Care Home: The Limes

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What the care home does well What has improved since the last inspection? The home has worked hard to meet the requirements from the last inspection. There was some evidence that staff supervision was being carried out at approximately 3 monthly intervals. This will further improve once the new assistant manager takes up post. The home has continued to make improvements to the facilities provided to residents. Since the last inspection there had been some structural alterations to the home. Workmen were on site during the visit widening doors to allow wheelchair access and fitting additional fire door to corridors. A programme of redecoration was underway and this was to start with the redecoration of the exterior of the building. Two new wet room/shower rooms have been fitted since the last inspection providing residents with more choice. CARE HOMES FOR OLDER PEOPLE The Limes Moorfield Close Swinton Manchester M27 0FN Lead Inspector Sue Jennings Unannounced Inspection 27 June 2006 10:00 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 DS0000038597.V301714.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 DS0000038597.V301714.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Limes Address Moorfield Close Swinton Manchester M27 0FN 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) 0161 794 3042 City of Salford Community and Social Services Maria Elnhrawy Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability (0) of places The Limes DS0000038597.V301714.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The number of persons requiring accommodation for personal care at any one time shall not exceed 30 persons aged 60 years and over. One service user aged between 50 - 60 years may be accommodated within the maximum of 30. Care staffing levels will not fall below the minimum levels specified in the Residential Forum Guidance for Staffing in Care Homes for Older People . The dependency levels of service users are assessed on a continuous basis and staffing levels adjusted where appropriate to ensure continued compliance with the Residential Forum Guidance for Staffing in Care Homes for Older People. The service should at all times, employ a suitably qualified and experienced manager, who is registered with the Commission for Social Care Inspection Thirteen (13) beds within the total of 30 situated on the ground floor are used for intermediate care. 16th November 2005 2. 3. 4. 5. Date of last inspection Brief Description of the Service: The Limes is a two-storey, purpose built, Local Authority provision set in its own grounds within a pleasantly landscaped cul-de- sac. The home offers 14respite care places, 11 rehabilitation places, 2 assessment places and 3 longterm care places. The respite places are allocated by Social Worker referral and these stays are from 1 night to 4 weeks. Residents admitted for assessment are also referred by social workers and these stays can be up to 3 weeks. The aims and objectives of the home are to provide rehabilitation, respite and assessment to service users from the local and wider community. There is also a social work team on site. Rapid response nurses, occupational therapists and physiotherapists support the management and care team. Service users are offered assessment and on going therapeutic services. Care planning and social work support is available to co-ordinate discharge planning and determine future care needs and care packages. The current fees for accommodation for assessment and rehabilitation services at the home range from £64.65 to £90.00 per week. The Limes DS0000038597.V301714.R01.S.doc Version 5.2 Page 5 Fees will be based on a financial assessment for those residents who live permanently at the home or require respite care. The fees include all meals, laundry, domiciliary chiropody, Occupational and Physiotherapy and entertainment. Additional costs include hairdressing, dry cleaning and telephone calls. The home is operated in partnership with the Salford Primary Care Trust and Salford Royal Hospitals Trust, which offers a multidisciplinary assessment for service users. Accommodation is provided on two levels. All rooms offer single occupancy. The Limes DS0000038597.V301714.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This site visit was undertaken as part of a key inspection, which includes an analysis of any information received by the Commission for Social Care Inspection (CSCI), in relation to this home prior to the site visit. The site visit was unannounced and took place over the course of 5.5 hours on Tuesday 27 June 2006. During the course of the site visit time was spent talking to the deputy manager and the homes administrator, 4 of the residents, 2 members of care staff and 2 members of the Primary Care Trust (PCT) staff to find out their views of the home. Time was spent examining records, documents, residents and staff files. Ten questionnaires were randomly sent to residents accommodated at the home, and the comments received by CSCI, were positive. A tour of the building was also conducted. During this inspection one of the requirements from the previous inspection had been addressed and there was evidence that this home continued to work hard to develop the service and meet the National Minimum Standards. During this inspection the key National Minimum Standards were assessed. What the service does well: Prospective residents’ needs were assessed before they were admitted into the home and residents admitted for rehabilitation were assisted to develop skills to enable them to return to their own home. Residents’ health, personal and social care needs were recorded and met. The medication practice was generally good although there were some gaps in the recording on Medication Administration Records (MAR) sheets. The home carries out quality monitoring using a ‘service users questionnaire’ the results of which are added to the service user guide. Residents’ social needs are recorded and met. Residents’ independence is maintained at the home, including managing finances as much as possible, to help them to maintain existing skills when they return home. Residents confirmed that they were treated with respect and that their privacy was maintained. The