Care Home: The Limes

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What the care home does well The assessment process of individuals is robust, which ensures that individuals accessing services are appropriately placed. Residents` initial assessments are then developed into care plans, which detail individual care needs and the role of staff in delivering care, including the wishes and expectations of the residents. The inspector recognised a positive relationship between residents and staff, which promoted a relaxing and homely environment for all. Residents and visitors, during the site visit indicated their satisfaction with the care they receive. Residents spoken with stated they were confident to bring to the attention of others any concerns they have. Residents have the opportunity to participate in organised activities. Care staff receive training relevant to the care needs of service users, with a majority of care staff having a National Vocational Qualification in Care. The welfare of residents is protected through robust recruitment practices and a complaints policy and procedure, as well as an adult protection policy of which staff are aware. What has improved since the last inspection? Care plans have been further enhanced with more detailed information on residents` mental health. The health of residents has been improved by the provision of training in Infection Control. A more detailed life history has been gathered from residents and relatives, so enabling care practices to take into consideration past likes, differences and life events. CARE HOMES FOR OLDER PEOPLE The Limes Derby Road Hinckley Leicestershire LE10 1QF Lead Inspector Keith Williamson Unannounced Inspection 12th October 2006 09:30 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 DS0000032890.V314729.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 DS0000032890.V314729.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Limes Address Derby Road Hinckley Leicestershire LE10 1QF 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) 01455 611728 01455 611728 www.leicestershire.gov.uk Leicestershire County Council Social Services Alison Patricia Binns Care Home 40 Category(ies) of Dementia (8), Dementia - over 65 years of age registration, with number (30), Learning disability over 65 years of age of places (4), Mental disorder, excluding learning disability or dementia (4), Mental Disorder, excluding learning disability or dementia - over 65 years of age (6), Old age, not falling within any other category (40), Physical disability (8), Physical disability over 65 years of age (20), Sensory impairment (4), Sensory Impairment over 65 years of age (4) The Limes DS0000032890.V314729.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. No person to be admitted to the home in categories DE or DE (E) when 30 persons in total of these categories/combined categories are already accommodated in the home. No person falling within category DE may be admitted to the home where there are 8 persons of category DE already accommodated in the home. No person falling within category MD may be admitted to the home where there are 4 persons of category MD already accommodated in the home. No person falling within category MD (E) may be admitted to the home where there are 6 persons of category MD(E) already accommodated in the home. No person to be admitted to the home in categories MD or MD (E) when 6 persons in total of these categories/combined categories are already accommodated in the home. No person falling within category PD may be admitted where there are 8 persons of category PD already accommodated in the home. No person falling within category PD (E) may be admitted where there are 20 persons of category PD(E) already accommodated in the home. No person to be admitted to the home in categories PD or PD (E) when 20 persons in total of these categories/combined categories are already accommodated in the home. No person to be admitted to the home in category SI when there are 4 persons of category SI already accommodated in the home. No person to be admitted to the home in category SI (E) when there are 4 persons of category SI (E) already accommodated in the home. No person to be admitted to the home in categories SI or SI (E) when 4 persons in total of these categories/combined categories are already accommodated in the home. No person falling within category LD (E) may be admitted to the home where there are 4 persons of category LD (E) already accommodated in the home. No person under 55 years of age who falls within categories DE, PD, MD and SI may be admitted to the home. The Limes DS0000032890.V314729.R01.S.doc Version 5.2 Page 5 Date of last inspection 05/09/05 Brief Description of the Service: The Limes is a care home providing personal care and accommodation for forty older persons, incorporated within the home is a specialist unit providing respite care for upto eight individuals with Dementia. The forty single bedrooms are without ensuite facilities. Accommodation is provided over two floors with access between the floors being via stairs or a passenger lift. The Limes is fully accessible, and a multitude of communal areas are provided on both floors of the home. The home has a central courtyard that is well maintained and which is accessible to all residents form the home and adjoining day centre. The home is owned by Leicestershire County Council Social Services Department and is situated close to Hinckley town centre where residents have access to shops, pubs, post office and other amenities. The home is easily accessible by private or public transport. The Limes DS0000032890.V314729.