly all of them were assessed as good. No residents were judged as being in a negative state of being and nearly 30% were observed to be in a positive state of being. What has improved since the last inspection? The home has improved across a range of areas since the last inspection. Of the sixteen requirements identified at the previous inspection, fifteen have been addressed in full and one showed progress. Of the sixteen good practice recommendations, fourteen have been addressed in full and there are plans to address the remaining two. Where a resident has an assessed need, a care plan is now always put in place to direct staff on how this need is to be addressed. Where residents are assessed as needing to be offered regular fluids or have their positions changed regularly, there is evidence that this is now taking place. Where care plans are up-dated following evaluation, all additions are now dated and liquid paper is not be used when correcting errors. Where residents need to be offered fluids to prevent risk of dehydration, the amount of fluids aimed for in 24 hours is stated on their care plan and the amount of fluid taken in by them is totalled every 24 hours. Where a resident is assessed as being at risk of pressure damage, care plans state how often that individual needs to have their position changed. Where resident is assessed as needing thickening agents to assist them in swallowing, their care plan states how much thickening agent they need. Where a resident is prescribed medication on an intermittent basis, systems have been put in place to ensure that the medicine is given to the person as prescribed. Prescribed items are now only be used for the person for whom they are prescribed. Where the resident is no longer in the home, all prescribed items are disposed of. Where residents are prescribed a medication on an "as required" basis, a care plan is always drawn up to direct staff on the indicators for the use of such medication. Where a resident goes out of the home for a period of time and their supporter needs to be given medication for them to take, there are clear guidelines and protocols drawn up relating to this.A policy and procedure on equipment shared across the site has been put in place, this conforms to health and safety and infection control guidelines. An audit of all items used in care has taken place and any deteriorated items have been disposed of all other such items were in a clean state. The deteriorating flooring in en-suite bathrooms is in the process of being replaced. Where residents share a room, wash bowls are no longer used communally. All topical applications are used only for that person. The areas between the washing machines were clean and be free of dust and debris. If a resident needs to have their door held open for any reason, a device which has been approved by the fire office is used. A larger supply of crockery and cutlery has been provided. There has been a review of the call bell system and the number of repeater buttons increased. Management training has been provided to all persons who are in charge of a shift of duty. Staff who work on night duty have been provided with fire safety training four times a year. What the care home could do better: Two requirements and three good practice recommendations were identified at this inspection. To prevent risk of spread of infection, staff must be provided with all equipment necessary to prevent spread of infection and trained in its use. To prevent risk to residents, where safety rails or lap belts are in use, a full written assessment of their need and suitability must be undertaken. Such assessments must be reviewed on a regular basis. When documenting provision of care on charts, staff should document what care is given in accordance with company policy and procedure. All limited life medication should be dated on the day of opening. The corridor carpets on the first floor should be replaced, before they deteriorate further and present a tripping risk. CARE HOMES FOR OLDER PEOPLE Glenside Manor - Lime Tree Wing South Newton Salisbury Wiltshire SP2 0QD Lead Inspector Susie Stratton Unannounced Inspection 9:00 1 & 9 November 2007 st th 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 Glenside Manor - Lime Tree Wing DS0000048135.V345979.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. Glenside Manor - Lime Tree Wing DS0000048135.V345979.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Glenside Manor - Lime Tree Wing Address South Newton Salisbury Wiltshire SP2 0QD 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) 01722 742066 01722 744443 limetree@glensidemanor.co.uk Glenside Manor Healthcare Services Ltd Joy Guthrie-Andrews Care Home 36 Category(ies) of Dementia (36), Mental disorder, excluding registration, with number learning disability or dementia (36) of places Glenside Manor - Lime Tree Wing DS0000048135.V345979.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing- Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia- Code DE- maximum of 36 places Mental disorder, excluding learning disability and dementia- Code MD- maximum of 36 places The maximum number of service users who can be accommodated is 36. 