Care Home: Limes Residential Care Home

What the care home does well During the RFI in April 2008 it was noted that the care plans were photocopies of the originals and the home was working with temporary files. The provider and her staff had ensured that all of this paperwork had now been filed in the correct place and care plans were back in place as the originals and not the photocopies that had been left following the RFI. Food is now of a good standard with cupboards and fridges containing plenty of fresh fruit and vegetables and grocery items. Residents are weighed regularly and their nutritional status assessed and documented. The home has had the bedrooms decorated and carpets and wardrobes replaced. There is a safe accessible garden to the back of the home and one particular resident looks after this. What has improved since the last inspection? Following the inspection in December 2007 twenty-three requirements were made and these have now all been met. The statement of purpose and service user guide has been reviewed and improved and is now available to all residents. On the day of the key inspection staff on duty were communicating well with the residents and no communication difficulties by staff were observed. The home now has an admission policy and procedure. Since the safeguarding investigation the home has not admitted any new residents so the procedure has not been tested.The home now has a complaints procedure and all complaints are logged and there is a clear investigation trail. This requirement was followed up during the random focused inspection (RFI) and had been met in April 2008. All residents are now weighed monthly and have a nutritional risk assessment in place. Their health needs are also monitored regularly by the general practitioner (GP). This requirement was followed up during the RFI and had been met in February 2008. Suitably trained staff now administer all medications and a record of those staff responsible is now kept. The activities programme has been reviewed and further developed. The home had kept records of food eaten by residents and more choice is offered. The provider also buys the food regularly so the cook can prepare wholesome and substantial meals. This requirement was followed up during the RFI and had been met in February 2008. Safeguarding adult procedures in the home have been strengthened and all staff have received training. Redecoration has taken place in bedrooms and furniture replaced and carpets renewed. Malodours within the home were not present on the three visits this year. Infection control procedures are now in place and staff have received training. This requirement was followed up during the RFI and had been met in April 2008. Staff numbers were reviewed and hours given for management and administration. The resident numbers have not changed this year, as there have been no new admissions. All new staff now has the required pre-employment checks and the reinstated staff now have the POVA first check. This requirement was followed up during the RFI and had been met in April 2008. Care practices have improved and were observed on the three visits made to the home this year. Care plans and risk assessments are now in place. All new staff now have an induction and appropriate training. Records are now kept of all training that has taken place and is planned for the year. New employees now work with an appropriately qualified and competent member of staff during their induction.Limes Residential Care HomeDS0000066830.V365423.R01.S.docVersion 5.2Page 8A new manager was appointed in February 2008 but was not registered. The provider has now appointed a deputy manager who has the registration papers to apply to become the new registered manager. Monthly visits will place to the home by the provider although she has visited the home daily since December including weekends. All records that are required in Schedule 4 of the Care Home Regulations are now in place. The stair lift was repaired following the inspection in December 2007 and the call bell system has been replaced. What the care home could do better: Following this key inspection no requirements were made. The commission will monitor the progress of this service by visiting the home to carry out a RFI before the end of the year. CARE HOMES FOR OLDER PEOPLE Limes Residential Care Home 11a Station Cresent Ashford Middlesex TW15 3JJ Lead Inspector Lesley Garrett Unannounced Inspection 25th June 2008 11:00 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 Limes Residential Care Home DS0000066830.V365423.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. Limes Residential Care Home DS0000066830.V365423.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Limes Residential Care Home Address 11a Station Cresent Ashford Middlesex TW15 3JJ 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) 01784 423341 0208 5783890 elmbank@talktalk.net Elmbank Residential Care Home Ltd Manager post vacant Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Limes Residential Care Home DS0000066830.V365423.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The named service users (as detailed in letter dated 6th March 2006) currently accommodated in the home who fall within the category of `dementia - over 65 years of age` may only continue to remain in the home subject to a full care management review and re-assessment of their individual care needs. No further admissions may take place in respect of that category. 