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The focus of the inspections undertaken by the Commission for Social Care Inspection is upon outcomes for service users and their views of the service provided. The primary method of Inspection used was ‘case tracking’ which involves selecting clients and tracking the care they received through looking at their records, talking with them where possible, and looking at their accommodation. This inspection took place over one weekday, commencing at 9.30am took six hours to complete, and was assisted by the registered manager. An opportunity was taken to look around the home, view records, policies and care plans and to talk to the residents and staff. Most of the residents were seen during the inspection any comments made to the inspector on their impressions of the home are included in this report. There are no privately funded service users at the home, and the cost of each placement is set by the Local Authority between £269 and £451.50 per week. There are additional costs for individual expenditure such as Chiropody, Optician and hairdressing services, and the fee will depend on the services received. Of the questionnaires forwarded by the commission for social care inspection, to the residents, their relatives few have been returned, any comments from them, and the questionnaires sent to interested professionals, have been included as part of this report. Comments from the General Practitioners included: (The Limes) “is one of the better homes locally” “No complaints at all, staff are always very helpful and caring” “…. we have a robust working relationship with the staff and clients, which maintains a good standard of care”. “there are always staff to assist with my assessments if needed”… Comments from the residents and their relatives at the inspection included: “we get good food here, I don’t need a menu, I know its going to be good” “we have no problems over mums care” “they don’t tell you what to do, you always have a choice” “there’s always someone to talk to” “they look after you” What the service does well: The Limes DS0000032890.V314729.R01.S.doc Version 5.2 Page 7 The assessment process of individuals is robust, which ensures that individuals accessing services are appropriately placed. Residents’ initial assessments are then developed into care plans, which detail individual care needs and the role of staff in delivering care, including the wishes and expectations of the residents. The inspector recognised a positive relationship between residents and staff, which promoted a relaxing and homely environment for all. Residents and visitors, during the site visit indicated their satisfaction with the care they receive. Residents spoken with stated they were confident to bring to the attention of others any concerns they have. Residents have the opportunity to participate in organised activities. Care staff receive training relevant to the care needs of service users, with a majority of care staff having a National Vocational Qualification in Care. The welfare of residents is protected through robust recruitment practices and a complaints policy and procedure, as well as an adult protection policy of which staff are aware. 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 The Limes DS0000032890.V314729.R01.S.doc Version 5.2 Page 8 contacting your local CSCI office. The Limes DS0000032890.V314729.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Limes DS0000032890.V314729.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3. Standard 6 is not applicable. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The content and the distribution of information could be improved to support prospective service users in making a decision as to where to live. EVIDENCE: The Statement of Purpose, which sets out the latest aims, objectives and philosophy of the home, about its services, facilities, and current staffing, was available for inspection on this occasion. This information along with the Service User Guide is kept on site, this details the initial assessment and referral process and includes environmental information. Incorporated is information as to how complaints, comments and compliments can be raised. The information provided by the Limes does not include views or comments of residents who already reside within the home. The Statement of Purpose and Service User Guide have been produced in other formats, with consideration being given to the range of residents needs for which the Limes is registered to provide for. The Limes DS0000032890.V314729.R01.S.doc Version 5.2 Page 11 As part of the assessment process residents and relatives are asked to provide a history of an individual’s life prior to admission, this were in place and are detailed, and assists in the delivery of care and activities provided. The Limes DS0000032890.V314729.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are looked after well in relation to health and care needs. EVIDENCE: The care plans of two residents were viewed, along with the care plans of two individuals accessing the respite facility, these reflected residents’ specific needs and contact with other health care professionals. Residents and or their relatives have signed their care plans, in all of the files viewed. Daily records, detailing residents day-to-day lives and reflected their plan of care, these also included contact with health care professionals and relatives and friends. Care plans were individually detailed regarding how individual mental health needs to be met, consistent with training staff have received on mental health and dementia. The Limes DS0000032890.V314729.R01.S.doc Version 5.2 Page 13 The medication and medication administration records (mar charts) of those residents whose records were case tracked were inspected and found to be in excellent order. The manager has introduced a secure way of ensuring medication that is not packed by the chemist, is administered appropriately by staff. Care plans of permanent residents now include their final wishes. Residents and their relatives were asked as to their views as to the care they receive, the following comments were made. “they don’t tell you what to do, you always have a choice” “there’s always someone to talk to” “they look after you” “we have no problems over mums care” Of the residents spoken with at the inspection, responses to questions were positive, regarding care and privacy, staffing and living in the home. The Limes DS0000032890.V314729.