12th March 2007 2. Date of last inspection Brief Description of the Service: Lime Tree Wing is a 36 bedded care home, which accommodates elderly persons and younger adults who need nursing care due to mental health needs, mainly dementia. On the day of the inspection, there were 36 persons resident in the home. The home was purpose-built in the early 1990s. Accommodation is provided over two floors, with a range of different sitting and dining rooms available to service users. Lime Tree Wing is part of a group of homes, all on one campus owned by Glenside Manor Health Care Services Ltd. Mr Andrew Norman is the nominated responsible individual. He is supported by a senior management team. The registered manager is Joy Guthrie-Andrews, she leads a team of nursing and care staff. A multidisciplinary team, including physiotherapists, occupational therapists, psychologists, speech and language therapists and social worker work across the campus. One catering and laundry department supplies all the homes and a maintenance team works across the site. The group of homes is situated in the village of South Newton, on the A36, five miles north west of the city of Salisbury. A mainline train station is in Salisbury, the A36 is on a bus route and ample car parking space is available on site. The home has a service users’ guide, which is offered to all prospective service users’ supporters. The fees are £795 a week. Extra charges include hairdressing, chiropody and sundries, such as toiletries. Glenside Manor - Lime Tree Wing DS0000048135.V345979.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included visits to the service and takes into account the views and experiences of people using the service. As part of the inspection, questionnaires were sent out to residents and their relatives and one was returned. Comments made by relatives in questionnaires to the provider and during the inspection process have been included when drawing up the report. As residents could not comment directly on care provision, a short observational framework was performed to assess staff provision of care in practice and residents response to this. An annual quality assurance assessment was submitted by the home prior to this inspection. This document provided information to support the inspection. As Lime Tree is a larger registration, the site visit took place over two days, on Thursday 1st November 2007 between 9:00am and 3:35pm and on Friday 9th November 2007 between 9:00am and 12:05pm. The manager, Mrs Joy Guthrie-Andrews was on duty for the first site visit. The responsible individual, Mr Andrew Norman and owner, Mr Denis Barry was present for feedback at the end of the inspection. During the site visits, we observed care for 19 residents, including five who were observed in detail, using our short observational framework. We reviewed care provision and documentation in detail for six residents, one of whom had been admitted recently. We also met with two visitors. As well as meeting with residents and visitors, we met with three registered nurses, six carers, a domestic and three laundresses. We also met with the human resources manger, the finance manager, the training manager and the operations manager. We toured all the building and observed a lunch-time meal. We observed systems for administration of medicines. A range of records were reviewed, including staff training records, staff employment records, maintenance records and financial records. What the service does well: Lime Tree has a comprehensive assessment system for prospective residents. This ensures that the home can meet the person’s needs and that the admission process is made as easy as possible for all people involved, particularly the resident and their relative. Staff work hard to preserve the privacy and dignity or residents, particularly when they are not able to ensure such needs are met themselves. A very wide range of equipment, which is correctly used, is available to meet residents’ disability needs. Glenside Manor - Lime Tree Wing DS0000048135.V345979.R01.S.doc Version 5.2 Page 6 The home has a thorough recruitment system, which ensures that prospective staff are only given employment after a rigorous recruitment process has been carried out. One relative commented “I am amazed by the patience and care and attention which is given to even the most difficult residents. Also by the care taken to ensure that the staff themselves are properly looked after.” Another relative reported “It is a very organised and happy place to visit” and another “I’ve already booked my place!” Observations of residents and staff made during the inspection showed that no staff interactions with resident were assessed as poor and nearly all of them were assessed as good. No residents were judged as being in a negative state of being and nearly 30 were observed to be in a positive state of being. What has improved since the last inspection? The home has improved across a range of areas since the last inspection. Of the sixteen requirements identified at the previous inspection, fifteen have been addressed in full and one showed progress. Of the sixteen good practice recommendations, fourteen have been addressed in full and there are plans to address the remaining two. Where a resident has an assessed need, a care plan is now always put in place to direct staff on how this need is to be addressed. Where residents are assessed as needing to be offered regular fluids or have their positions changed regularly, there is evidence that this is now taking place. Where care plans are up-dated following evaluation, all additions are now dated and liquid paper is not be used when correcting errors. Where residents need to be offered fluids to prevent risk of dehydration, the amount of fluids aimed for in 24 hours is stated on their