Care Home: Lime House

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What the care home does well Lime House provides comfortable accommodation for people living there. The home is good at making sure residents health is taken care of by seeing doctors and other health care workers when needed. Before people move into the home time is spent talking with them to find out about their care needs and if these can be met by the home. Opportunity is also made available for people and their relatives to visit before they decide if they want to come and live there. Lime House helps people to live their lives as they choose including arranging social activities in the home and regular trips out. People were also very satisfied with the food provided. Comments were received from people about the activities and choice of food, `care is taken to give me nourishing and attractive meals that meet my needs, I very much appreciate this kindness and skill`, `I`m not keen on activities but I have been given a room that houses me and my favourite books`, `very good food` and `they offer a variety of activities`. Other feedback included; `I am very happy at Lime House`, `staff are caring and considerate`, `they cater for my relatives needs`, `it`s a home from home` and `I`m completely satisfied with the services offered by Lime House.` What has improved since the last inspection? Good practices recommendations made during our last visit had been addressed. The statement of purpose and home`s welcome pack has been updated so that the right information is available for people, both new and those already living at the home. This contains a copy of the complaints procedure so that people are clear about what to do if they have any concerns. Improvements are being made to the environment. This will include a new salon where people will be offered additional treatments as well as hairdressing. Work identified following the food hygiene inspection has also been addressed ensuring the environment is well maintained and meals are prepared safely. What the care home could do better: The home`s manager has not yet registered with us (the commission) since being appointed in October 2006. This must be addressed as a matter of urgency. Copies of the new documents about what the home offers are to be forwarded to us. Care plans and risk assessments need to be expanded upon to show the changing needs of people living at the home and how these are to be met by staff ensuring any potential risk is minimised. Information must be provided to us to show that action required on the gas safety and electric circuit certificates have been addressed so that people are not placed at risk. CARE HOMES FOR OLDER PEOPLE Lime House Newton Road Lowton Nr Warrington Cheshire WA3 1HF Lead Inspector Lucy Burgess Unannounced Inspection 14th February 2008 09:15 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 Lime House DS0000005746.V359215.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. Lime House DS0000005746.V359215.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lime House Address Newton Road Lowton Nr Warrington Cheshire WA3 1HF 01942 674135 01942 678796 lime.house@nugentcare.org 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) Nugent Care ** Post Vacant *** Care Home 32 Category(ies) of Dementia - over 65 years of age (11), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (1), Old age, not falling within any other category (32) Lime House DS0000005746.V359215.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 32 service users to include:Up to 32 service users in the category of OP (Older People over 65 years of age) Up to 11 service users in the category of DE(E) (Dementia over 65 years of age) Up to one service user in the category of MD(E) (Mental Disorder over 65 years of age) 2. 3. The service should employ a suitably qualified and experienced Manager who is registered with the CSCI. The Registered Person must ensure that all staff working in the home have dementia awareness and dementia care training, which equips them to meet the assessed needs of the service users accommodated, as defined in the individual plan of care. The service should at all times employ suitably qualified and experienced members of staff, in sufficient numbers, to meet the assessed needs of the service users with dementia. 4. Date of last inspection 5th July 2006 Brief Description of the Service: Lime House provides residential care for up to thirty-two residents who are elderly, of either sex. This includes up to eight residents over sixty-five with dementia and one resident over sixty-five with a mental disorder. The home is part of Nugent Care, whose head office is based in Liverpool. Lime House premises are leased from Wigan Council. Lime House is set within its own landscaped grounds in a residential area. The home has a main house and a lodge, which are connected by a link area. The majority of residents live in the main house, which has two lounge areas and a dining room with a sitting area. The lodge has a combined lounge and dining room. Lime House DS0000005746.V359215.R01.S.doc Version 5.2 Page 5 The home is in Lowton. There is a reasonable level of public transport, shops and local facilities in the area. Fees range from £360.50 to £455. Additional charges are made for hairdressing, toiletries and newspapers. Lime House DS0000005746.V359215.