Care Home: The Limes

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What the care home does well Some written information about the service users and their individual needs was detailed, and provided staff with useful information from which to provide support (see below). The service users were encouraged to make their own choices about what they wanted to do each day, to be independent, for example preparing their own meals, and to take part in a range of activities both inside and outside the home. This kept them usefully occupied and gave them the opportunity to learn new skills and meet other people. One service user told us that they "enjoyed the things they did each day". The service users and staff had good relationships and there was a friendly atmosphere in the home. Visitors were made welcome at all times. The service users were well supported to maintain positive relationships with their families and one service user enjoyed going out with her mother twice a week. Importance was placed on healthy eating and service users were encouraged and supported to chose and prepare healthy meals. Staff worked hard to support people in this area of their lives. The service users had all the health care they needed and medication was managed safely in the home. This helped to keep the service users as well as possible. There were thorough systems to ensure service users were listened to and protected from harm. The home was maintained, furnished and decorated to a high standard, and was a pleasant, clean safe place for service users. The outside areas were also well kept, and pleasant, and provided attractive areas for the service users to enjoy in nice weather. All the staff were well qualified, and had a range of training opportunities, which gave them a good understanding of their role, and the needs of the service users. What has improved since the last inspection? Some written details of the personal support needed by some individuals had been improved and for example there was information about what assistance people needed in the bathroom. Some medication procedures had been developed that provided staff with better written guidance on more aspects of medication management. Some of the problems that had arisen from the change to more independence for service users with respect to meals prepared and food eaten had been resolved. Some of the problems associated with new management and the accompanying changes had been addressed and the morale within the staff group had improved. What the care home could do better: The written information about the home should be improved. It needs to be reviewed and updated so that there is accurate information about the way the home is run and the changes that have been made. The needs of the service users that have lived in the Limes for a number of years should be re assessed, and the written information about these needs should be updated, so that staff have more accurate information from which to support people. Things that affect people`s mental and physical health should be identified and written down, to assist staff to understand and provide the correct support, and should include all the significant history and events in people`s lives, for example bereavement. This should help staff provide the correct support and prevent relapses in mental health. Also any advice and instructions from health professionals, including the dietician should be written down as guidance to staff. The risks associated with healthy eating and service users` independence with respect to meals should be clearly and accurately assessed and there should be clear plans and guidance for staff in relation to weight fluctuation and diabetes. Service users should be encouraged to manage their own medication if at all possible. There should be a written assessment of the risk that shows whether or not people are capable of managing their own medication, and if so what staff need to do to monitor and support them. There could be better staffing arrangements so that service users have more choice and options about what to do at the weekend. The team building thathas been taking place needs to continue so that staff morale and team work improves even more. There should also be better records kept in the home to show how people are recruited to work in the home, and to show that the correct procedures that help to protect people from unsuitable staff are followed. The management should ensure that the views of the service users about the running of the home are sought and analysed so that the home is run in their best interest. The management must ensure that any work needed on the electrical wiring in the home to make it safe is carried out, or has been carried out, to protect those who live and work in the home. CARE HOME ADULTS 18-65 The Limes 17 Walverden Road Brierfield Nelson Lancashire BB9 0PJ Lead Inspector Mrs Pat White Unannounced Inspection 24th March 2009 09:00 The Limes DS0000009515.V374610.R01.S.doc Version 5.2 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 DS0000009515.V374610.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 Adults 18-65. 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 DS0000009515.V374610.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Limes Address 17 Walverden Road Brierfield Nelson Lancashire BB9 0PJ 01282 697414 F/P 01282 697414 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) Making Space Mrs Pamela Jean Stroud Care Home 7 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (7) of places The Limes DS0000009515.V374610.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC To Service Users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding Learning Disability or Dementia - Code MD The maximum number of Service Users who can be accommodated is: 7 Date of last inspection Brief Description of the Service: The Limes is a care home registered with the Commission for Social Care Inspection to provide accommodation and personal care for 7 adults with a mental disorder (excluding learning disability and dementia). The building dates back to the 16th Century and adjoins a Quaker meeting house. It is situated close to local amenities such as shops and pubs and is approximately half a mile from Brierfield, and one mile from Nelson town centre. Accommodation is provided on two floors in seven single bedrooms, all of which have en suite facilities. There is a lounge on each floor, with the lounge on the ground floor providing space for dining. All furnishings and fittings are domestic in character. The home has designated smoking areas. The home has a Statement of Purpose and a Service User Guide providing information about the care provided, the qualifications and experience of the owner and the staff, and the services the residents can expect if they choose to live at the home. The weekly fees charged by Making Space were £502 – 50p and service users paid for clothes and made a contribution to entertainment and holidays out of their own money. The Limes DS0000009515.V374610.