3rd April 2008 Date of last inspection Brief Description of the Service: The Limes Residential Care Home is registered to provide accommodation and personal care for up to 16 older people. Situated in a quiet residential area, the home is within walking distance of Ashford town centre and is accessible by road and rail public transport systems. The building is a two- storey detached house that is domestic in scale and character. There is an attractive enclosed garden at the rear of the premises and limited car parking facilities at the front. Bedrooms are on the ground and first floor, accessible by stairs and stair-lift. These are all single occupancy, of varying sizes and shapes and fitted with washbasin and emergency call system. Facilities include an adapted assisted bathroom and walk- in shower. There is a large combined lounge and dining room on the ground floor beside the kitchen. A separate utility room is in an outbuilding and office facilities are in the attic. Fees are set at a flat rate of £450 per week. Limes Residential Care Home DS0000066830.V365423.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection of the care home was an unannounced ‘Key Inspection’. Mrs L Garrett, Regulation Inspector, carried out the inspection and the registered provider and the deputy manager represented the service. For the purposes of this report the person in charge will be referred to as the provider. We (the commission) arrived at the service at 11:00 and was in the home for five and a quarter hours. It was a thorough look at how well the home is doing. It took into account information provided by the home and any information that CSCI has received about the service since the last key inspection in December 2007. Following the last key inspection in December 2007 the service was given a quality rating of zero stars poor. Statutory notices were written in line with CSCI’s improvement plan. The notices referred to monitoring the residents weight and ensuring that they all have a nutritional risk assessment in place and that these assessments are monitored. The home was also asked to ensure that sufficent food was available at all times. We asked the home to ensure that infection control procedures were improved, correct procedures were followed when recruiting members of staff and that a clear complaints log be kept. Random focus inspections (RFI) then took place on the 25th February and the 3rd April 2008 to make sure that the home had complied with the notices referred to above. It was found that the home had fully complied with these notices at this time. The home has also been subject to investigation by the Surrey safeguarding team. The team had its last meeting regarding the home in June 2008 and the provider has been told that although no other meetings are planned the home will continue to be monitored. During this key inspection we spent time talking with some of the people living at the home and visitors that were in the home in order to seek their views about the home and the care they receive. The home was not asked to supply a further AQAA (Annual Quality Assurance Assessment). The last AQAA completed was for the key inspection in December 2007 and this is an annual document. We looked at how well the service was meeting the key national minimum standards and complying with the regulations and has in this report made judgements about the standard of the service. Limes Residential Care Home DS0000066830.V365423.R01.S.doc Version 5.2 Page 6 Documents sampled during the inspection included the home’s Statement of Purpose and Service User Guide, care plans, daily records and risk assessments, medication procedures, staff files, a variety of training records, and the home’s safeguarding and complaints policies and procedures. From the evidence seen and comments received, we consider that the home would be able to provide a service to meet the needs of individuals who have diverse religious, racial or cultural needs. What the service does well: What has improved since the last inspection? Following the inspection in December 2007 twenty-three requirements were made and these have now all been met. The statement of purpose and service user guide has been reviewed and improved and is now available to all residents. On the day of the key inspection staff on duty were communicating well with the residents and no communication difficulties by staff were observed. The home now has an admission policy and procedure. Since the safeguarding investigation the home has not admitted any new residents so the procedure has not been tested. Limes Residential Care Home DS0000066830.V365423.R01.S.doc Version 5.2 Page 7 The home now has a complaints procedure and all complaints are logged and there is a clear investigation trail. This requirement was followed up during the random focused inspection (RFI) and had been met in April 2008. All residents are now weighed monthly and have a nutritional risk assessment in place. Their health needs are also monitored regularly by the general practitioner (GP). This requirement was followed up during the RFI and had been met in February 2008. Suitably trained staff now administer all medications and a record of those staff responsible is now kept. The activities programme has been reviewed and further developed. The home had kept records of food eaten by residents and more choice is offered. The provider also buys the food regularly so the cook can prepare wholesome and substantial meals. This requirement was followed up during the RFI and had been met in February 2008. Safeguarding adult procedures in the home have been strengthened and all staff have received training. Redecoration has taken place in bedrooms and furniture replaced and carpets renewed. Malodours within the home were not present on the three visits this year. Infection control procedures are now in place and staff have received training. This requirement was followed up during the RFI and had been met in April 2008. Staff numbers were reviewed and hours given for management and administration. The resident numbers have not changed this year, as there have been no new admissions. All new staff now has the required pre-employment checks and the reinstated staff now have the POVA first check. This requirement was followed up during the RFI and had been met in April 2008. Care practices have