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was a key inspection, which included a site visit and took place over one day, for a period of 8½ hours. The service did not know that the inspector was to visit. During the inspection care and medication records were looked at as well as information about the staff and health and safety including how the home and equipment were kept safe. The inspector also looked around the building to check if it was clean and well decorated. As part of the inspection process the provider’s are asked to complete a selfassessment survey information document (Annual Quality Assurance Assessment). This was sent to the home before the inspection and had been completed by the manager and returned to us prior to the site visit. Other information was gathered from the feedback surveys we sent out. We received completed surveys from 1 relative and 8 people who live at the home. Time was also spent during the visit speaking with staff and people who live at the home. Comments have been added to the report. Discussion and feedback was held with the Manager. What the service does well: Lime House provides comfortable accommodation for people living there. The home is good at making sure residents health is taken care of by seeing doctors and other health care workers when needed. Before people move into the home time is spent talking with them to find out about their care needs and if these can be met by the home. Opportunity is also made available for people and their relatives to visit before they decide if they want to come and live there. Lime House helps people to live their lives as they choose including arranging social activities in the home and regular trips out. People were also very satisfied with the food provided. Comments were received from people about the activities and choice of food, ‘care is taken to give me nourishing and attractive meals that meet my needs, I very much appreciate this kindness and skill’, ‘I’m not keen on activities but I have been given a room that houses me and my favourite books’, ‘very good food’ and ‘they offer a variety of activities’. Lime House DS0000005746.V359215.R01.S.doc Version 5.2 Page 7 Other feedback included; ‘I am very happy at Lime House’, ‘staff are caring and considerate’, ‘they cater for my relatives needs’, ‘it’s a home from home’ and ‘I’m completely satisfied with the services offered by Lime House.’ What has improved since the last inspection? What they could do better: The home’s manager has not yet registered with us (the commission) since being appointed in October 2006. This must be addressed as a matter of urgency. Copies of the new documents about what the home offers are to be forwarded to us. Care plans and risk assessments need to be expanded upon to show the changing needs of people living at the home and how these are to be met by staff ensuring any potential risk is minimised. Information must be provided to us to show that action required on the gas safety and electric circuit certificates have been addressed so that people are not placed at risk. Lime House DS0000005746.V359215.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Lime House DS0000005746.V359215.R01.S.doc Version 5.2 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 Lime House DS0000005746.V359215.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were appropriately assessed before admission to the home to ensure their needs can be fully met. EVIDENCE: The home has information available for people who are considering moving to the home. The statement of purpose and welcome pack (service user guide) have been reviewed and updated to reflect the changes that have taken place. These provide information about the facilities and service offered within the home and what people can expect. This enables people to make a decision about whether the home is able to meet their needs. Copies of the new documents are to be forwarded to us. Information was looked at with regards to people living at the home, this included people who had recently moved in. The manager explained that where people are funded by the local authority an assessment is requested. Lime House DS0000005746.V359215.R01.S.doc Version 5.2 Page 11 The home also carries out their own assessment to ensure that they have all relevant information. Information seen on the files included a pre-admission assessment and pre admission risk screening tool. These had been completed prior to the people moving in. Discussions are held with prospective residents and their relatives when gathering information. On admission a further record is completed to welcome the new person. This involves introducing them to other people living at the home and the staff on duty, establishing what food preferences people have, what their preferred routines is, any requests they may have i.e. newspaper and arrangements for personal items. In gathering this information this ensures that the home are only admitting people that they are sure they are able to fully meet their needs. Information gathered is then used to develop the care plan. Information was received from relatives and people living at the home in the feedback surveys. People expressed that they received sufficient information about the service, which helped them to make a decision about moving into the home. Standard 6 does not apply, as Lime House does not provide Intermediate Care services. Lime House DS0000005746.V359215.