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 star. This means that the people who use the service experience good outcomes. This inspection site visit was carried out at the Limes on the 24th March 2009. The site visit was part of a key (main) inspection to determine an overall assessment on the quality of the services provided by the home. This included checking important areas of life in the home that should be checked against the National Minimum Standards for Younger Adults, and checking the progress made on the matters that needed improving from the previous key and random inspections. Since the previous main inspection in April 2007 we received information that suggested that some changes in the running of the home were having an adverse effect on the people living and working there. Following the receipt of this information we carried out a random inspection in June 2008. This inspection highlighted some concerns that we asked the management to address. Therefore the next main inspection was brought forward from April 2010 to the 24th March to monitor these issues. This inspection included: talking to people living and working in the home, a partial tour of the premises, observation of life in the home, looking at service users’ care records and other documents and discussion with the registered manager. In addition survey questionnaires from the commission were sent to the home for service users and staff to complete. At the time of writing only two questionnaires had been received from staff and only one of these was still working in the home. Most of the service users said that they didn’t want to speak to us about what it’s like living at the Limes, but all seven completed and returned questionnaires. The views expressed in the questionnaires are included in the report. In addition the home provided the commission with written information, prior to the inspection, about the service users, staff and services provided, and some of this is also included in the report. What the service does well: The Limes DS0000009515.V374610.R01.S.doc Version 5.2 Page 6 Some written information about the service users and their individual needs was detailed, and provided staff with useful information from which to provide support (see below). The service users were encouraged to make their own choices about what they wanted to do each day, to be independent, for example preparing their own meals, and to take part in a range of activities both inside and outside the home. This kept them usefully occupied and gave them the opportunity to learn new skills and meet other people. One service user told us that they “enjoyed the things they did each day”. The service users and staff had good relationships and there was a friendly atmosphere in the home. Visitors were made welcome at all times. The service users were well supported to maintain positive relationships with their families and one service user enjoyed going out with her mother twice a week. Importance was placed on healthy eating and service users were encouraged and supported to chose and prepare healthy meals. Staff worked hard to support people in this area of their lives. The service users had all the health care they needed and medication was managed safely in the home. This helped to keep the service users as well as possible. There were thorough systems to ensure service users were listened to and protected from harm. The home was maintained, furnished and decorated to a high standard, and was a pleasant, clean safe place for service users. The outside areas were also well kept, and pleasant, and provided attractive areas for the service users to enjoy in nice weather. All the staff were well qualified, and had a range of training opportunities, which gave them a good understanding of their role, and the needs of the service users. What has improved since the last inspection? Some written details of the personal support needed by some individuals had been improved and for example there was information about what assistance people needed in the bathroom. Some medication procedures had been developed that provided staff with better written guidance on more aspects of medication management. The Limes DS0000009515.V374610.R01.S.doc Version 5.2 Page 7 Some of the problems that had arisen from the change to more independence for service users with respect to meals prepared and food eaten had been resolved. Some of the problems associated with new management and the accompanying changes had been addressed and the morale within the staff group had improved. What they could do better: The written information about the home should be improved. It needs to be reviewed and updated so that there is accurate information about the way the home is run and the changes that have been made. The needs of the service users that have lived in the Limes for a number of years should be re assessed, and the written information about these needs should be updated, so that staff have more accurate information from which to support people. Things that affect people’s mental and physical health should be identified and written down, to assist staff to understand and provide the correct support, and should include all the significant history and events in people’s lives, for example bereavement. This should help staff provide the correct support and prevent relapses in mental health. Also any advice and instructions from health professionals, including the dietician should be written down as guidance to staff. The risks associated with healthy eating and service users’ independence with respect to meals should be clearly and accurately assessed and there should be clear plans and guidance for staff in relation to weight fluctuation and diabetes. Service users should be encouraged to manage their own medication if at all possible. There should