care plan and the amount of fluid taken in by them is totalled every 24 hours. Where a resident is assessed as being at risk of pressure damage, care plans state how often that individual needs to have their position changed. Where resident is assessed as needing thickening agents to assist them in swallowing, their care plan states how much thickening agent they need. Where a resident is prescribed medication on an intermittent basis, systems have been put in place to ensure that the medicine is given to the person as prescribed. Prescribed items are now only be used for the person for whom they are prescribed. Where the resident is no longer in the home, all prescribed items are disposed of. Where residents are prescribed a medication on an “as required” basis, a care plan is always drawn up to direct staff on the indicators for the use of such medication. Where a resident goes out of the home for a period of time and their supporter needs to be given medication for them to take, there are clear guidelines and protocols drawn up relating to this. Glenside Manor - Lime Tree Wing DS0000048135.V345979.R01.S.doc Version 5.2 Page 7 A policy and procedure on equipment shared across the site has been put in place, this conforms to health and safety and infection control guidelines. An audit of all items used in care has taken place and any deteriorated items have been disposed of all other such items were in a clean state. The deteriorating flooring in en-suite bathrooms is in the process of being replaced. Where residents share a room, wash bowls are no longer used communally. All topical applications are used only for that person. The areas between the washing machines were clean and be free of dust and debris. If a resident needs to have their door held open for any reason, a device which has been approved by the fire office is used. A larger supply of crockery and cutlery has been provided. There has been a review of the call bell system and the number of repeater buttons increased. Management training has been provided to all persons who are in charge of a shift of duty. Staff who work on night duty have been provided with fire safety training four times a year. 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 summary of this inspection report can be made available in other formats on request. Glenside Manor - Lime Tree Wing DS0000048135.V345979.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 Glenside Manor - Lime Tree Wing DS0000048135.V345979.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): 3; Lime Tree does not provide intermediate care, so 6 is N/A Quality in this outcome area is excellent. This judgement has been made using available evidence, including visits to this service. Prospective residents have a full and detailed assessment of need prior to admission to ensure that their individual needs can be met. EVIDENCE: All prospective residents receive a comprehensive assessment of their nursing and care needs prior to admission. Where possible, written assessments are obtained from persons currently responsible for care. Where a prospective resident is unable, or due to their condition refuses, to be involved in the assessment, this is documented, together with information on whom the assessment information was obtained from. Glenside Manor - Lime Tree Wing DS0000048135.V345979.R01.S.doc Version 5.2 Page 10 The manager reported that she was always fully involved in admission processes. She reported that there was often a long waiting list for people waiting for admission and would decide who was most appropriate for admission, depending on their individual needs and how they would mix with other people resident in the home. Staff said that they were informed at report about prospective new residents and had access to all assessment documentation, so that they could plan for the person’s admission. The manger reported in the annual quality assessment that a welfare support officer is to be employed to offer extra support, advice and information to people during the admission process. This person will also liaise with outside agencies where needed. Assessments seen were very detailed and included a wide range of relevant matters. In their annual quality assurance assessment, the manager stated that they actively gain information to highlight the person’s individuality, values and beliefs. This was fully reflected in the records we inspected. It was particularly of note that a person’s spiritual needs were documented where it was of importance to the person. Admission assessments we inspected included details of the importance of family contact to the person. All assessments were written in clear non-judgemental language. None of the newly admitted residents were able to comment to us on the admission process. One of the newly admitted residents was observed as part of the short observational framework and it was observed that staff were clearly working together to get to know them. Staff were observed to encourage the person to move around in the lounges if they wanted to, ensure that they were not left alone at mealtimes, helping them to take in additional fluids and encouraging the person to make conversation and eye contact. The person appeared to be responding to contacts, showing no complex behaviours and to be trying to relate to staff and other residents at mealtimes. Glenside Manor - Lime Tree Wing DS0000048135.V345979.