Inspection on 06/01/10 for Lime Tree House

This is the latest available inspection report for this service, carried out on 6th January 2010.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lime Tree House 16/07/08

Lime Tree House 14/02/08

Lime Tree House 04/09/07

Lime Tree House 12/10/06

Lime Tree House 17/05/06

Lime Tree House 14/12/05

Lime Tree House 07/06/05

Lime Tree House 19/10/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 03/06/2010.

Key inspection report Care homes for older people Name: Address: Lime Tree House Chantry Green, Main Street Upper Poppleton York YO26 6DL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Jean Dobbin     Date: 0 6 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Lime Tree House Chantry Green, Main Street Upper Poppleton York YO26 6DL 01904795280 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Dinka.rch@gmail.com Roseville Care Home Ltd Name of registered manager (if applicable) Mrs Marie Denise Whitelock Type of registration: Number of places registered: care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Lime Tree House provides personal care and accommodation for up to 26 older people and is owned and managed by Roseville Care Homes Ltd. It was last inspected on 9 January 2009. The home is a large detached property set in private gardens in the village of Upper Poppleton on the outskirts of York, to the west of the city. There is some parking on the site, and on the road nearby. Upper Poppleton has village amenities within walking distance. People expressing an interest in moving to Lime Tree House are given a brochure about the home and a Statement of Purpose and service user guide are available, which describe the facilities and services provided there. The latest inspection report, written by our predecessor The Commission for Social Care Inspection is displayed in the reception area of the home. On 6 January 2010 we were told the weekly fees to live at Lime Tree House are between £450 and Care Homes for Older People Page 4 of 33 Over 65 26 0 Brief description of the care home £525 per week. Additional charges are made for hairdressing and chiropody services and personal items like newspapers and personal toiletries. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This is what was used to write this report. Information about the home kept by the Care Quality Commission. Information asked for, before the inspection, which the manager provides. This is called an Annual Quality Assurance Assessment or AQAA. This tells us about how the service is affecting outcomes for people living there, as well as some numerical information about the home. A visit to the home by one inspector, which lasted about 7.5 hours. This visit included talking to people who live there and their visitors, and to staff and the manager about their work and training they had completed. It also included checking some of the records, policies and procedures that the home has to keep. Care Homes for Older People Page 6 of 33 Some time was also spent watching the general activity to get an idea of what its like to live at Lime Tree House. Information about what was found during the inspection was given to the general manager at the end of the visit. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? The company have recruited an experienced manager who has applied to be registered with the Care Quality Commission. A business and improvement plan for the home has been developed, which helps to focus on what areas need to improve, and by when. The manager has prioritised ensuring personal care practices and the written records about that care are to a good standard. Written information about the home, which is given to prospective residents and their families has now been reviewed, so it more accurately describes Lime Tree House and the facilities it provides. Care records have now been reviewed and in some cases re-written to make them more user-friendly and so that they more accurately describe the care and support people need. This means people are more likely to receive safe, consistent support. Peoples social needs are now being better met, though some very recent changes need more time to become an established part of the homes routine. However people told us they thought there was more going on at the home nowadays and there were photographs displayed of two outings last summer. Some fire safety and food hygiene records have improved in order to better protect people from harm. However some shortfalls are still evident. Care Homes for Older People Page 8 of 33 There has been ongoing re-decoration and refurbishment to improve the environment for people living there. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The pre admission assessment ensures that individual care needs can be met at the home and the prospective resident receives information and help to enable them to choose whether Lime Tree House is the right place for them. Evidence: Several care plans were looked at as part of the inspection to check whether peoples needs had been looked into before the decision was made as to whether they should move to the home. Those records for people who have recently moved to the home generally contained very detailed assessments of their needs, which had been completed by the general manager. These included information about peoples abilities to manage their day-today lives independently, as well as their preferences, such as how many pillows they like to sleep with and what sorts of foods they particularly like or dislike. They had been signed by the individual or a family member