be a written assessment of the risk that shows whether or not people are capable of managing their own medication, and if so what staff need to do to monitor and support them. There could be better staffing arrangements so that service users have more choice and options about what to do at the weekend. The team building that The Limes DS0000009515.V374610.R01.S.doc Version 5.2 Page 8 has been taking place needs to continue so that staff morale and team work improves even more. There should also be better records kept in the home to show how people are recruited to work in the home, and to show that the correct procedures that help to protect people from unsuitable staff are followed. The management should ensure that the views of the service users about the running of the home are sought and analysed so that the home is run in their best interest. The management must ensure that any work needed on the electrical wiring in the home to make it safe is carried out, or has been carried out, to protect those who live and work in the home. 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 DS0000009515.V374610.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Limes DS0000009515.V374610.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The written information about the home was not up to date and did not give people an accurate picture of the aims and objectives of the service. People’s needs had been assessed, and were being met in the home, but the written information was not always up to date on all matters of personal and health care. EVIDENCE: Written information was available for service users and visitors in the form of a service users guide and statement of purpose. However these documents had not been reviewed and updated to reflect the changes in aims and objectives of the service towards greater independence of the service users. Some restrictions on choices were also not accurately portrayed in these documents. No one had been admitted to the home since the previous main inspection two years ago so the admission procedures could not be properly assessed. However all those living in the home said in the questionnaires that they had been involved in deciding to live at the Limes. They all had a written assessment of their needs to assist staff to understand what support they needed. But not all these assessments had been reviewed or updated and The Limes DS0000009515.V374610.R01.S.doc Version 5.2 Page 11 some information was out of date. This could mean that staff do not have sufficient guidance about the support people need. However there was evidence that after serious incidents affecting service users the multi disciplinary team reassessed people’s needs to establish whether or not the Limes was still a suitable place for them to live, and also to establish what further support people needed. But for one person whose needs had been reassessed by the multidisciplinary team, it was not clear whether or not the Limes could meet these needs. The Limes DS0000009515.V374610.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care plans addressed in detail some of the changing needs of the service users but not all these plans had up to date information about some important health matters. Service users had adequate choices in their everyday lives and were supported to take responsible risks in order to enhance their independence. EVIDENCE: The inspection methods, including looking at records, showed that all the service users had a plan of care, based on the original assessment of their needs. There was a good level of detail in some areas e.g. personal history and personal hygiene to guide staff in what action they needed to take to support people. There was evidence that the plans had been reviewed and updated at least every six months and agreed with the service user. However on 2 plans looked at, some important details were missing about some aspects of physical and mental health, such as for one service user the dietician’s The Limes DS0000009515.V374610.R01.S.doc Version 5.2 Page 13 advice about weight loss, and how to manage this. For another service user there were no records of a significant event in a person’s life, the possible affect on that person and what support was required (see standard 18). This could mean that people were not given the right support. In discussion with the manager and staff it was clear that service users were encouraged to make choices about lifestyle and routines which encouraged independence in some areas of their lives, e.g. activities and meals. However there was also evidence from talking to people and looking at records that choice was restricted in some areas. There was no evidence to demonstrate that the service users could not manage their medication (see standard 20), choice of activities were restricted at the weekend when there was only one member of staff on duty, and service users still did not have a choice about what time to come in and night. These matters were not accurately portrayed in the information given to people (see previous section) and could lead to misunderstandings. However the service user questionnaires showed that they were all satisfied with the level of choice and independence they had in the home. Service users also had opportunity to participate in the running of the home. Service users’ meetings were held at regular intervals and the minutes showed that a variety of topics were discussed and that some service users participated. Service users were encouraged to be independent and would go out unaccompanied if possible. Some service users were seen coming in and out of the home as they wished at the time of the site visit. There were risk assessments to support this, and for some other aspects of promoting independence such as food preparation and the move to more independent living. However not all of these were as detailed as they should be in terms of useful guidance to staff on how to support people and overcome any risks. For example the risk assessments associated with people’s abilities to prepare healthy meals did not indicate people’s skills and what specific support they needed. Also service users did not have keys to the front door and there were no risk assessments to underpin this decision. The Limes DS0000009515.V374610.