Limes DS0000038597.V301714.R01.S.doc Version 5.2 Page 7 The staff spoken to said that the manager and deputy managers were “supportive and approachable”. The homes décor, furniture and facilities are of a high standard. The atmosphere in the home was warm and welcoming. Staff were observed to be pleasant and courteous with residents. This was confirmed in discussions with residents. Staff were seen to have good interactions with residents and were observed dealing with residents individual needs. Staff recruitment was appropriate and there were adequate numbers of committed and well-supported staff deployed to meet residents’ needs. There was evidence of the availability of a wide range of staff training. Meals served appeared to be nutritious, well balanced and nicely presented. The staff ask residents on a daily basis what they would like to eat for that day. Alternative meals are available on request. Comments from residents were positive and included things like “the food is really nice” and “there is always a good choice of food”. The home kept a log of complaints and compliments and evidence seen indicated that no complaints had been received by the home. A number of thank you cards and letters were displayed on the notice board outside the manager’s office. The home demonstrated good practice in maintaining hygiene standards and had also received a silver award from Salford Council for food hygiene. There are frequent meetings between the PCT staff and care staff in the home to make sure the care provided is well co-ordinated. What has improved since the last inspection? The home has worked hard to meet the requirements from the last inspection. There was some evidence that staff supervision was being carried out at approximately 3 monthly intervals. This will further improve once the new assistant manager takes up post. The home has continued to make improvements to the facilities provided to residents. Since the last inspection there had been some structural alterations to the home. Workmen were on site during the visit widening doors to allow wheelchair access and fitting additional fire door to corridors. A programme of redecoration was underway and this was to start with the redecoration of the exterior of the building. The Limes DS0000038597.V301714.R01.S.doc Version 5.2 Page 8 Two new wet room/shower rooms have been fitted since the last inspection providing residents with more choice. 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 Limes DS0000038597.V301714.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 DS0000038597.V301714.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): 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ care needs are assessed and met by the home. EVIDENCE: The home provided an easy to read booklet detailing the services provided. This was sent to all prospective residents and gave information about fees, what services were available, meal times, social activities, the number of the bedroom they would be using and details of how to make a complaint. Residents were admitted to the home following an assessment using the single assessment approach where health and social care agencies work together to assess an individuals needs. The therapy team assesses the referrals for rehabilitation and assessment centrally and places are allocated on the basis of the date of referral i.e. first come basis. The Limes DS0000038597.V301714.R01.S.doc Version 5.2 Page 11 A sample of residents’ files was examined during the site visit and assessments of need were seen to demonstrate good practice by involving the prospective resident and/or his/her representatives. The home provides 13 intermediate care beds in a dedicated area on the ground floor and there are dedicated staff including physiotherapists and occupational therapists deployed to work with those residents admitted for rehabilitation. The home does not offer nursing care and district nurses visit the home on request from the GP. The assessment and rehabilitation unit has the support of a trained nurse. A Care Manager usually makes referrals for assessment, respite care and rehabilitation places. The Limes DS0000038597.V301714.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): 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. Overall the health and personal care needs of the residents were being met at the home. EVIDENCE: Medication at the home was administered from a Venalink system or from the original containers. Risk assessments were in place for the residents who self medicated. During the site visit a new resident was admitted and they had brought in medication from home. The assistant manager on duty carried out a risk assessment of the residents ability to self-administer medication. On examining the ‘blister pack’ brought in by the resident the assistant manager noted that the medication had been taken incorrectly i.e. all the morning blisters for the week had been taken and no night medication had been taken. The Limes DS0000038597.V301714.R01.S.doc Version 5.2 Page 13 This prompted the assistant manager to advise the resident to allow staff to administer medication until an appointment with a GP could be made. The GP was later contacted to review the resident’s medication. Advice/guidance on when (PRN) medication should be given needs to be included in the care plan. This should provide staff with details of why medication is prescribed and in what circumstances and for what conditions PRN medication is given. Staff also need to be aware of the signs to look for in those residents who are unable to ask for PRN medication. The requirement made at the last inspection is reiterated in this report. The medication was stored in a metal trolley, which was secured to the wall. Each individual file was found to contain an up to date photograph of the resident for easy identification. The plans of care were found to be detailed, informative and clearly set out the action that needed to be taken by staff to ensure that all aspects of health, personal and social care needs of the residents were met. The resident’s care plans included appropriate risk assessments. Residents spoken to appeared to be aware of their care plan and one said “ I had to sign it to say I agreed”. All residents were registered with a local General Practitioner (GP). The residents admitted to the home for rehabilitation or assessment, were usually registered with a local GP on a temporary basis. Residents could be seen in the privacy of their own room. There were arrangements in place for dental, optical and chiropody services for all residents. Nutritional screening, continence assessments and oral hygiene needs of residents were undertaken on admission and a plan of care had been implemented where appropriate. Six (6) residents were spoken to during the site visit and all said that the staff in the home were respectful and that their dignity was maintained. One resident said, “Do you know I could not walk when I came here? They have worked wonders. They are all very nice.” One resident said, “ The staff are very pleasant, they will help you when needed.” Another said, “The girls are very good to me, I like it here it suits me.” The Limes DS0000038597.V301714.