Care Home: The Limes

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Limes Beverley Close Basingstoke Hampshire RG22 4BT two star good service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Peter McNeillie Date: 2 9 0 8 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: The Limes Beverley Close Basingstoke Hampshire RG22 4BT 01329835400 01329834448 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): BLISS Residential Care Ltd Mrs Tracy Ann Clare care home 5 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 0 0 learning disability Additional conditions: The registered person may provide the following category of service only: Care home providing personal care (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disability (LD) The maximum number of service users to be accommodated is 5. Date of last inspection 2 9 0 8 2 0 0 8 Care Homes for Adults (18-65 years) Page 4 of 27 A bit about the care home Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 27 How we did our inspection: This is what the inspector did when they were at the care home This report was written after taking into consideration a number of sources of information and evidence. These included information provided at registration, a site visit to the service, information obtained from examining residents and staff records, personal observations, talks with residents staff and management and responses by the manager to a CSCI Annual Quality Assurance Assessment (AQAA) prior to the inspection. This key unannounced visit was the first inspection since registration in february 2008 and took place on 29/08/08 between the hours of 09.00 am and 1.00pm. During the inspection at which all of the key standards for care homes for younger adults and any previous requirements were assessed. As this was the homes first inspection since registration and therefore there was not a history of sustained improvement, as a result of our findings we were unable to award an overall quality rating of excellent. The results and findings contained in this report will determine the frequency and type of future inspections. Care Homes for Adults (18-65 years) Page 7 of 27 What the care home does well What has got better from the last inspection What the care home could do better Risk assessments in respect of residents self medicating need to be more detailed and transparent. Menus need to be displayed in a foemat that all residents can understand. Care Homes for Adults (18-65 years) Page 8 of 27 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Peter McNeillie The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 01622724950 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries.southeast@csci.gsi.gov.uk or by telephoning our order line - Care Homes for Adults (18-65 years) Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home has a system of assessing and identifying residents diverse needs which ensures residents safety and that their assessed needs can be met that involves residents and/or their representatives. Evidence: Since registration in February 2008 only two residents have been admitted. We were informed that the homes admissions policy and procedure requires, no resident is admitted into the home without a full assessment of need and risk being carried out by the manager or a senior member of the homes management team in consultation with the resident in tandem with an assessment by the potential residents external care manager. The registered manager explained to us despite having many requests to admit new residents applicants were only being accepted if the home was 100 satisfied it could meet all of the assessed needs and the resident was compatible with other residents. We viewed the pre admission assessments of both residents. Care Homes for Adults (18-65 years) Page 11 of 27 All of the records seen confirmed that the residents were admitted in accordance with the comprehensive admissions policy and procedure using an assessment tool that incorporated the use of pictures to ensure full understanding of the process by all parties. We were informed that any alternative methods of communication would be used to ensure all parties were fully aware and understood the process. All assessments viewed included evidence the potential resident had been consulted and contributed to the assessment process. Care Homes for Adults (18-65 years) Page 12 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home has a well-developed system of planning and reviewing care which reflects residents wishes, aspirations, diversity and ensures residents needs are met within a risk management policy and involves residents, residents representatives or relatives in decisions that affect them. Evidence: Both residents care/written support plans which can be produced in a format best suited to the resident were viewed. Plans which are reviewed at least monthly included confirmation that the resident or their representative had been involved in and consulted about the plan are based on an initial assessment of needs and risk which took into consideration, resident’s needs, wishes, choices, aspirations, risks, details of any health care professional involved, communication methods, dietary needs and help required with eating and drinking. Staff who had a good understanding of the contents of the care plans and risk assessments were able to explain how the care plan was put into day-to-day practice. Care Homes for Adults (18-65 years) Page 13 of 27 To ensure equality and diversity are promote within the service we were informed that:full assessments of needsis identified during the transitional/assessment process. care plans are person centred, identifying all needs goals ,desires,and aspirationsetc. We offer a key worker system, so that staff skill