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users were encouraged to lead a lifestyle of their own choosing within a structured framework of organised occupational and leisure activities, and which included maintaining strong links with their families. The meals prepared were healthy and appetising and were in accordance with the service users’ preferences and independence. EVIDENCE: The care records and discussions with staff and service users showed that service users had opportunities to maintain and develop practical life skills and take part in fulfilling activities. Service users were encouraged and supported to be independent and carried out domestic tasks, such as preparing meals (see previous section) and tidying bedrooms. Service users took part in activities in the local community, which included walking, going to the library, shopping and restaurants. Staff provided assistance with activities as necessary, and had knowledge of events in the The Limes DS0000009515.V374610.R01.S.doc Version 5.2 Page 15 nearby area. Several service users also attended a local college, some went to a “drop in” for people with mental health problems and one person went to church on a regular basis. An annual holiday was arranged for those who wanted to go. However at the weekends when there is only one member of staff on duty activities could be restricted for some service users who need a member of staff with them. The manager told us that following the appointment of new staff the times that 2 support workers are on duty could be increased. The service users were supported to maintain relationships with their friends and families and those who had opportunities, met their parents and relatives on a regular basis. Relatives were welcome in the home and were usually invited to special occasions. With respect to the home’s routines, service users indicated on the questionnaires that routines were flexible enough to suit individuals, Some service users rights were upheld such as having keys to their rooms to enhance their privacy. Rights relating to smoking and alcohol were explained in the written information about the home and were managed individually. For some decisions about rights the multidisciplinary team was involved in order to ensure the best decision was made. However the arrangement of service users having to be in at a certain time at night, including the weekend, and not having a key to the front door remained unchanged. Also there was no evidence to indicate why service users were not supported to manage their own medication (see standard 20). Since the last main inspection there was a greater emphasis on service users being as independent as possible in terms of choosing and preparing their own food. This had not been a smooth transition and was one of the focuses of the random inspection last year. Since then the staff and service users were better adjusted and the new systems seemed to be working satisfactorily. Service users were encouraged, and assisted if need be, to prepare healthy snack meals of their choice. A communal main meal was served in the evening prepared by staff, though those who wanted to make their own were supported to do so. Healthy eating was emphasised in the home. The records of food eaten showed a good variety of dishes and good choices for the snack meals. This new arrangement of greater independence suited the service users’ preferences and lifestyles. The arrangement was monitored with individual service users through underpinning risk assessments, staff meetings and residents meetings. However there was evidence through looking at some records, and discussion with the manager, that there was insufficient information about the service users’ dietary needs to ensure that they had the right food in the right quantity (see previous and following sections). The Limes DS0000009515.V374610.R01.S.doc Version 5.2 Page 16 The Limes DS0000009515.V374610.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal support was provided in a manner, which was appropriate for individuals and respected the service users’ rights to privacy and dignity. Service users’ had access to the different sorts of health care they needed and medication was managed safely. EVIDENCE: Written details of the personal support that service users needed was written on the care plan and the level of this detail had improved since the previous main inspection and indicated whether service users needed prompting or assistance. All had en suite rooms with a bath or shower. This enhanced the privacy and dignity arrangements for the service users and there were no restrictions on the use of these personal facilities. The records viewed and discussion with the manager showed that the residents had access to health services, including dentists and chiropody, and the advice of specialist services had been sought as necessary. Residents’ physical and mental health was monitored and all service users had involvement with the mental health services and appropriate health screening. The Limes DS0000009515.V374610.R01.S.doc Version 5.2 Page 18 However whilst there was no evidence that people’s health was being adversely affected, the written information – risk assessments and care plans – did not have enough information to guide staff on how to manage some important aspects of their health (see previous section). This could mean that service users’ needs are not always understood or that the right support is not always given. Practices followed by staff with respect to the management and administration of medication ensured that service users were given medication correctly and that medication was managed safely in the home. Policies and procedures were developed in accordance with the Royal Pharmaceutical Guidelines. Also all staff had undertaken appropriate training for the management of medication. The manager undertook regular audits to ensure that practices and procedures were being followed. However none of the service users were responsible for their own medication. There was evidence on the care plan of service users’ consent to staff taking this responsibility but there was no evidence that service users’ capability in this respect had been assessed. This was in contradiction to the home’s greater emphasis on service user independence and could mean that some residents were missing the opportunity to be independent in this respect. In addition one service user was responsible for managing some medication but not others, and this was not underpinned by a risk assessment. Also for one service user whose records were viewed there was insufficient written guidance on when to give pain relief. The Limes DS0000009515.V374610.