Care Home: The Limes

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What the care home does well People living at the home have the opportunity to undertake visits to the home and have an assessment completed in order to decide if the home can meet their needs. All for the people living at the home have a care plan which details the care they need. Feedback from people living at the home and their relatives indicated their satisfaction with the running of the home and the care and support they receive as many positive comments were made about home. Commented included: "the staff are good and work very hard." "They really look after us and the meals are nice." The home offers good training opportunities for all of the staff. There is a well-qualified and competent staff team who have been working at the home for a long time. They is a good relationship and rapport between the care staff and people living at the home. What has improved since the last inspection? The majority of the requirements from the previous site visit have been complied with by the time of this inspection. There have been no major service changes. What the care home could do better: There are no major areas requiring improvement although the home must address the areas as outlined in the report. CARE HOMES FOR OLDER PEOPLE The Limes 12 Limes Avenue Mickleover Derby Derbyshire DE3 0DB Lead Inspector Nancy Bradley Unannounced Inspection 23rd June 2008 09:00 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 The Limes DS0000001983.V367199.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. The Limes DS0000001983.V367199.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Limes Address 12 Limes Avenue Mickleover Derby Derbyshire DE3 0DB 01332 516819 01332 521531 woodhousejulies@aol.com 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) Mrs Bexson Mrs Frances Susan McGarrity Julie Serena Woodhouse Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places The Limes DS0000001983.V367199.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th July 2007 Brief Description of the Service: The Limes is a 34 bedded home for older people situated in Mickleover, in a residential area in the suburbs of Derby. The property was originally a private dwelling and has been converted into a care home. It is a grade 2 listed building with attractive grounds. Resident’s bedrooms are situated on the ground and first floors with the first floor being accessed by a passenger shaft lift and additional stairs by a stair lift. Five bedrooms have en suite facilities. Private telephone lines are available for those who wish to have them. Communal areas are bright and spacious and have view over the gardens. Information about the service is provided through the combined Statement of Purpose and Service User Guide, both of which are made available to residents and their families. The pervious inspection report is located in the reception area. Fees for the home at the time of the site visit were £353 to £490 per week depending on the care required. Items not included in this fee are detailed in the Service user guide. The Limes DS0000001983.V367199.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This was an unannounced key inspection and took place over a total of five hours. We spoke with the registered manager, the administrator, care staff and people living at the home. The inspection activity during this site visit was to assess the service against the key National Minimum Standards and these are identified through the report. We looked at all the information that we received or asked for, since the last key inspection. This included the following: The annual quality assurance assessment (AQAA) that was sent to us by the home. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the home. Additionally, time was spent in preparation for the visit, looking at the service history and the previous inspection report. Records were examined relating to the people living there and the general running of the home. We sent out “Have Your Say” questionnaires and we received ten completed questionnaires from people living there who confirmed they were very happy at the home, they liked living there, had no complaints, were well looked after by the staff and had never be happier. At the time of this site visit the home had thirty-two people in residence. We received ten completed questionnaires from care staff. All were happy working at the home, and very positive comments about the manager stating how supportive and approachable she was. We received a letter from a relative expressing their of support for the manager and the work undertaken by her. They commented on how well she manages the home and they are very satisfied in the care their relative receives. We received a warm, friendly and enthusiastic welcome from the people living at the home. What the service does well: The Limes DS0000001983.V367199.R01.S.doc Version 5.2 Page 6 People living at the home have the opportunity to undertake visits to the home and have an assessment completed in order to decide if the home can meet their needs. All for the people living at the home have a care plan which details the care they need. Feedback from people living at the home and their relatives indicated their satisfaction with the running of the home and the care and support they receive as many positive comments were made about home. Commented included: “the staff are good and work very hard.” “They really look after us and the meals are nice.” The home offers good training opportunities for all of the staff. There is a well-qualified and competent staff team who have been working at the home for a long time. They is a good relationship and rapport between the care staff and people living at the home. What has improved since the last inspection? 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. The Limes DS0000001983.V367199.R01.S.doc Version 5.2 Page 7 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 The Limes DS0000001983.V367199.R01.S.doc Version 5.2 Page 8 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): Standards 1 and 3. Standards 6 Not applicable to this service. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure people’s needs are fully assessed prior to moving into the home; this ensures that all people’s holistic needs are appropriately met. EVIDENCE: A copy of the combined Statement of purpose and Service user guide was available in the reception area and there was evidence to support that this document had been recently been reviewed. The AQQ indicated this was at the beginning of the year. The document continues to meet the required standard. The availability of this document ensures that the people living at the home have all of the required information to make an informed decision about moving into this home, and feedback from the people consulted and the completed questionnaires confirmed this. The Limes DS0000001983.V367199.R01.S.doc Version 5.2 Page 9 The discussions with people living at the home indicated that they generally think the home meets their needs. Comments received about the staff team and the home included “ I always receive wonderful care at the Limes, the staff are very good, very helpful and staff listen to me.” The three files examined contained assessments that provided sufficient information to enable the staff team to find out what people needed, in