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 & 10 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents nursing and personal care needs are met and staff work hard to ensure that residents’ dignity is respected. EVIDENCE: The manager and her staff have put much work into developing their assessment and care planning systems since the last inspection. All residents have full assessments, for example assessment of risk of pressure damage or dietary risk. Where risk is identified, a care plan is put in place to direct staff on how risk is to be reduced. A wide range of care plans are developed to ensure that staff are fully directed in how to meet residents’ individual needs. Care plans reviewed were individualistic in style and related to the person. Glenside Manor - Lime Tree Wing DS0000048135.V345979.R01.S.doc Version 5.2 Page 12 Care plans were written in measurable terms and the language used was nonjudgemental. All care plans are regularly evaluated and up-dated when a resident’s condition changed Staff were observed to provide care in accordance with plans of care. Where frail persons were unable to move themselves or give themselves diet or fluids, monitoring charts were used. These were completed, however some staff were not always documenting, for example changes of position in the column indicated and were documenting elsewhere on the chart, this would make audit complex. Additionally some staff placed a tick in the column, rather than stating what position a person was placed in. We observed that where frail residents were unable to move themselves, that staff regularly used a hoist and lifted them up to relieve pressure from sitting for an extended period in a chair. Fluids taken in were totalled every 24 hours and if a person was not taking in enough fluids in 24 hours, this was noted and action taken. Where a person experienced complex needs, for example one person had fits, full records of each episode were maintained and it was clear that their GP was promptly contacted. Where a resident’s condition was noted to have changed, staff routinely performed basic checks such as blood pressure or obtained urine samples, to exclude medical complications. If observations showed that a medical need required attention, the person’s GP was contacted. A GP was visiting during the inspection. It was clear that there were effective professional relationships between the GP, manager and staff. A chiropodist was also visiting. The chiropodist documents actions and treatments in the nursing records to inform staff and enable them to meet resident’s foot care needs. None of the residents had complex wounds. One person did have a minor wound. A care plan was in place to direct staff on how the wound was to be managed. The effectiveness of the care plan was regularly reviewed. It was noted as good practice that none of the residents had a urinary catheter in place, despite high levels of incontinence experienced by residents. One registered nurse has been given responsibility for the overall management of medicines in the home. The clinical room for storage of medicines has been up-graded since the last inspection, so that all medicines can be safely and tidily stored away, ensuring more effective stock control. There is a full audit trail of medicines received into the home, administered to residents and disposed of. We observed a medicines round, this was performed in an organised manner. A medication error had occurred shortly before the site visit commenced. It was noted as good practice that this had been noted by a registered nurse soon after it had occurred, that a full investigation had commenced and the persons’ GP contacted. Controlled drugs were safely stored and full records maintained. Most limited life medicines had been dated when opened, however this had not happened in every case. This is needed so that such medicines can be promptly disposed of when they reach their expiry period. Glenside Manor - Lime Tree Wing DS0000048135.V345979.R01.S.doc Version 5.2 Page 13 Where residents are prescribed drugs on an “as required” basis, a care plan is drawn up to direct staff on the indicators for use of such drugs for them. It was noted that as much as possible mood altering drugs were kept to a minimum and where they were used, their use was regularly reviewed. As residents were not able to comment on nursing and care provided, observations of care were observed using our short observational framework, making observations of five residents, over a two hour period. This showed that residents were asleep for only 13.7 of the time observed. This mainly related to one very frail person and three of the people were not asleep for any of the time periods observed. No negative behaviours were observed. The only observation of withdrawn behaviours related to the person who was asleep most of the time and could have related to them taking some time to wake up. There were of observations (54.5 of the time) that residents were passive, sitting watching what was going on but not taking an active part, although they responded when a member of staff approached them. However, considering that Lime Tree cares for people with complex nursing needs relating to dementia it was positive to note that for 29.5 of the time, residents showed positive states of being, with smiles at staff, attempts at communication with staff and other residents and active decision making, for example choosing where they wished to sit. Residents were observed to be engaged for 61.1 to the time frame. This percentage was affected by the very frail person who was