Care Home: The Limes Nursing Home

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What the care home does well This was not evaluated on this visit. What the care home could do better: The registered provider needs to ensure that the systems he is developing for effective quality and monitoring are consistently implemented and applied during the day to day running of the home. Arrangements must be made to provide storage for controlled medication which meets with the requirements of current legislation. The registered manager must appoint a manager who is competent, qualified and experienced to run the home. Random inspection report Care homes for older people Name: Address: The Limes Nursing Home 816 Wilmslow Road Didsbury Manchester M20 2RN two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Ann Connolly Date: 1 2 0 8 2 0 0 9 Information about the care home Name of care home: Address: The Limes Nursing Home 816 Wilmslow Road Didsbury Manchester M20 2RN 01614462141 01614459524 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Britannia Care Homes Limited care home 42 Number of places (if applicable): Under 65 Over 65 42 old age, not falling within any other category Conditions of registration: 0 The registered person may provide the following category/ies of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 42 Date of last inspection Brief description of the care home The Limes Nursing Home is a care home providing nursing care for a maximum of 42 older people. The Limes Nursing Home is formed around an adapted and refurbished Victorian house with a modern extension set in its own grounds. Accommodation is on 4 floors all of which have lift access and are wheelchair accessible. Facilities within the home are located in two separate wings, each with a communal lounge and dining area. The kitchen and administration office is located on the lower ground floor, next to one of the dining rooms. There is a central office and separate staff room located at Care Homes for Older People Page 2 of 9 Brief description of the care home the main entrance to the home, which is central to the two wings. There are two treatment rooms, located in each of the two wings. In one wing there is a large lounge on the ground floor, which gives access to an enclosed conservatory providing a bright, airy view of the grounds of the home. There is a dining room on the lower ground floor. The second lounge has a French window that gives direct access to the garden and has a small dining area. There is a small kitchen next to the lounge where visitors and staff are able to make light refreshments. There are 20 single bedrooms, and 11 double rooms with en suite facilities. The gardens are laid to lawn, and well maintained with sufficient car parking available for visitors and staff. The home is located within a short walking distance of Didsbury village and all its amenities. There are two local parks within short walking distance from the home. Bus stops to Manchester and surrounding areas are within 100 yards of the home. The weekly fees for residents vary from Three hundred and seventy five pounds and eighty fourpence to Five hundred and ninety five pounds. Charges for hairdressing, newspapers and chiropody are extra, but are invoiced following supply. Care Homes for Older People Page 3 of 9 What we found: We visited the home because the Annual Service Review identified that there was no registered manager in post and we had concerns that the registered provider was failing to notify us of incidents affecting the health and well being of people living in the home in a timely manner. This is important as this provides us with information about how the home is managing incidents that happen and it is also a legal requirement. This visit was to establish what arrangements were in place for the day to day management and running of the home, and to find out what action had been taken to recruit a manager or submit an application for someone to become the registered manager of the home. The visit was carried out by the lead inspector for this service and lasted five hours. During the visit we looked at the following: The recording and reporting of incidents ( Regulation 37 notifications) affecting the well being of the people living in the home, and at the systems in place to manage these. The systems and recording processes for managing complaints. The systems for auditing and monitoring medication. The systems for auditing care plans. The arrangements for supervising and supporting staff. We looked to see if the requirements from the last inspection had been addressed. We spoke with the clinical nurse lead, the provider, people living in the home and some care staff. Feedback was given to the registered provided at the end of the inspection. During discussions with the registered provider he was able to demonstrate and provide evidence that he had identified several areas of concern in the management of the home which required urgent attention. These concerns reflected our own assessment and findings based on information we have received since the last inspection of the service. At the time of this visit he had appointed a new member of staff to support him in developing management systems to address the shortfalls and to set up a range of audit and monitoring systems. We recently received a letter from the registered provider about an incident affecting the well being of a person living in the home. This had arisen as a result of a medication error. The information in the letter showed a lack of understanding about the purpose of a regulation 37 notification when we must be notified without delay of any incident affecting the well being of a person living in the home. Since sending this letter, the registered provider has acknowledged there have been shortfalls in understanding about what incidents must be reported to us and policies and procedures have been amended to ensure that all