mix is varied and appropriate. We fully adhere to the equeal opportunities policy and procedure. We have contacted the local library to find out abour local groups etc relevanyt tp service users needs i.e the gay community. Residents right, and the opportunity to take risks is seen as fundamental. The home takes into full account any residents understanding the concept of risk and risk taking and supported residents to make decisions for themselves within a risk assessment framework. This process identified individual risks and how they were to be managed, enabling residents to take part in activities in a safe manner. Should restrictions need to be imposed these would be agreed with the resident and recorded in the care plans. Care Homes for Adults (18-65 years) Page 14 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The social activities family contacts and the provision of varied and nutritious meals were well managed and reflected residents interests and choices. Evidence: The home has developed individual activities programmes developed for each resident based on their interests and choices using educational and employment services and resources within the home and the wider community. Records viewed indicated that residents were attending further education classes and in one instance voluntary employment. As part of providing suitable employment the home are in negotiations with Turning Point which is a government initiative to provide paid employment for persons with a learning disability. Whilst the home is prepared organise social ativities and assist with transport, in an atempt to encourage more independance residents are encouraged Care Homes for Adults (18-65 years) Page 15 of 27 and supported to make their own arrangements and manage their own time. Currently activities available include, music, it skills, attending church, swimming, cooking, crafts, life skills and trips out to places of interests. One resident has her own pet. Resident’s families and friends are encouraged to visit at any time. Residents who are free to receive visitors in private and choose who they wish to see, are supported in maintaining family contacts, establish friendships and can make and receive telephone call in private. A written daily menu based on resident’s likes and dislikes was available. The homes staff and management recognised that alternatives to a written menu is of importance for some residents with a learning disability who may find the addition of pictures would be beneficial to their understanding and assist in them making meaningful choices. A vertbal undertaking was given by the manager to assist residents that required menus will be developed in an alternative format to assist choice and understanding. Care Homes for Adults (18-65 years) Page 16 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Satisfactory arrangements are in place, ensuring the personal emotional, health care and medication needs of residents are met. Evidence: Guidelines seen and comments by staff indicated choice was being exercised by residents in respect of all aspects of their lives these would include providers of personal services, bedtimes, clothes, food, gender of carer, GP, dentist optician and key worker. Records viewed also indicated that any special medical or health or social care needs would be provided following consultation with the appropriate professional, these might include the local; learning disability team, doctors, district nurses, physiotherapists, occupational therapists, speech and language therapists, and care managers. Records were kept of appointments with all health and social care professionals and included details of any advice and treatment given All residents are registered with a doctor of their choice and are able to exercise a preference about the gender of the doctor consulted. Care Homes for Adults (18-65 years) Page 17 of 27 Medication records confirmed that all prescribed drugs and medicines, which are securely stored and administered in accordance with a medication policy and procedure by trained staff who confirmed they were aware of and had read the procedure. The record of drugs and medicines administered to residents and unwanted drugs disposed of were complete and accurate. A procedure that ensures residents who wish may assume responsibility for their own medication was in place. Records viewed confirmed no resident was responsible for their own medication however in our view risk assessments need to be more explicit and clearly indicate how and why the decision was reached as to whom is responsible for administering and recording medication taken by residents. A verbal undertaking was given by the manager to ensure records reflected this. Care Homes for Adults (18-65 years) Page 18 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home has clear policies and procedures in place which ensures residents are able to complain and are protected from abuse. Evidence: A whistle blowing and Adult Protection Policy and Procedure have been implemented to work in tandem with the procedure produced by Hampshire County Council. All management staff spoken to demonstrated they were aware of the procedure to follow should they witness or suspect the abuse of a resident. The complaints procedure, which was also included in the service users guide included information on how to contact The Commission for Social Care Inspection (C.S.C.I), was seen, as was record of complaints. CSCI has received no complaints since registration. Residents spoken with confirmed they knew how and to whom to complain. Staff stated they felt comfortable in discussing issues with management on behalf of any resident and were confident any issues raised would be dealt with promptly and fairly. Care Homes for