asleep for most of the observation period. In contrast one person was noted to be engaged throughout the observation period and another for 78 of the observation period. It was noted as good practice that all staff interactions, apart from one, were observed to be good and the one adequate interaction may have related to something outside our line of vision which needed attention from the member of staff. No poor staff interactions were observed. Some of the very frail residents spend their day in a smaller sitting room on the first floor. One carer was allocated to remain with these residents and attend to their needs. She clearly knew all these residents very well and supported them throughout the site visit. Some residents are too frail to get up and remain all or most of the time in bed. These residents looked comfortable and had well brushed hair and clean fingernails. It was noted as good practice that despite high levels of continence problems experienced by residents, that no odours were observed in any part of the home. Staff are to be congratulated for ensuring that residents’ dignity was observed in this important area. Most staff, particularly the deputy manager always addressed residents by their own preferred name. A few staff were observed to call residents by general terms of endearment such as “love” or “dear”, without using the person’s name. The deputy manager reported that she had been working with staff since she came into post to address this matter and that staff performance in this area had much improved. Glenside Manor - Lime Tree Wing DS0000048135.V345979.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. People are supported by staff to continue to choose how they spend their days, who maintain contact with people outside the home and are helped to eat a varied diet. EVIDENCE: All residents have an individual care plan drawn up relating to their social care needs. Staff reported that they needed support from residents’ relatives to do this. One carer reported how they approached relatives to ask them to bring in photographs, so that they could then support the resident in remembering or discussing matters which were of importance to them. It was observed that where residents spent all or most of their time in their room, that care was taken to put on music or television that they wanted, for example, one person had a tape of the music they liked turned on, another had the local radio station on and another did not have any background noise. All resident who remained in bed had the height of the bed adjusted so that they could see out of the window if they wished to, from their bed. Glenside Manor - Lime Tree Wing DS0000048135.V345979.R01.S.doc Version 5.2 Page 15 Residents who were able to get out of bed spent their time in one of three lounges. There is a small lounge on the first floor, where people who prefer a quieter atmosphere remain. There is a large lounge, dining room and conservatory sitting room, on the ground floor where most people spend their days. There is also a small sitting room on the ground floor for people who do not enjoy the busier atmosphere of the main lounges. A new sensory room is in the process of being developed and it is anticipated that it will become operational in December 2007. At the time of the inspection, the home did not have an activities coordinator in post, it was reported that interviews were to take place shortly for a person to work in this role. A member of staff is always allocated to remain in the sitting rooms to meet residents’ needs, however they do not generally have time to perform diversonal activities as they need to meet residents general care needs. The carer allocated to the sitting room was observed to spend much of her time assisting residents to have drinks and to ensure that they were safe when they moved around the rooms. The observation performed as part of the inspection showed that most interactions between staff and residents related to tasks such as reminding a person where a chair was so that they could sit down safely or reminding them that lunch was coming soon. Visitors were reported to be actively encouraged. Staff reported that several visitors frequently came into the home. One relative was present at lunchtime and assisted their relative to eat their lunch. Another resident was present during the morning and engaged another resident as well as their relative in conversation. Residents are enabled to personalise their rooms and many showed pictures such as family members or where they had last lived, on their walls. Ensuring that a person is able to choose where they have limited communion skills is complex. Staff reported that when a new person was admitted as well as getting information from relatives, they also tried to observe the person to find out from their behaviours such matters as for example, what they liked to wear or the types of drinks they preferred. At mealtimes, some residents were shown the different choices of meals, if that would help them choose what they would like to eat. The laundry staff understood the importance of residents wearing their own clothes, they reported that clothes were marked before they came to them and despite the laundry giving a service to all six homes on site, it was noted as good practice that the receptacle for clothes where the owner could not be identified, was nearly empty. A mealtime was observed. Some residents sat in the dining room, a few sat in a quieter area at a table in the conservatory