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported in meeting their personal and health care needs however information recorded in the plans needs to reflect their current and changing needs so that any areas of potential risk are minimised. EVIDENCE: Information is held for each of the people living at the home. As already identified earlier in the report this includes assessment information. Other records includes personal details, relevant contact details for people involved, an individual contract, care plan, weight records, progress reports and a ‘getting to know you document’. This document includes information about the person’s hopes, beliefs, interests, family history and any significant events, providing a good pen picture of the person. Care plans had been written in the 1st person however had not been signed and dated by the person to evidence their involvement. Whilst it was clear through discussion with the manager and supervisor that they were fully aware of the specific needs of people, care plans did not fully Lime House DS0000005746.V359215.R01.S.doc Version 5.2 Page 13 reflect this information. One person was receiving support from district nurses due to pressure care and a referral had been made to the dietician due to other concerns, however there was no information in the plan with regards to what intervention was being made and guidelines for staff with regards to specific support. Further risk assessments had not been completed other than that recorded on the pre-admission risk screening. Another plan stated that this person required assistance in managing a colostomy bag, that their diabetes was diet and medication controlled and that they were on warfirin medication. However there was no information about the level of support to be offered by staff or what checks were made either by the home or health professionals to ensure their health and well being was maintained. Where particular areas of concerns have been identified either through the assessment process or following admission a specific risk assessment should be completed for each area clearly showing staff what support is to be provided to minimise such risk, these should be reviewed on a monthly basis along with the care plan or more frequently depending on the level of concern. Each person has access to a GP and additional support is provided from other health care professionals should this be required. This may include the district nurses, dietician, continence advisor etc. Staff provided support to appointments as well as on transportation. Families are consulted with in relation to whether they wished to be kept informed of any issues or if assistance is required should someone need to go to hospital. Agreements are recorded on file. The medication system was also looked at. During the day time the medication trolley is secured to the wall near to the dining room so that it is easily accessible. It is then returned to the office at the end of each day. Medication is only administered by senior staff that have completed relevant training. Administration records are maintained and were found to be in good order. All items received to the home as well as those returned to the pharmacy are recorded and signed for. Records are maintained with regards to controlled drugs. These are signed for by two members of staff. Additional records are also held with regards to homely remedies such as paracetamol and senna. Separate storage is available within the office for controlled drugs and items that need to be refrigerated. At present only 1 person living at the home self medicates. A risk assessment has been completed and is reviewed as part of the care plan. The supervisor spoken with said that the home receives good support from the supplying pharmacy and local GP. ‘Clinics’ are held each Friday when the Lime House DS0000005746.V359215.R01.S.doc Version 5.2 Page 14 doctor visits the home providing opportunity for medication to be reviewed if necessary. The last pharmacy audit was carried out on the 30 January 2008, no issues were identified. From observation made, attention had been given to people’s appearance ensuring their dignity was respected. People were appropriately dressed, some ladies were wearing make up and jewellery and a number of people were having their hair done by the visiting hairdresser. Staff spoke to people in a respectful manner and were seen to knock on doors before entering ensuring peoples privacy was maintained. Some of the comments received from people included; ‘I am very happy at Lime House’ caring and considerate’, ‘they cater for my relatives needs’, ‘it’s a home from home’ and ‘I’m completely satisfied with the services offered by Lime House.’ Lime House DS0000005746.V359215.