order to provide the required level of support and care. The home accepts emergency admissions and we examined the file for a person who was admitted in an emergency. The registered manager completed a care plan following a visit, which then enabled the person to be admitted within the day. The care was then reviewed within seventy-two hours. This is good practice and in accordance with the National Minimum Standards. The registered manager confirms the placement and care arrangements in writing to the person being admitted and to their relatives. People are invited to look around the home before deciding if they wish to move in. The staff spoken with demonstrated a good understanding of the needs of older people and all stated how they are committed to their role. They felt they received enough information, to deliver appropriate care, and received good support from the management team. The Limes DS0000001983.V367199.R01.S.doc Version 5.2 Page 10 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): Standards 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 involved in decisions, which affect their lives and have an active role in the planning of their care and support, which meets their personal, health and social needs. EVIDENCE: People spoken with confirmed that they are consulted about their care plans and there was evidence on record to confirm this. The person who was receiving the care or their relatives signed the care plans. Care staff also understood the importance of people who were receiving the care being involved in this process and being supported to take control of their lives. The registered manager completes the care plans electronically and then a copy is printed for people’s records and for staff to access. Each person’s file examined contained the required information to enable the care staff to provide individual care and support to meet their assessed care needs. The records contained information concerning the people’s life style, preferences The Limes DS0000001983.V367199.R01.S.doc Version 5.2 Page 11 and daily routines, this is good practice as indicates the home is providing person centre care. The records contained the required assessments to identity any risk’ and support requirements in relation to moving and handling, tissue viability, nutrition and falls. People confirmed that they have access to health care professionals when needed, and attended routine or specialist healthcare screening clinics. People confirmed that they are consulted about the monthly review of their care plans and are involved in any changes made to their care plan. The medication practices and storage was seen and these were found to be satisfactory. The staff who administer the medication have received some training provided by the local pharmacy and some have completed an advanced medicines management course. There was evidence to support that individuals who wished to self medicate had an assessment undertaken to confirm that they are able to do this safely. Direct observations and feedback indicated that the staff deliver care in a manner that upholds people’s privacy and dignity, Visitors spoken to also stated that they felt the care was excellent. People spoken with stated that support is always good and the staff do” what I want and we are able to choose what we do and when we do it”. The Limes DS0000001983.V367199.R01.S.doc Version 5.2 Page 12 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): Standards 12,13,14 and15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have access to social, cultural and recreational activities that meet their expectations. Meals were of a good standard. EVIDENCE: People confirmed in their feedback that they felt the home was relaxed, the routines were flexible, and they indicated they are always consulted on a daily basis and additionally through house meetings and the newsletter. Details of entertainments and social activities were posted on the notice board, which detailed a variety of in-house activities such as: bingo, board and card games, sing-along, arts, crafts, quizzes, and movement to music. People have access to a library, which provides books in large print and talking books. On the day of the visit people were observed listening to music, and having a sing along in the lounge. The AQAA confirmed the people at the home have access to religious services of their choice and some people continue to access hobbies and social clubs as they did when living in the community. One person stated that they do not always like to take part in activities but enjoy going to the pub. The Limes DS0000001983.V367199.R01.S.doc Version 5.2 Page 13 People’s relatives, family and friends visit throughout the day, and those spoken with stated how they are welcomed into the home; one comment made in the visitor book was “it was good to see the inspector checking.” Comments from people living at the home, from direct observations and completed questionnaires confirmed that the meals provide were of an excellent standard. We joined the people for the lunchtime meal. The tables were set with napkins and a variety of drinks depending on people’s individual choice. The atmosphere was pleasant and relaxed. People confirmed that choices are available and stated that the menu detailing the meals for that day is displayed outside the kitchen area and on the notice board outside the main lounge. The catering staff had a good knowledge of people’s dietary needs and have attended relevant a courses on nutrition for older people. The Limes DS0000001983.V367199.R01.S.doc Version 5.2 Page 14 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): Standards 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to safeguard peoples’ welfare and ensure that their concerns are listened to and acted upon. EVIDENCE: People stated that they felt able and confident to raise any concerns they had with the registered manager, who they stated would listen and resolve any issues. Discussions with the care staff and minutes of house meetings, confirmed that they are fully informed about the complaints procedure and would have no hesitation in putting their concerns to the manager. The complaints records were examined and there have been no complaints since the last site visit. The home has its complaints procedure on display throughout the home giving information to both people living at the home their families and friends. The procedure contains the current contact details of the Commission for Social Care Inspection. The procedure informs the complainants that they are able to contact the Commission at any stage of the complaint if they wish to do so. Procedures are in place in relation to safeguarding of vulnerable adults and include issues around whistle blowing. The staff members spoken to confirmed access to this training and had a good awareness of the procedures to follow. The registered manager confirmed that all care staff has undertaken training in The Limes DS0000001983.V367199.R01.S.doc Version 5.2 Page 15 safeguarding adults, this included the catering or domestic staff have. Certificates were displayed in the staff room confirming the training with Derbyshire and Derby City Adult Services Departments. There have been no safeguarding issues since the last site visit. The home currently does not use any from of physical resistant. However the policy on physical intervention is ambiguous. The Limes DS0000001983.V367199.