sitting area, people also ate in the first floor smaller lounge and some people ate in their rooms. Discussions with staff indicated that very few people were able to eat without assistance. Glenside Manor - Lime Tree Wing DS0000048135.V345979.R01.S.doc Version 5.2 Page 16 Staff sat with residents, encouraging them and supporting them to eat. Staff plated up meals in an attractive manner, giving different size portions, according to what people wanted or were known to prefer. Residents who wished to have seconds (or thirds) were observed to be able to do so. The manager reported in the annual quality audit that they had recently worked with families to improve and develop menus, to increase the choice for pureed diet and a choice of hot and cold meals at lunchtime and supper. The amount of crockery and cutlery has been greatly increased since the previous inspection. Aids were provided when needed. Enough food is held in the kitchen for people to eat snacks between meals if they wish. One person was observed to be enjoying a bowl of porridge at 10:45am. Glenside Manor - Lime Tree Wing DS0000048135.V345979.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, 17 & 18 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents are protected by the home’s systems for ensuring that residents’ rights are upheld, complaints listened to and vulnerable adults safeguarded. EVIDENCE: The home has a complaints procedure, which is available to residents and their supporters in the service users’ guide and is displayed in the main entrance area. The manager reported that she tries to maintain close links with family and other supporters, to ensure that they are meeting resident’s needs. None of the residents were able to inform us about how they raised issues. However two relatives spoken to reported on how supportive staff were if they had any concerns. The complaints log was reviewed during the inspection. This showed that the manager is following the home’s complaints procedure. No complaints have been received by us since the last inspection. The training department have put work into developing staff knowledge of human rights legislation since the last inspection. It was noted that all residents now have a care plan relating to this area, including whether they wish to exercise their right to vote. These were individually written for each resident, often with the support of relatives and other supporters. Glenside Manor - Lime Tree Wing DS0000048135.V345979.R01.S.doc Version 5.2 Page 18 All staff receive regular straining in safeguarding vulnerable people. All staff spoken with showed an awareness of the importance of the area. All resident have an individual plan relating to their individual needs as a vulnerable person. These are regularly reviewed. Residents are supervised when in communal areas and the member of staff allocated to the area was aware, among other matters of the need to observe some residents who were not aware of their own more complex behaviours, to ensure that other residents were safeguarded. Staff reported that occasionally some residents could show complex behaviours. They showed a good understanding of the management of such behaviours, according to each person’s individual need. The manager showed a good awareness of her responsibilities under safeguarding adults procedures. No referrals have been made under the local procedures since the last inspection. Glenside Manor - Lime Tree Wing DS0000048135.V345979.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22 & 26 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents are supported by an environment which suits their needs, which is regularly maintained and has high standards of cleanliness. EVIDENCE: Lime Tree was purpose-built several years ago. It has wide corridors, which can allow two wheelchairs to pass at the same time. All doors are also fully wheelchair accessible. The Glenside Group employ a team of maintenance staff and staff working in the home reported that the maintenance department responded promptly when items needed attention. The home is undergoing a process of up-grading and redecorating bedrooms and ensuites; the plan is that this work will be completed by the end of December 2007. Glenside Manor - Lime Tree Wing DS0000048135.V345979.R01.S.doc Version 5.2 Page 20 On the first floor, the carpet is old and beginning to show some bubbles, these will need attending to before the carpet deteriorates further and becomes a tripping hazard to residents and staff. The home has a range of different lounges, to suit different people. Residents can also walk along the corridors is that is what they prefer to do. There is an secure wheel-chair accessible patio garden area at the back of the building, which staff reported was popular in the summer time. All bedrooms are en-suite. However due to their disability, many residents are not able to use bathing facilities provided in some en-suites. There is currently one communal bath, this is on the first floor. A disabled shower is in the process of being developed on the ground floor. Disabled wcs are provided close to all lounge areas. The home has a wide range of equipment provided to support people with complex needs. Each floor has several different hoists for manual handling which staff use according to individual resident assessed need. All beds are adjustable height and the home are gradually purchasing profiling beds which will be able to go down to the floor. Pressure relieving equipment is provided, in