incidents affecting people in the home are notified to us in a timely manner using a regulation 37 notification. The home have reported to us in their Annual quality Assessment (AQAA) that they Care Homes for Older People Page 4 of 9 received few complaints. During the visit the complaints file was looked at and it was empty. We were told that any issues of concern were usually addressed immediately and so it was felt there was no need to make a record of them. The importance of recording all complaints and issues of concern was discussed with the registered provider, and the outcome was an undertaking from the provider to ensure that all complaints were properly recorded. This will provide evidence to show that all concerns no matter how small are taken seriously and show what action was taken to address any concerns. There was a complaints monitoring file (currently unused) that included proforma to detail the nature of any complaint, the investigation and outcome. The provider told us that one member of staff is now responsible for monitoring and auditing all complaints about the service. There is an internal policy for the management of complaints which states that the service is responsible for monitoring and recording all complaints received to identify any apparent adverse trends in service quality as part of the normal day to day management review process. The provider told us that all staff would receive training and guidance about managing complaints and recording issues of concerns. The recent reports of an error in medication administration raised concerns about the monitoring and management of medication procedures in the home. During this visit, we found that the provider had also identified shortfalls in the way the home monitored how staff were administrating medication, As a result of this finding a regular medication audit has been implemented. The first audit was carried out on the 18/06/09. Althought the audit is in its infancy and requires further development,the initial findings are that the home has taken the shortfalls seriously and is in the process of addressing these. Since the recent medication error a memo has been sent out to all staff informing them of the requirement to read and sign medication policies and procedures for the safe handling of medication. There was documentary evidence to show that staff had received updated training in the safe handling of medication from the supplying pharmacist on the 16/07/09. It was suggested that the provider obtains detailed information of the course content to ensure that all key aspects of good practice are covered in the training delivered to staff. During this visit we noted that the controlled drugs cabinet does not comply with recent updates in legislation and a requirement has been made for the provider to ensure that controlled drugs are stored in a cabinet which meets current legislation. We looked at three care plans during this visit and these were detailed and comprehensive. When we looked at records we found evidence of a monitoring and auditing system to check that all care plans are up to date and being used appropriately by nursing and care staff. This auditing system had only recently been implemented and the provider recognised that this needed further development and that it must be consistently applied in the monitoring and auditing of key areas of practice in the home. The audit covered all aspects of care plans, from the initial assessment, social and medical details, updating and reviewing of care plans and risk assessments. There was also a section to assess how well staff used and made recordings in the care plans.We talked to care staff during this visit and there was evidence of a good understanding of how care plans should be used to ensure that people in the home were supported in a safe and appropriate way. We looked at processes for monitoring and supervising staff. There was a structured supervision programme in place. This assisted in the management process of identifying Care Homes for Older People Page 5 of 9 any training and development needs and ensured that people in the home are supported by a well trained staff team. At the time of this visit the provider told us that in the absence of a registered manager he was currently managing the home with the support of two staff who had responsibility for taking the clinical lead. The recognition by the provider of an absence of management audit and monitoring systems has resulted in a staff appointment to support him with the day to day management of the home. We found that management systems were in the process of being developed to audit and monitor key areas of practice to demonstrate that staff were following policies and procedures. The provider told us that he is currently considering options regarding the ongoing management of the home. The provider is aware that he must arrange for the appointment of a manager who is qualified,competent and experienced to run the home. We looked at the requirements made at the last inspection visit and found that the two requirements made had been fully addressed. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 9 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 7 of 9 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Controlled durgs must be stored in a cabinet that meets current legislation This will ensure that medication is stored in a safe and approapriate way. 30/10/2009 2 31 9 The registered provider must 16/11/2009 appoint a manager who has the qualification, skills and experience necessary for managing a care home. This will ensure that the home is run in the best interest of the people living in the home, and ensure that systems in place ensure that their health, safety and well being is promoted. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 8 of 9 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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