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 good. This judgement has been made using available evidence including a visit to this service. People are encouraged and supported to exercise choices in their daily routines in relation to lifestyle, food and activities and to maintain contact with their relatives. EVIDENCE: Opportunities are provided to meet people’s social, religious and recreational needs and preferences. The home employs an activity worker who works 20 hours per week. The programme in place offers bingo, arts and crafts, quizzes and reminiscence. Occasionally an outside entertainer also visits the home. For those people who benefit from more 1-2-1 support, hand massages and walks are offered. Support is also provided by the homes volunteers. During the visit one volunteer spent time at the home offering people a manicure and chatting with them. They said that they visited the home each week and enjoyed spending time with people. Outings are also organised such as a pantomime, visiting the local park, pub lunches and shopping trips. There is also access to a minibus, which is used Lime House DS0000005746.V359215.R01.S.doc Version 5.2 Page 16 for such events along with the driver who also has responsibility for maintenance within the home. Work was being carried out at the home during the visit with regards to the new salon. This was being moved to a larger room so that the facilities could be improved. Once completed this will be used for ‘pamper days’ offering hairdressing and manicures etc. The home is also supported by the ‘Friends of Lime House’. This is a group made up of relatives and people known to the home. Events are held to raise additional money for specific items, which benefit those living there. Fundraising events have included a garden party, Manhattan Ball, a further one is planned for June 2008 and an auction, which raised £12,000, was very well supported by local people and companies. Items such as a camera for the home and funds towards a holiday for a small group of people with staff support have been purchased. The religious needs of people are also addressed with services from both the Catholic Church and Church of England being held. Routines were seen to be flexible. The home offers several areas where people can sit and relax either enjoying music or watch the television, alternatively people spend time in their own rooms. Arrangements are made for those people requesting a newspaper. Visitors are welcome at any time throughout the day. People are encouraged to maintain relationships with family and friends enjoying visits both in and way from the home. Care notes also contain details of activities people like to take part in as well as details of hobbies and interests. There are also meetings held where activities and meals can be discussed. Feedback from people about the activities and choice of food, ‘care is taken to give me nourishing and attractive meals that meet my needs, I very much appreciate this kindness and skill’, ‘I’m not keen on activities but I have been given a room that houses me and my favourite books’, ‘very good food’ and offers a variety of activities’. A choice of meals are provided throughout the day including a cooked breakfast on request. The main meal is served at lunch times, with a lighter meal in the evening. Drinks and snacks are available throughout the day. Meals are home cooked and the use of convenience foods is limited. Details of the menus are displayed within the dining room. The dining room was clean and tables were nicely set. Lime House DS0000005746.V359215.R01.S.doc Version 5.2 Page 17 Time was spent talking with the cook and looking at food stocks. The kitchen area was clean, tidy and well organised. Records are completed in relation to health and safety and stock control. A food hygiene inspection was held on the 30 August 2007. A number of areas were identified within the report in relation to food safety, the kitchen environment and hand washing and toilet facilities. This was discussed with the cook who stated that all the work had been completed. Lime House DS0000005746.V359215.R01.S.doc Version 5.2 Page 18 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. This judgement has been made using available evidence including a visit to this service. An effective complaints system is in place, with which people are familiar. Staff training and good recruitment practices ensured that, as far as possible, residents were protected from abuse. EVIDENCE: The home holds policies and procedures with regards to complaints and protection. A copy of the procedure is also available within the documents provided about the home as well as being discussed at meetings. This ensures that people living at the home and their relatives are aware of what to do should they have any issues or concerns. No formal complaints have been received by the commission. We received completed surveys from 8 people living at the home and 1 relative, all commented that they were aware of the procedure to follow if the had any concerns or complaints. One person said, ‘I’ve never had to use this service’. Information provided by the manager within the AQAA states that there has been 1 safeguarding issue. This was discussed with the manager who said that the incident had been between two people who live at the home and consultation had taken place involving relatives, the GP and the social work team. Lime House DS0000005746.V359215.R01.S.doc Version 5.2 Page 19 Staff have received training in relation to safeguarding and evidence of this was seen on staff files. This will ensure that staff are clear about the procedure to follow should an issue arise ensuring people are protected. Lime House DS0000005746.V359215.R01.S.doc Version 5.2 Page 20 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home appeared clean, comfortable and well maintained, providing a safe environment for people living at the home. EVIDENCE: Lime House in a large detached property