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems were in place to ensure any concerns of residents would be acted upon. Appropriate policies and procedures and staff training were in place to help protect service users from abuse. EVIDENCE: Both informal and formal arrangements were in place for the registered manager and staff to listen to and act on the views and concerns of service users, by means of resident’s meetings and everyday conversation. There was a formal complaints procedure to which service users had access. In the questionnaires competed by the service users most said that they knew who to speak to if they were not happy with something and knew how to make a complaint. The information received prior to the site visit stated that no complaints had been made in the previous 12 months made to the home. One complaint made by a service user about some missing personal property was withdrawn when the item had been found. Since the previous inspection there had been an incident between two service users. The manager had managed this appropriately and according to procedures and with the involvement of the multi disciplinary team. These The Limes DS0000009515.V374610.R01.S.doc Version 5.2 Page 20 procedures were in accordance with Government guidance, and would help protect service users. Staff undertook suitable training in Protection of Vulnerable Adults and this should further help to protect people The Limes DS0000009515.V374610.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28 & 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The service users live in a comfortable, clean, safe and well - maintained home, furnished to a high standard and which suited their needs and was in keeping with the service user group. EVIDENCE: The Limes is a listed building attached to a Quaker Meeting House. A Housing Association owned the property and was responsible for the up keep of the structure of the building. Making Space was responsible for the decorating and furnishing of the home and for which there was an annual budget. The building is set in its own grounds with car parking facilities for visitors. At the time of the site visit the grounds were attractive and well maintained and provided a pleasant area for the benefit of service users. We were told that some of the back garden was being developed for growing vegetables. The Limes DS0000009515.V374610.R01.S.doc Version 5.2 Page 22 Accommodation was provided in 7 single rooms, all of which had an en suite facility with shower. Each bedroom had drink making facilities, and seating arrangements for visitors. The en suite facility in the bedrooms enhanced the privacy of each service user and promoted independence. In addition to the en suite facilities there were also two communal bathrooms with domestic baths, to offer service users a choice. Communal space consisted of one lounge/dining room on the ground floor and a further lounge on the first floor that was a designated smoking lounge. Smoking was not allowed in other areas of the home. The areas of the home seen were furnished and maintained to a high standard, in keeping with the service user group, and there was a relatively new and modern kitchen. At the time of the site visit the lounge/dining area was being reorganised to make easier access to the kitchen from the dining area. There was a planned programme of refurbishment and maintenance and service users could take part in the decisions made. The home was clean and free from offensive odours at the time of the site visit, and service users confirmed in the questionnaires that a high standard of cleanliness was maintained. Though one service user objected to the smell of the smoking lounge. There was a laundry room, which was well kept, and procedures that allowed service users to assist with their own personal laundry. The Limes DS0000009515.V374610.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33 & 34 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An experienced, skilled and well - qualified staff team supported the service users. EVIDENCE: The inspection methods, including the information provided by the home prior to the inspection, indicated that the staff team was well qualified and experienced, with the permanent support staff qualified to at least NVQ level 2, and most to level 3 and 4. The home had been through an unsettled period due to changes in the management, and in the aims and objectives of the service. The effect of this on the home was a focus of the random inspection. At this key inspection we found that the staff morale and team unity had improved and that work was still in progress to ensure further improvements. At the time of the site visit new staff were in the process of being appointed to fill staff vacancies. The Limes DS0000009515.V374610.R01.S.doc Version 5.2 Page 24 There had been a review of the staffing arrangements in the home that had resulted in the cook’s post being removed from the staff team. Also this review had not yet improved the staffing levels at certain times of the week when at the weekend, and in the evening, there was only one member of staff on duty (see above). However we were also told that with the appointment of the two new members of staff referred to below there would be scope for increasing support to service users at certain times of the week. There was also evidence that staffing levels were temporarily adjusted according to the need for extra supervision and monitoring of some service users at certain times. There were insufficient records available in the home for two people being appointed, to assess the staff recruitment procedures. This was due to not having access to the computer records, and also because some of the records were kept at head office. Copies of these were not available in the home at the time of the site visit. We were advised that one new member of staff had commenced work after all the necessary checks had been undertaken, and was undergoing the induction training, and that another person would commence work when the references had been received. There was no tracking system being used in the home for the manager to record and check the important information needed in respect of staff recruitment. The information supplied by the home prior to the site visit, and discussions with staff, indicated there was a variety of training opportunities, some of which were run by Making Space and some of which were directly relevant to the field of mental health. All long serving members of staff had training records and structured supervision with a manager that identified training needs and opportunities. The Limes DS0000009515.V374610.