improved and were observed on the three visits made to the home this year. Care plans and risk assessments are now in place. All new staff now have an induction and appropriate training. Records are now kept of all training that has taken place and is planned for the year. New employees now work with an appropriately qualified and competent member of staff during their induction. Limes Residential Care Home DS0000066830.V365423.R01.S.doc Version 5.2 Page 8 A new manager was appointed in February 2008 but was not registered. The provider has now appointed a deputy manager who has the registration papers to apply to become the new registered manager. Monthly visits will place to the home by the provider although she has visited the home daily since December including weekends. All records that are required in Schedule 4 of the Care Home Regulations are now in place. The stair lift was repaired following the inspection in December 2007 and the call bell system has been replaced. 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. Limes Residential Care Home DS0000066830.V365423.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 Limes Residential Care Home DS0000066830.V365423.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): 13&6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents will now have the information they require to make decisions about admission to the home. EVIDENCE: Since the last inspection in December 2007 the provider stated that the service user guide and statement of purpose has been updated. This was observed during the inspection and was available in the reception. The provider said that these new documents were now with the printers and when they are returned she will place one in each bedroom so that residents have their own updated copy. There have been no new admissions to the home since the last inspection. This has been a voluntary arrangement between the provider and the adult safeguarding team. During this inspection it was not possible to check if the Limes Residential Care Home DS0000066830.V365423.R01.S.doc Version 5.2 Page 11 admission procedures for the home had been followed. The provider and the deputy manager both stated that they would not admit residents to the home out of their registration category and both had good knowledge of what the registration requirements were. The provider stated that when the home begins to admit residents again both she and the deputy manager would do the assessments until she is satisfied that the deputy can do this on her own. We looked at the pre-admission documentation that will be used and this will allow staff to make a good assessment of prospective residents care needs. The home does not accommodate residents for intermediate care. Limes Residential Care Home DS0000066830.V365423.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 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments in place for all residents reflect their current care needs and all have been reviewed and updated. EVIDENCE: There are currently eleven residents in the home and we sampled two individual care plans. These plans detail the care that each resident requires and any risks that may be associated with any activity undertaken. The care plans were observed to have been regularly reviewed and updated and consultation taken place with the resident or their representative. We observed that residents had been consulted about the time they like to go to bed at night and when they would like to get up. Residents that were spoken to on the day of inspection stated that the staff were kind and that they were receiving the care that they needed. It was observed that the residents were all appropriately dressed for the weather and that fluids were regularly offered to the residents throughout the inspection. Limes Residential Care Home DS0000066830.V365423.R01.S.doc Version 5.2 Page 13 During the day we spent most of the time in the lounge/dining room observing the residents and staff. Interactions between them were appropriate with staff speaking in a respectful way promoting their dignity and privacy. Staff during this visit did not speak across residents or discuss their personal care with one another. Staff were observed to support residents with fluids, their meals and assisting with mobilising. The provider confirmed that the general practitioner (GP) visits regularly when called by the home. It was seen in the care plans that decisions made on these visits are all documented along with any actions required by the care staff. Other health care professionals are regular visitors to the home including the district nurse, opticians, chiropodist and dentist. All decisions made and treatments received were documented in the care plans. Medication procedures and practices were examined. A monitored dosage medication system is used and medication record keeping was satisfactory in the records sampled. Most medication is stored in a locked medication trolley kept in the kitchen when not in use. A metal medication cabinet with controlled drug (CD) storage is also available in the home. The deputy stated that the CD’s are checked every day by two carers. The home has a medication policy that was observed and also all staff have sample signatures in place. All staff that administer medication have now received training. During the day it was also observed that staff addressed residents appropriately by their documented preferred name. All personal care took place in the privacy of their own room or bathroom. Staff were observed to knock on residents’ doors prior to entering. Limes Residential Care Home DS0000066830.V365423.