set in extensive grounds. There is parking available at the front of the property and ample garden space. One area to the rear of the property provides a safe enclosed garden where people are able to sit and relax during the nice weather. To ensure that the home is maintained to a good standard both internally and externally they have access to a maintenance worker and gardeners. There are two large lounges, one quite and one TV lounge, which both overlook the enclosed garden. Additional space is provided in the ‘Lodge’, which has its own lounge /dining area. A small number of bedrooms were Lime House DS0000005746.V359215.R01.S.doc Version 5.2 Page 21 looked at. Rooms had been personalised with people bring items from home. Some of the rooms have been fitted with a door bell. There are also a number of bathrooms and toilets provided throughout the building. Signs are clearly displayed so the people can see where bathrooms and toilets are located. Assisted bathing is available and toilets are situated close to communal areas. At present work is being carried out to provide a new sluice room and hairdressing salon. The home was awarded £9000 as part of the local authority capital grant. This is being used to purchase a macerator for the sluice room. Staff are provided with protective clothing such as gloves and aprons. Adequate hand washing provisions were available in bathrooms and toilets. Staff are asked to wear appropriate clothing if they are spending time in the kitchen area. A large laundry is situated within the basement. This was clean and well organised. The manager explained that at present all personal laundry is carried out within the home however larger items such as bedding is sent out. Alternative arrangements are being explored so that this can be managed at the home. The home employs a number of staff that are responsible for ensuring the maintenance and domestic work. On the day of the visit the home was found to be warm, clean and tidy. There was no malodour. Lime House DS0000005746.V359215.R01.S.doc Version 5.2 Page 22 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 good. This judgement has been made using available evidence including a visit to this service. Sufficient trained staff were on duty throughout the day and night to ensure the needs of the residents could be met. EVIDENCE: Staffing at the home comprises of the manager, supervisors and care staff. There is also a team of ancillary staff who take responsibility for the domestic work, catering, laundry and maintenance work. An activity worker is also employed 20 hours a week providing opportunities for social activities and outings. Copies of rotas were looked at. Sufficient staff were seen to be on duty throughout the week. Where shifts required cover this had been done by existing members of the team offering continuity. Whilst agency staff are used the manager explained that this was through a regular agency used by the organisation and that the staff provided had previously worked at the home. Additional staffing was being looked at due to some long standing members of the team retiring or being on maternity leave. Opportunity is made available for a staff handover during change of shifts. This allowed for information to be shared within the team. Lime House DS0000005746.V359215.R01.S.doc Version 5.2 Page 23 Generally information about staff recruitment is held centrally at the head office however recent recruitment information was available within the home. Files were looked at for 3 staff that had been recruited since our last visit. Information held on file included; application form with full employment history, disclosure information regarding POVA 1st checks and criminal record check), health screening and references. It was noted that some staff had previously worked at the home and returned or had changed role within the company however the manager had recruited them as well as providing them with a references. Where possible alternative references should be sought offering another view about the person suitability for the role. It was found that staff did not commence work unless the relevant checks had been carried out and that further criminal checks were made for those people who had changed post. In relation to training, there was evidence of new staff completing an induction so that they are aware of what is expected of them. Additional courses such as safeguarding, moving and handling, food hygiene, fire safety, infection control and first aid have been offered to staff over the last year. As the home provides support to a number of people with dementia care needs, the manager and one of the supervisors have also completed training in dementia care mapping. This provides guidance on the different types of dementia, methods of communication and care planning so that staff are clear about how they are to meet their specific needs. Information was provided in relation to NVQ training. Currently 12 members of the team have completed NVQ level 2 and two of the supervisors are currently completing level 3. Two further supervisors are qualified NVQ assessors. The manager and another supervisor hold level 2, 3 and 4. Arrangements are to be made for the new staff to enrol on the course. The atmosphere in the home was very relaxed. Interactions between people were warm and friendly. Staff spoken with felt support in their role and