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A qualified and experienced person managed the home. Appropriate policies and procedures were in place to safeguard the health and safety of the staff and service users. EVIDENCE: The present manager was appointed about 2 years ago, and is experienced and sufficiently qualified to run the home. This change in management, and changes in the direction from Making Space about the aims and objectives of the service caused a period of unrest in the home, and was a focus for the random inspection undertaken in July 2008. Concerns identified at this time resulted in this key inspection being brought forward. At this inspection we found that according to the people spoken with there was an improvement in The Limes DS0000009515.V374610.R01.S.doc Version 5.2 Page 26 the morale of the staff team, and also the view that the team was now pulling together more. However only one member of staff working in the home returned a completed questionnaire so a general staff view on this was not obtained. Further improvements were expected as all concerned continued to work for the best interests of the service users. The information supplied by the home prior to the inspection, and which is their self - assessment of the quality of the service, was completed and returned when we asked for it. However not all the sections, regarding how the service could improve, had been fully completed, so it was not clear how problems and improvements needed, would be addressed. The home had good quality monitoring systems in place, which should result in the views of service users and relatives being sought every 6 months. Visiting professionals are also asked to give their views of the service. However the service user and relative questionnaire surveys had not been carried out for about a year, so no up to date information was available to demonstrate whether or not the home was run in the service users’ best interests. There were a wide range of health and safety policies and procedures to help ensure a safe environment for service users and staff. Staff received health and safety related training, which included moving and handling, food hygiene, first aid, infection control and fire safety. The information supplied by the home, and records seen during the site visit, confirmed that fire equipment, gas and electrical systems were serviced at appropriate times. To minimise the risk of scalding all water outlets were fitted with preset valves and window restrictors were fitted as appropriate. However the report of the inspection of the electrical wiring of the home in 2008 was “unsatisfactory” and there was no evidence that this had been addressed and made safe. The fire records viewed showed that the fire precautions in the home were satisfactory and should help protect people in the event of a fire. The equipment was maintained appropriately, there were monthly fire drills and weekly testing of the fire alarm, and residents were involved in the fire drills. The Limes DS0000009515.V374610.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 2 3 3 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 x 26 4 27 4 28 3 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 2 35 x 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 3 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 x 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 3 3 2 x x 2 x The Limes DS0000009515.V374610.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? One not completely met. 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 YA6 Regulation 15 Requirement Timescale for action 30/04/09 2. YA9 YA19 12(1)&(3) 3. YA42 13 (4) The care plans and risk assessments must include sufficient details about all aspects of physical and mental health, including risk and trigger factors to assist staff in understanding and prevention of deterioration of physical and mental health. The risk assessments 30/04/09 underpinning the service users’ ability to organise and prepare a sufficiently healthy diet, and care plans, must be sufficient in detail with guidelines to assist staff to manage fluctuations in weight and diabetes. The home’s electrical wiring 30/04/09 must be safe to protect people living and working there RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. The Limes Refer to Good Practice Recommendations DS0000009515.V374610.R01.S.doc Version 5.2 Page 29 1. Standard YA1 The service user guide and the statement of purpose should be reviewed and updated to reflect all the changes in the home. The needs of the service users should be reviewed and updated so that there is accurate information from which to develop the care plans. Any rules, such as about front door keys and the time service users have to be in at night, should be made explicit in the written material given to service users, for example the Service user Guide. Decisions made should be underpinned by risk assessments that demonstrate how the decisions have been made and why. The care plans or MAR sheets should include sufficient written guidelines to staff on when to administer “when required” medication. Whether or not service users are able to manage part or all of their medication should be underpinned by risk assessments that clearly demonstrate how and why decisions are made, and how self medication could be supported and managed safely. Sufficient staff recruitment records should be kept in the home to demonstrate the procedures that are followed and whether or not all the necessary checks have been completed before people commence work in the home. The home should ensure that the company’s quality monitoring systems are implemented each year so that service user views are collected and used to plan the service. 2. 3. YA2 YA7 YA16 4. 5. YA20 YA20 6. YA34 7. YA39 The Limes DS0000009515.V374610.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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 DS0000009515.V374610.R01.S.doc Version 5.2 Page 31 - 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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