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users experience a homely life style and visitors are encouraged to visit. Various activities are available to residents, matching individually, their cultural, religious and recreational needs. EVIDENCE: The Activity Organiser has gathered the views of residents to establish their social needs; these events are now detailed in individual plans of care. Residents’ participation in activities continues to be individually recorded along with any comments they have made. Residents continue to have the opportunity to a variety of activities, these range for individual shopping trips, to organised group outings and a varied choice of activities and pastimes within the home. The Inspector sat with residents during the lunchtime meal, residents made positive comments as to the food at The Limes, alternatives are always available, and residents continue to serve themselves by the placing of vegetables in serving dishes on dining tables. Staff were observed to assist some less able residents in a sensitive manor with food choices. The Limes DS0000032890.V314729.R01.S.doc Version 5.2 Page 15 Residents and their relatives were asked as to their views as to the activities and social care they receive the following comments forwarded were positive and included: “we get good food here, I don’t need a menu, I know it’s going to be good” “we have no problems over mums care” “they don’t tell you what to do, you always have a choice” “there’s always someone to talk to” The Limes DS0000032890.V314729.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Processes are in place for service users to affect their daily lives, and promote their welfare. EVIDENCE: Residents when asked were confident that should they have any concerns, they were clear as to whom they could speak with, in addition there is a written complaints procedure, and information as to how to contact advocacy services. Staff who were interviewed were aware of adult protection policies and procedures which detail staffs role in protecting residents from abuse, this includes “whistleblowing” policies, these support staff in raising issues of concern. The manager and senior staff maintain a Complaint Record this was viewed, and confirmed that the home has received three complaints since the last inspection; these have been dealt with appropriately. The Commission for Social Care Inspection has not received any expressions of concern. The Limes DS0000032890.V314729.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A comfortable and clean standard of accommodation is provided for service users. EVIDENCE: The Limes benefits from a secure door entry system, which promotes the welfare and safety of residents, anyone wishing to leave or enter the building needs to request for the doors to be opened. The manager indicated an alternative entry system is being looked at to assist the entry of visitors to longer-term residents. The environment is comfortable and homely. Residents spoke positively of their environment, all areas seen being decorated to a high standard. The Limes has a central courtyard, which houses a gazebo and seating, with plants and flowers in pots, this area is in the process of being decorated. The Limes DS0000032890.V314729.R01.S.doc Version 5.2 Page 18 A number of communal lounges are provided on the ground and first floor, providing a choice of space for residents. Equipment is available to assist service users and staff in the delivery of personal care, which includes assisted baths, moving and handling equipment including hoists. A replacement and upgrading programme is in place with changes to a ground floor bathroom, and dining room currently being planned. The manager and care staff confirmed they have now received formal training in Infection Control; the need for this training was highlighted at the last inspection. Laundry facilities are provided, which includes a sluicing facility. The Limes DS0000032890.V314729.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Trained and qualified staff are employed following robust recruitment checks and in sufficient numbers to meet the care needs of residents. EVIDENCE: Staff rotas indicated good levels of staffing which were sufficient to meet the needs of residents. The Limes senior staff team consists of the Registered Manager, Deputy Manager and two Assistant Managers. The home employs twenty-five care staff, the manager indicating that sixteen of those having attained a National Vocational Qualification at level 2 or above, that equates to 64 of the current care staff group. Staff training records reflected a variety of topics of training accessed, which include health and safety, adult protection, care practices and specific training in mental health. The manager confirmed that the recording of attendance of staff on training was still under review. Members of staff confirmed they had attended a variety of training sessions since the last inspection. Records of four members of staff were viewed and found to contain all relevant documentation including Criminal Record Bureau checks and the appropriate proofs of identification; one being recruited since the last inspection of this service. All staff have job descriptions in place. The Limes DS0000032890.V314729.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Registered Manager offers a clear sense of leadership, formal mechanisms for residents and their representatives to comment and shape improvements within the home still requires further work. EVIDENCE: The Registered Manager has attained the National Vocational Qualification in Care at level 4, and the Registered Managers Award. Staff spoken with stated they received one to one supervision sessions and appraisals with a member of the management team, these take place on a regular basis and are used to discuss training needs, changing needs of residents and any areas of concern. The Limes DS0000032890.V314729.R01.S.doc Version 5.2 Page 21 Members of the management team have designated areas of specific responsibility, ensuring that all aspects of resident care are met, and that the home is operated efficiently. Records of tests to fire safety equipment were in good order and health and safety issues were well documented. A number of generic and specific risk assessments were noted on residents’ files. The Limes DS0000032890.V314729.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 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 4 10 3 11 3 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 4 X 3 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 3 X 3 The Limes DS0000032890.V314729.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Limes DS0000032890.V314729.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Leicester Office The Pavilions, 5 Smith Way Grove Park Enderby Leicester LE19 1SX National Enquiry Line: 0845 015 0120 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. 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