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 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 provides a comfortable and attractive environment which suits the people who live there and their needs EVIDENCE: We viewed several bedrooms, with peoples consent theses were personalised in accordance with their personal preferences and wishes. People commented on how they liked their rooms, and they confirmed they had places to lock their valuables and are given the choice to have a key to their room if they wish. Discussions with people living at the home indicated that the home is always clean and maintained to a good standard. The registered manager informed us there was a rolling programme for the The Limes DS0000001983.V367199.R01.S.doc Version 5.2 Page 17 re- decoration of the home. However following the recent fire and due to the expenses, which they incurred, the refurbishment programme for this year has not been fully completed. Once they are reimbursed they will continue with the refurbishment of the home. People have access to grounds outside, which have a variety of seating areas available. The outside grounds areas were well maintained and colourful with hanging baskets, and flowers. The home maintains good hygiene procedures All staff have had training in infection control. The Limes DS0000001983.V367199.R01.S.doc Version 5.2 Page 18 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): Standards 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. The home has robust recruitment procedures in place, which protect vulnerable adults. EVIDENCE: The number of staff on duty on the day of the site visit was consistent with the numbers identified on the planned staffing rota. Feedback from people indicated that they felt staffing levels were satisfactory and that there were sufficient staff to meet their needs. Information in the AQAA indicated the home had sufficient number of qualified people working at the home. Following the previous site visit and the requirement made all of the required checks are now being undertaken on staff prior to being employed. Robust recruitment procedures are in place, which ensures that staff appointed are suitable to work with vulnerable people. Several staff personnel records were examined which confirmed that thorough employment checks were carried out. All new staff are required to provide two references, a full employment history, have a clear Criminal Records Bureau clearance and complete a probationary period. The Limes DS0000001983.V367199.R01.S.doc Version 5.2 Page 19 As part of providing a full employment history applicants need to provide an accurate chronology of their employment history with the days date month and year. From recent staff recruitment records examined, applicants were only providing the year in one instance. This area of shortfall were discussed with the registered manager. The home maintains a record of all staff interviews undertaken. The questions asked and the recording of the interviews was discussed with the registered manager. Several of the questions may be classed as inappropriate. There should be a formal recorded of interviews. The staff personnel records were well presented. From discussions with the Manager and from examination of records the home is providing good training and development opportunities. Details are recorded in the AQAA. Completed questionnaires from staff identified the training opportunities as strength and one of the reasons they have stayed at the home. All staff have a personal development plan. The Limes DS0000001983.V367199.R01.S.doc Version 5.2 Page 20 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): Standards 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 is well managed, with staff regularly seeking the views from the people who live there. EVIDENCE: People living at the home stated that they felt they were consulted about dayto-day issues, and found the registered manager to be approachable and receptive to new ideas. Feedback from the people indicated that the home was well managed and that there was a good rapport between the people living at the home and the staff. We also observed this. Staff stated that they found the management team to be supportive and confirmed that they provide guidance and direction, and have access to regular supervision and team meetings. The Limes DS0000001983.V367199.R01.S.doc Version 5.2 Page 21 The registered manager as been at the home for a number of years and has the required qualification and experience to care for older people. Systems were in place for the ongoing monitoring of standards and for the purpose of quality assurance, and these included; house meetings, satisfaction questionnaires for people who live at the home, and relatives, in order to measure the success of the home in meeting its aims and objectives. We examined the system in place for the management of people’s finances, which is managed through a computer system. People have their own finance sheet detailing all of their transactions, and the systems in place were clear and easy to follow with an effective audit trail, therefore safeguarding people from any financial risks. The AQAA indicated that that safe working practices were in place at the home. Records showed that portable electrical appliance tests, waste disposal contract, bacteriology and legionnaires tests, service certificates for moving and handling equipment and electrical wiring certificates were in place. As discussed with the registered manager more information is required from the AQAA. Information provided was adequate for this inspection. Records were seen that demonstrated that the maintenance person employed at the home undertook weekly checks on the fire alarm system, emergency lighting, fire extinguishers and hot water temperatures and a maintenance contract was in place for the fire alarm system, fire fighting equipment, emergency lighting. The Limes DS0000001983.V367199.R01.S.doc Version 5.2 Page 22 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 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 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 3 X 3 X 3 X X 3 The Limes DS0000001983.V367199.R01.S.doc Version 5.2 Page 23 No Are there any outstanding requirements from the last inspection? 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 OP18 Regulation 13 Requirement The home must have a clear policy on when it uses resistant or physical interventions on the people it cares for. Timescale for action 31/08/08 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. 2. 3. 4. Refer to Standard OP15 OP29 OP29 OP33 Good Practice Recommendations The practice of rinsing of pots in the dinning room should be assessed. The home should sign and date all interview records. The home should revise its questions being asked at interview so they are more appropriate to the position being interviewed for. The registered manager should provide more information when completing the AQAA The Limes DS0000001983.V367199.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection East Midland Regional Office Unit 7 Interchange 25 Business Park Bostocks Lane Nottingham NG10 5QG 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 The Limes DS0000001983.V367199.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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