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 a visit to this service. The provision of food within the home has improved since the last inspection with residents now enjoying a wholesome balanced meal with choice available. EVIDENCE: On the day of inspection residents were observed either sitting in the lounge or the dining room area with the television. Two residents were watching the television, another reading magazines and one resident was outside gardening. Staff explained that all residents were now up but one resident prefers to stay in their room. One member of staff was sitting with one of the residents playing a board game. Staff confirmed that activities take place in the afternoon Monday to Thursday. In the afternoon residents were sat in the lounge doing gentle exercises whilst sitting in their chairs. The activity programme was displayed on the notice board. The activity organiser spoke with us and explained that the home is about to have their BBQ where all residents, relatives and friends are invited and a musician has been booked for entertainment during the afternoon. Limes Residential Care Home DS0000066830.V365423.R01.S.doc Version 5.2 Page 15 Visitors are welcome to visit the home at any time. The provider said there was no restrictions but that it was better to avoid meal times. Some of the visitors will take their family members out for the day and again this is encouraged by the home. On the day of the site visit two friends were visiting a resident. They both commented that the home had been improved recently with new carpets and furniture. They also said they were always welcomed by staff and given a cup of tea without having to ask for it. We recently assessed the provision of fresh fruit and vegetables and the variety of menus available to residents in February 2008. Requirements made at the inspection in December 2007 had been found to be met at that time. There has been no change since that time. The full time cook was not on duty on the day of inspection but a suitably qualified member of staff was cooking lunch that day. Residents were observed eating their lunch and they told us that they had enjoyed it. Very little waste was seen and they were asked if they would like anymore. Food likes and dislikes are all documented and this was seen and for some residents that have had identified eating problems in the past their food intake for the day is monitored and documented. The provider stated that she still does all the food shopping for the home and ensures there are always enough stocks. A blackboard is displayed in the dining room and the days meal in chalked on to this for residents information. Limes Residential Care Home DS0000066830.V365423.R01.S.doc Version 5.2 Page 16 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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected by the home’s complaints and safeguarding adults procedures. EVIDENCE: The complaints procedure is displayed on the wall in reception and is now available in the service user guide. The home has received two complaints since the last inspection, which have been investigated by the provider and outcomes have been documented. No complainant had contacted the commission with any concerns. Since the last inspection we have been contacted regularly by means of Regulation 37 notifications. The home has been investigated this year by the safeguarding adult procedures of the local authority. The final meeting has just taken place and the provider has been told that the home will be closely monitored over the next few months. The home has in place its own policy on safeguarding adults, which matches the local authority’s multi agency procedures. Staff spoken to on the day had a good knowledge of the safeguarding procedures and understood how to report any concerns. We looked at the home’s training records which confirmed that all staff had attended safeguarding training on the 14th June 2008. Certificates Limes Residential Care Home DS0000066830.V365423.R01.S.doc Version 5.2 Page 17 had not arrived at the home the provider stated they were still waiting for them. Limes Residential Care Home DS0000066830.V365423.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, well-maintained environment, which is free from offensive odours. EVIDENCE: Since the last inspection the provider has began the process of improving the home’s environment. All the carpets and wardrobes in the bedrooms have been replaced and the rooms redecorated. Some bedrooms benefit from wall mounted flat screen televisions. Call bells are now secured to the walls and the residents are now able to access them at all times. A new call bell system has been installed which requires staff to enter a pin number on entering the room which monitors how long staff spend with each resident. The provider stated that this system now allows her to monitor the staff and how long they spend with each resident but most importantly it ensures that residents are monitored at night. Limes Residential Care Home DS0000066830.V365423.R01.S.doc Version 5.2 Page 19 The provider stated that the next project that is planned is for the kitchen to be painted and new cupboards are to be fitted. All bedrooms that were viewed had been personalised and the garden was observed to be secure and to be well maintained, with seating and sunshade for residents’ safety. One particular resident spends most days outside gardening what ever the weather. The resident stated that this is something that they really enjoy. The home was clean and hygienic. All bathrooms seen during the tour of the building had paper hand towels and hand wash in place. Gloves and aprons were placed in the downstairs bathroom for all staff. Staff were observed to remove the aprons and gloves before moving to the next resident. No offensive odours were noticed. All staff has now received their infection control training and three members of staff are doing a six-month course that is provided by a local college. Limes Residential Care Home DS0000066830.V365423.