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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provided a good environment for the residents who live there with a wide range of activities and a nutritious, well balanced and varied diet for residents. EVIDENCE: The home had an open visiting policy and visitors could be seen in the privacy of resident’s own room or in any of the communal areas. Residents spoken to confirmed this to be the case. One said, “My daughter can visit at any time and we go into my bedroom if we want to be private.” The resident files contained a personal history, which included significant life events, hobbies and interests, pets, religious and spiritual observance. The menus offered a varied, wholesome and nutritious diet. A choice of alternative meals was available. Staff consulted residents on a daily basis for their preferred meals. The Limes DS0000038597.V301714.R01.S.doc Version 5.2 Page 15 Residents spoken to said that the meals were always nice. One resident said, “The meals are very nice.” Another said, “It is the first time I have been here but the food seems to be good.” On the day of the site visit the meal served was braised steak and onions/sausage casserole with croquet potatoes and carrots, and the sweet was either bread and butter pudding or fruit and custard. The meals were taken from the central kitchen in ‘hostess’ style heated trolleys and served hot in the small satellite dining rooms. Staff were given a list of what residents had chosen and were observed asking residents if they still wanted this choice and offered assistance to those residents who required help with their meal. One resident made comments about the evening meal being too early for them and suggested that it would be more appropriate around 5 o’clock. Residents have access to an advocacy service. The home did not manage finances for residents in receipt of short-term care. The home did, however, provide safe storage for valuables, including a lockable unit in each room. A therapy room was provided within the home for those residents admitted for rehabilitation. Three of the residents spoken to said that an organist comes into the home. They said that he was there the previous night and he was very good. The home completed a ‘daily living skills’ questionnaire for each person admitted to the home. Activities were advertised on notice boards and the assistant manager said that residents were also consulted informally about activities. Residents are able to attend religious services either in the community or a minister of their chosen denomination can visit them in the home if preferred. A private room can be made available for these meetings. Family and friends are encouraged to visit regularly, where this is not possible staff at the home will assist residents to maintain contact via telephone or letter. Residents are able to go out with relatives whenever they wish. The Limes DS0000038597.V301714.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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had policies and procedures in place to ensure the residents were safeguarded from abuse. EVIDENCE: The home had a complaints procedure in place that was located in the entrance foyer. Residents received a copy, which is included in the Service User Guide/leaflet, on making an enquiry about admission or on admission to the home. The Commission for Social Care Inspection had not received any complaints about this service and the assistant manager stated that the home had not received any complaints. A notice board in the home displayed a large number of thank you cards and letters. Comments from residents received via survey forms indicated that they were generally aware of what to do in the event of making a compliant. The home had policies and procedures relating to abuse/protection of vulnerable adults, a copy of the Salford Multi-Agency policy for the Protection of Vulnerable Adults from Abuse and a ‘Whistle Blowing’ policy. Staff spoken to stated in the event of an allegation of abuse they would “report to the manger” adult protection training was said to be ongoing and was been The Limes DS0000038597.V301714.R01.S.doc Version 5.2 Page 17 included in the induction programme. They knew where to locate the policies and procedures if needed. One resident spoken to said, “I have nothing to complain about. They are very good to us.” Another said, “If I did have a complaint I would speak to any member of staff.” Another resident said “I have never had any complaints.” Other residents spoken to said that they would not be afraid to make a complaint and asked, “Why should we?” The Limes DS0000038597.V301714.