Adults (18-65 years) Page 19 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . A safe, well maintained, clean ,suitably furnished and well located home is provided for residents which meets their needs. Evidence: The home, which blends in with neighboring properties and has no stigmatizing signage, is situated in a pleasant residential area in Basingstoke close to shops, communal facilities, a sports centre and with easy access to the M3 Motorway. All areas of the home were very clean and free from unpleasant odors and obvious hazards, furniture was new, comfortable, homely and in a good state of repair and met the residents needs. Residents who were full of praise for the facilities and their own accommodation rating it The best, were able to access all areas of the home including the garden. There is a rolling programme of maintenance to ensure that the building is well maintained, decorated and kept safe for the resident and staff. It was evident agreat deal and of time, resources, consideration and expertise had clearly gone into decorating furnishing, and equipping the spacious building. Care Homes for Adults (18-65 years) Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Resident’s needs are met by sufficient numbers of well trained and supported staff who are recruited and selected using a procedure designed to protect all residents. Evidence: The planned daily staffing levels for the home each at least are for at least three members of staff to be on duty at all times during the daytime hours and one waking and one sleeping member at night. At the time of our visit, in our view the number of management, care staff available met the residents’ needs, a view supported by the care staff and residents. the manager informed us staffing levels would be adjusted at any time to meet the needs of residents both temporary and permanent. We viewed three staff recruitment and training files selected at random. All files viewed included evidence that staff are employed in accordance with a robust recruitment and selection procedure, which is designed to protect residents. This involves the completion of an application form, the signing of a rehabilitation of offender’s declaration, an interview, and satisfactory Criminal Record Bureau (CRB) disclosure, Protection of Vulnerable Adults (POVA) and reference checks. Care Homes for Adults (18-65 years) Page 21 of 27 Following their appointment, records seen confirmed that all staff are subject to an in house and a learning disability quality(LDQ) sector skills induction covering the first twelve weeks of employment. The programme includes first aid, handling medication, food handling, moving/ handling, safeguarding, and infection control. All staff are expected to undertake a National Vocational Qualification (NVQ) Course. Information provided by the registered manager in the AQAA indicated that 50.0 of staff has been trained to NVQ level three 12.5 to NVQ level two, with a further 27.5 currently on a course leading to a level two qualification. When the staff on courses at present finish their studies 100 of care staff will be trained to at least NVQ level two. Those responsible for this achievement are to be commended. At the time io our vist as part of there committment to their staff the homes management were in the process of develpoing a potfolio as part of an application for Investors in People status. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The management of the home ensures the health, safety and welfare of residents and staff are promoted and the home is run in the best interests of the residents whose views about living in the will be formally sought as will the views of other stakeholders. Evidence: The service is well managed by a manager who has had many years management and residential experience holds a Registered Managers level four qualification, an N.V.Q. level four in care, a Higher National Diploma in managing health care services and a certificate of Community Mental Health. Staff who described the management as approachable and accessible and willing to listen to any ideas they may have for the improvement of the service also informed us there was a clearly defined management structure and they were fully aware all of their responsibilities and the limits of their authority. As part of her action plan the registered manager is developing satisfation surveys that will seek the views of residents, residents relative/representatives, staff, health care Care Homes for Adults (18-65 years) Page 23 of 27 professionals and social care professionals. As the home has only been registerd for a few months, the very detailed comprehensive records viewed and the two residents so far admitted are fully capable of communicating any concerns problems etc they have we are not concerned that this process is not yet operational. A health and safety policy was in place to ensure the day-to-day safety of staff and residents. Procedures include, weekly health and safety checks, the regular servicing of equipment, staff training in the techniques of moving and handling infection control, control of substances hazardous to health (C.O.S.H.H.) first aid, health and safety, reporting accidents and procedures to follow in the event of fire (including evacuation). As part of the health and safety arrangements and to protect residents, all of the hot water supplies to baths were fitted with thermostatic controls are set at 43 degrees centigrade and all radiators and hot pipes covered. Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 27 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 27 of 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. 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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