accordance with residents’ individual needs. A wide range of different chairs are available to support residents who have different seating needs. More sounders for the call bell system have been provided since the last inspection. Equipment, such as wheelchair scales is used less often across site and where such equipment is used, there are clear procedures in place to ensure correct cleaning, to prevent risk of cross infection between different registrations. The laundry is to the side to the building and provides a service to all six registrations on site. At the time of the inspection, the laundry was clean and well organised. Laundry staff reported that staff always kept to the group’s policies and procedures on separation of different types of laundry, this includes potentially infected laundry. All parts of the home were clean, including difficult to reach areas, such as undersides of bed frames. The cleaner was observed to pull out beds and clean underneath and behind them as part of their duties. In a home where residents experience a high degree of continence issues, including double incontinence, it is much to the credit of staff that there was no odour anywhere in the home. Glenside Manor - Lime Tree Wing DS0000048135.V345979.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents are supported by the numbers of staff on duty and the emphasis placed on training by the provider. There are safe systems for assessing the suitability of prospective staff. EVIDENCE: Lime Tree has a core group of staff who have worked in the home for many years. They knew the needs of the residents and their relatives and are fully aware of the procedures in the home. Any staff turnover is what would be anticipated for a registration of this size. The home’s off-duty roster shows that they have enough staff on duty to meet resident need. One relative reported “The staff make the place” another described staff as “excellent”. Staff work with one another and are prepared to help the home, for example at times of unplanned absence, such as sick leave. Due to the dependency and needs of residents, staff worked mainly in pairs and staff confirmed that there were enough people on duty for them to be able to do this. Central site services have developed an absence management procedure, to ensure that staff are supported and relevant action taken in case of sickness. Glenside Manor - Lime Tree Wing DS0000048135.V345979.R01.S.doc Version 5.2 Page 22 The Glenside Group encourages training and has a department run by an experienced and qualified training manager to support all registrations on site. One new member of staff described how they were supported throughout their induction period and had been linked to a “buddy” and a mentor. Induction programmes seen were fully completed and complied with current guidelines. Staff are supported in undertaking National Vocational Qualifications (NVQs) and over 50 of care staff are trained to NVQ2 or above. Training is also provided to registered nursing staff, most recently they have been supported in developing their management skills. The training department supports staff in developing skills relating to dementia care and is currently developing a programme, similar to their Cognitive Rehabilitative Training, provided to other registrations on site. Single training sessions are offered to staff on areas relating to resident care, such as diabetes and swallowing difficulty. All staff training records are held on computer file and can be regularly reviewed by relevant persons, to ensure that staff are maintaining their skills base. A central human resources department supports all registrations on site. This is run by an experienced human resources manger. Files showed that all staff provide a cv/application form and that any gaps service records are probed at interview. All people have references from at least two people on file, all of which are directly sourced, and complete a health check. All people have relevant police checks performed. People from aboard have a full check on their immigration status. All applicants are interviewed by two people, this includes prospective staff from abroad, and a full interview assessment completed. Copies of relevant certificates are retained on file and registration with relevant professional bodies checked. One of the senior managers reported that they have recently introduced a “trial” shift for the most recent employees and have found it useful, particularly where people are not used to the specialities at Glenside Manor. Glenside Manor - Lime Tree Wing DS0000048135.V345979.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents are supported by the home’s management systems, however attention to detail relating to certain areas of health and safety need to be further developed, to fully reduce risk to residents. EVIDENCE: The current manager has been approved by our central registration team since the previous inspection. She is an experienced registered nurse who has worked in this field for several years and was previously the deputy manager. Glenside Manor - Lime Tree Wing DS0000048135.V345979.R01.S.doc Version 5.2 Page 24 She is currently undertaking the Registered Managers Award. She is supported by a newly appointed deputy. Since her appointment, the current manager has worked hard to improve the home across a range of areas where standards needed attention. It is much to her credit that of the sixteen requirements identified at the previous inspection fifteen have