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 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 premises are safe and the homes environment, including the standard of hygiene, was well maintained both internally and externally. EVIDENCE: The home felt comfortable and homely. All areas of the home were tastefully decorated and furniture was of a domestic nature and of a high standard. The home had a programme of routine maintenance and renewal of the fabric and decoration. The home provided a passenger lift to enable residents’ access to all floors. Grab rails were evident throughout the home to aid the residents and a variety of electrical hoists were available. Appropriate aids were fitted i.e. assisted baths, handrails and raised toilet seats for residents who required assistance. A therapy gym was also provided. The Limes DS0000038597.V301714.R01.S.doc Version 5.2 Page 19 Workmen were on site fitting wider doors to allow wheelchair access to all areas of the home. Two new shower rooms had been fitted one of them was a wet room for those residents who were unable to stand for long periods. The deputy manager said that the programme of re-decoration was due to start the week commencing 3/7/06 when the exterior of the building will be painted. Privacy locks were fitted to bathroom and toilet doors and an emergency call system was available. The need for any other aids would form part of the assessment carried out prior to admission. Residents’ bedrooms were seen to be comfortable and personalised. One resident said, “I have a lovely room. It is always lovely and clean.” There were alcohol gel dispensers throughout the home and at entrances and exits for sanitising hands and to reduce the risks of infection to residents. Notices were displayed reminding visitors to sanitise their hands before entering and leaving the home. Residents’ bedrooms had been fitted with a privacy lock suited to their capabilities and accessible to staff in emergencies. The Limes DS0000038597.V301714.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 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 numbers and skill mix of staff appeared sufficient to meet the needs of the residents accommodated. EVIDENCE: The numbers and skill mix of the staff, at the time of inspection appeared to be sufficient to meet the needs of the number of residents accommodated. Accommodation was provided on 2 floors, with the minimum staffing levels of 3 staff in the morning and 2 staff in the afternoon being provided, covering both floors. Three waking staff were provided at night. Where residents went on home visits additional staff were deployed to work in the home to ensure residents needs were met. There are 38 support workers at the home, 24 of whom have NVQ level 2 and 2 are studying towards this qualification. The home has met the target of 50 of staff achieving this qualification by January 2006. The Limes DS0000038597.V301714.R01.S.doc Version 5.2 Page 21 Staff recruitment was managed by Salford Council’s personnel department and included obtaining appropriate references and a CRB/POVA checks. The manager completed the shortlist of candidates and interview procedure. A sample of four staff files were examined and of the staff files viewed evidence was seen that they contained copies of the application form, references and CRB disclosure numbers. Staff spoken to confirmed that they had attended induction training and some study days. Training needs were identified during supervision and the home provided ongoing refresher training in Health and Safety, Basic Food Hygiene, Fire Safety, First Aid and Moving and Handling. The Limes DS0000038597.V301714.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 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’s quality monitoring systems protected residents and the home had systems and procedures in place, which safeguarded and protected residents financial interests. EVIDENCE: The registered manager was on leave at the time of the site visit. The visit was facilitated by one of the assistant managers with some information provided by one of the administrators. A quality assurance and quality monitoring system was in place. Questionnaires had been sent out to residents and their relatives/representatives in an attempt to gain their views. The Limes DS0000038597.V301714.R01.S.doc Version 5.2 Page 23 The administrator reported that the home does not handle/manage residents finances. Families assist residents who are unable to manage their own finances. All residents were in receipt of their personal allowances. Evidence was seen that the manager ensures the health, safety and welfare of the residents and staff are protected at all times. A health and safety policy was in place and risk assessments of the premises and safe working practices had been carried out. This was to ensure that both residents and staff had relevant information to enable them to live and work in a safe environment. Relevant certificates were on file to show that appropriate servicing of equipment used by residents in the home had been carried out. The home’s certificates of registration and public liability insurance had been displayed in the entrance hall. These were accurate and up to date. Fire equipment had been regularly maintained and staff had received fire awareness training. One member of staff spoken to said that on hearing the fire alarm sound “We all meet in the market place (the homes Foyer) and then to our area of work to start to get residents to a place of safety/fire exit.” Another member of staff said, “Eccles fire service have been in to give a talk about fire procedures.” The assistant manager, residents and staff appeared to have a good relationship. Through discussion it was clear that the assistant manager had a good understanding of the conditions and illnesses that are associated with old age and was able to address such issues quickly, benefiting the residents. The Limes DS0000038597.V301714.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 DS0000038597.V301714.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? yes 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 OP9 Regulation 13 Requirement A care plan for the administration of medication, including when required (PRN) medication, which confirms why medication is prescribed and in what circumstances and for what conditions PRN medication is given must be in place for each resident. (Previous timescale of 20.12.05 not met) Timescale for action 20/07/06 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 DS0000038597.V301714.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ 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. Extracts may not be used or reproduced without the express permission of CSCI The Limes DS0000038597.V301714.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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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