said that the manager was ‘fair and supportive’. Lime House DS0000005746.V359215.R01.S.doc Version 5.2 Page 24 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 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was well managed which was reflected in the good outcomes for people with regard to the quality of care they were receiving. However the manager must ensure that an application is forwarded to the Commission in relation to her registration. EVIDENCE: The current manager has been in post since October 2006, having held an ‘acting’ position following the registered manager retiring in March 2006. The manager has worked at Lime House for several years prior to this and has completed the NVQ Level 4. Whilst information was requested in 2006 for the new manager to register with us, this has yet to be done. Immediate action must now be taken without further delay. Lime House DS0000005746.V359215.R01.S.doc Version 5.2 Page 25 Support continues to be provided from Head Office through regular visits and telephone contact. There remains a clear line of accountability in the home ensuring the outcomes for people are good. Systems are in place with regards to quality assurance system. Regular resident and staff meetings take place and are minuted. Minutes read from the last staff meeting addressed issues in relation to dignity and standards of care. Internal audits are in place with regards to medication, accidents, staffing and plans etc. Further visits by a representative of the organisation also take place on a monthly basis and a written report is then produced of the findings. Information collated through the auditing informs part of the homes business plan, which is reviewed by the manager and her line manager. External auditing also takes place. The Contracts Section of Wigan Social Services Department, in conjunction with a company called RDB Limited undertake a voluntary star rating of homes in Wigan. This includes consultation with people living at the home and staff. Lime House has been awarded 5 stars, which is the highest rating. Lime House encourages people to manage their own finances with help from a representative if needed. A lockable facility is provided in all bedrooms for safe keeping of money and other valuables. Money is only held for a small number of people. Appropriate records are maintained and receipts are kept. As already identified the home employs a maintenance worker. Their role is to carry out fire safety checks, water temperatures as well as general repairs within the home. Servicing records were also available. These included the hoists, passenger lift, fire equipment, laundry equipment, small appliances, electric circuits, emergency lighting and gas. Action was required following the gas servicing, the manager stated that the work had just been carried out. Evidence of this is requested. The five year electric report dated July 2007 states ‘unsatisfactory’, action was also identified within the report. Work had been carried out to the floodlight at the front of the property in January and information seen stated ‘additional scheduled repairs to be done July 2008’. This is to be followed up be the manager ensuring that all immediate issues have been completed. Information is documented in relation to accidents and incidents. These are monitored on a monthly basis to ensure that prompt action is taken should concerns be identified. Notifications are also forwarded to us ensuring that we are kept informed of any issues concerning the well being of people living at the home. Lime House DS0000005746.V359215.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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Lime House DS0000005746.V359215.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 OP31 Regulation Section 11 Care Standards Act 2000 Requirement An application for a suitably qualified, competent and experienced manager to be registered with CSCI must be submitted. The responsible individual must keep the CSCI (Commission for social care inspection) informed of progress in meeting this requirement. Timescale 28/04/06 and 1/09/07 not met. Care Plans and risk assessment should clearly reflect all areas of support and intervention required ensuring staff have all relevant information so that they are able to met the individual needs of people as well as minimise any areas of potential risk. Timescale for action 30/03/08 2. OP7 12/15 30/03/08 3. OP38 13 30/03/08 Action required within the unsatisfactory electric circuit certificate musty be addressed to ensure that people are not placed at risk. Evidence of work completed should be forwarded to us. DS0000005746.V359215.R01.S.doc Version 5.2 Page 28 Lime House 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 OP1 Good Practice Recommendations Copies of the up to date statement of purpose and welcome pack are forwarded to CSCI. Where possible an alternative references should be sought offering another view about the person suitability for the role. The manager is asked to provide evidence to show that the work completed in relation to the gas supply has been completed. 2. OP29 3. OP38 Lime House DS0000005746.V359215.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 Lime House DS0000005746.V359215.R01.S.doc Version 5.2 Page 30 - 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. 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