been met in full and one showed progress. Of the sixteen good practice recommendations, fourteen have been met in full and there are plans in place to address the other two. The Glenside Group has an established system for reviewing quality of care provision. All units are visited regularly by a member of the senior management team and a monthly report drawn up. These reports are of a good quality and identify issues which need to be addressed, not only good practice matters. Senior managers seek views of residents and their supporters by making questionnaires freely available in the home. There was evidence that the managers respond when matters are raised. When individual areas are being considered, for example development of menus, the home actively seeks views of residents and their relatives. Complaints and accidents are regularly reviewed by senior mangers. Systems are being developed to progress link nurses in areas such as manual handling and infection control, who can lead on these areas and report back to managers, to further improve quality of service provision. The home does not hold any moneys for residents. All financial matters are dealt with by a central finance department. This department received invoices for services such as chiropody and hairdressing and debits individual computer accounts. Full invoices are sent out to residents’ supporters quarterly or more frequently if they prefer. The training department has systems available to ensure that all relevant staff complete all mandatory training. All staff, at all levels undertake manual handling training on an annual basis. Staff were observed several times to perform manual handling during the inspection and they were observed to complete the procedure in a safe manner, supporting the resident throughout. Staff are also trained regularly in fire safety and it was noted as good practice that there was increased training in fire safety for people who work night duty. Records show a good uptake of first aid and all staff who handle food have appropriate training. One recently employed catering assistant was being supported to attend college to undertake NVQs in catering. Staff are trained in infection control and those spoken with showed an awareness of the area. Alcohol hand rub has recently been provided at entrances to the home. Some areas of staff performance need attention, during the inspection, it was observed that staff carried a yellow bag (which is for potentially infected waste) with them on the linen trolley. They were observed to put waste into bags with their hands, touching the sides. This could cause hand contamination, leading to a cross infection risk and as such bags are needed, foot pedal operated mobile receptacles are indicated. Glenside Manor - Lime Tree Wing DS0000048135.V345979.R01.S.doc Version 5.2 Page 25 On another occasion, a member of staff was observed to carry used linen from a bed, not wearing gloves and again in this client group, this could present a risk of cross infection and gloves should always be worn when handling used bed linen. Many residents needed safety rail on their beds. Documentation relating to this has improved but still needs more development. At the start of the inspection, the managers were advised to consider guidelines from the Health and Safety Executive relating to risk assessments for safety rails and the needs for regular evaluations of their use. By the end of the inspection, they had obtained this information and were considering how to include it within their current documentation systems. They were advised that where a resident needs safety rails or other devices such as lap belts, that an assessment of need must always be drawn up and that this must be regularly reviewed, to ensure that the person’s risk can only be managed by use of such equipment. Glenside Manor - Lime Tree Wing DS0000048135.V345979.R01.S.doc Version 5.2 Page 26 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 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 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 3 18 3 2 3 2 4 X X X 3 STAFFING Standard No Score 27 3 28 3 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Glenside Manor - Lime Tree Wing DS0000048135.V345979.R01.S.doc Version 5.2 Page 27 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 OP38 Regulation 13(3) Requirement Staff must be provided equipment necessary to prevent spread of infection and trained in its use. Where safety rails or lap belts are in use, a full written assessment of their need and suitability must be undertaken. Such assessments must be reviewed on a regular basis. REQUIREMENT IN PROGRESS: Previous timescale 31/5/07 Timescale for action 31/12/07 2. OP38 14(a)(c) 31/12/07 Glenside Manor - Lime Tree Wing DS0000048135.V345979.R01.S.doc Version 5.2 Page 28 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. 3. Refer to Standard OP7 OP9 OP19 Good Practice Recommendations When documenting provision of care on charts, staff should document what care is given in accordance with company policy and procedures. All limited life medication should be dated on the day of opening. The corridor carpets on the first floor should be replaced, before they deteriorate further. Glenside Manor - Lime Tree Wing DS0000048135.V345979.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Regional Office 4th Floor Colston 33 33 Colston Avenue Bristol BS1 4UA 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. 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