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The training and recruitment procedures and practices within the home have improved since the last inspection. EVIDENCE: Since the last inspection the number of residents in the home has remained at eleven so that there are five empty beds. The rotas for the staff were observed which showed that everyday there is a senior carer in charge with the support of two carers for the morning shift. There is the same amount of staff for the afternoon shift and two carers do the night shift. The provider stated that she continues to monitor the home on a daily basis and this includes weekends and during the night. Evidence of these visits can be seen in the visitor’s book. There have been no admissions this year to the home and therefore staff numbers will need to be reviewed following any admission to the home in the future. The provider agreed that more staff would need to be recruited if the resident numbers increase depending on their pre-admission assessment. It will be a recommendation at the end of the report that the rota identifies who the person in charge is for each shift and their job title, as this was unclear on the current rotas. Limes Residential Care Home DS0000066830.V365423.R01.S.doc Version 5.2 Page 21 Since the last inspection the provider and deputy manager state that training has improved. All staff have now attended health and safety, COSHH, safeguarding adults and infection control. The provider also said that all staff would have completed a six-month dementia training course by the end of the year. Two recruitment folders were sampled and they contained all the necessary information that allows the provider to safely recruit new members of staff. All new staff receive an induction and the folders also demonstrated that the staff receive regular supervision sessions with a senior member of staff. The provider stated that all staff now have the National Vocational Qualification (NVQ) or are attending training for it at the moment. Staff spoken to on the day of inspection confirmed that the provider ensures that training takes place regularly and that they had attended. Limes Residential Care Home DS0000066830.V365423.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management arrangements at the home have been erratic but assurances have now been given that they will now settle. EVIDENCE: The home has not had the benefit of a registered manager since 2006. The person that the provider had recruited in February 2008 and that was present during the RFI visits in February and April has now been dismissed by the provider. The provider stated that there had been some problems with this person and that she felt it was better not to continue with their employment at the home. Limes Residential Care Home DS0000066830.V365423.R01.S.doc Version 5.2 Page 23 The provider has now appointed a deputy manager who has been at the home since January 2008 and she was in the process of completing the application form to become the registered manager. A telephone call was made to the home two weeks following the inspection and the provider confirmed that she was about to post the application form to CSCI. The deputy manager has level 4 NVQ and is currently in the middle of her registered managers award qualification. The deputy manager stated that she had already been completing the supervision and appraisal for the staff when the last proposed manager was in post. The provider explained that she understands the importance of securing a registered manager for the home. The previous nominated person had failed to complete the application form that had been given to her prior to going on her annual leave. A requirement will be made at the end of the report for the current deputy manager to submit her application as soon as possible following this key inspection. The provider has maintained daily contact with the home since the last inspection and this includes the weekends she also does all the food shopping and delivers this to the home. The provider stated that during April and May questionnaires were sent to all residents and their families or friends. The opinions of other healthcare professionals were also sought. We saw these questionnaires and the comments were very favourable to the home. Compliments included the high standard of care residents receive, the kindness of staff and the quality of the staff. Comments also received said that the cleanliness of the home was of a good standard and that the malodour had now improved/disappeared. The provider said that she had drawn up an action plan to address any issues that had been raised following the survey. It was stated that relatives deal with the residents’ money. The provider said that the home pays any bills for example the hairdresser, and the receipt is then given to the relatives who pay the home. Health and safety records were looked at and it was observed that all the necessary certificates were current and in place. These included the fire alarm and emergency lighting, call bells, gas and electric. Limes Residential Care Home DS0000066830.V365423.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 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 3 Limes Residential Care Home DS0000066830.V365423.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP31 Regulation 8 Requirement The registered provider will ensure that the current deputy manager completes her application form to become the registered manger and posts this to CSCI as agreed at the time of inspection and a follow up telephone call. Timescale for action 25/08/08 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 OP27 Good Practice Recommendations It is recommended that the staff rota contain information that states who is in charge for each shift and all staff members job titles. Limes Residential Care Home DS0000066830.V365423.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Limes Residential Care Home DS0000066830.V365423.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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