to confirm their agreement with Care Homes for Older People Page 11 of 33 Evidence: what had been written down. The information gathered in this assessment helps to build up a picture of an individuals needs and helps to make sure the care provided is tailored to what they want. Whilst most were dated in advance of the person being admitted, one assessment was not well completed so it was difficult to be certain that it had been done before the person moved to the home. One care plan looked at contained a written assessment completed by a care manager, from the local authority. The manager had also carried out her own assessment to check that the individuals needs could be met at the home. We spoke to two people who had moved to the home recently, but neither could recall being visited by the manager, before they moved there. Both people said that their families visited the home on their behalf and then talked to them about what it was like. One said they were given written information to look at but added that they already knew about the home, as they lived locally. The Statement of Purpose, which describes the services and facilities provided by the home has been reviewed in the last year and now more accurately describes the home and how it operates. Lime Tree House does not provide intermediate care. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal and healthcare needs are generally well met but some of the record keeping needs to more accurately reflect the risk to people and how these risks are being managed. Evidence: Two care plans were looked at in detail at this visit and several others more briefly. Care plans are used in care homes to describe the care and support people need to stay in charge of their lives as much as possible. They help to ensure this support is provided in a consistent and safe manner. Those care plans looked at were written in a very person-centred way describing what an individual can do for themselves, and what help the carers need to provide. Examples include pass flannel to X, as they will wash their hands and face. And Y can dress self with encouragement. Carers to say whats in their wardrobe and let Y decide. This sort of information is good practise as it helps to ensure carers dont carry out tasks that the individual can do for themselves. It also ensures that people are supported in a consistent manner. Care plans were generally reviewed monthly to Care Homes for Older People Page 13 of 33 Evidence: make sure they are still appropriate. Assessments were seen of the risk of a person falling, developing a pressure sore or losing weight, because of a health problem or poor appetite. One assessment though had identified a risk of harm, but it was unclear what had been done to minimise that risk. The manager told us that she had asked the community nurses to visit, but this had not been written down. Another person had been prescribed high calorie drinks because they had lost weight, but the discussion with the doctor had not been recorded. The manager then told us, and we saw, that this sort of information is generally written in the daily records. However as the days pass these details become difficult to find. The manager must be able to show that health care professionals have been consulted in a timely way, when peoples wellbeing is at risk. And this information must be incorporated into the individuals care plan. The home is unable to monitor one persons weight, however they have been assessed as at risk of weight loss because of their poor appetite. The manager needs to seek guidance from the individuals doctor to check whether there is anything more they should be doing in order to keep them well. One person has specialist equipment to minimise the risk of them developing a pressure sore. The care plans provide good detail about checking this equipment to make sure it is working as it should be. As previously mentioned care staff mainly record referrals and discussions with health care professionals in the daily records. This way of working was discussed with the manager. We saw that some people had attended hospital appointments and had been seen by their doctor in the last few days. Information from these visits needs to be recorded in the care plans so that these records are kept up-to-date and accurately describe the care an individual needs. Evidence of visits by the chiropodist and optician were also seen. Medication systems were looked at and were generally satisfactory. Senior care staff have completed extra training to make sure they are competent to carry out this task and the manager carries out her own checks to satisfy herself that medicines are being managed properly. One person looks after their own medicines and these are securely stored in their room. An assessment had been completed when the individual first decided to self- Care Homes for Older People Page 14 of 33 Evidence: medicate and they had signed to say they would look after them in a responsible manner. The decision to continue being responsible for their own medicines is relooked at each month as part of the review process and the individual then signs to confirm that the care plans describe the care and support they want. There were good records to show that people were having their medicines according to their prescription, though some record keeping still needs improving. These shortfalls were either addressed on the day, or the manager said she would sort them out in the days following the visit. The home keeps a record of the signatures and initials of care staff at the home who administer medicines. Whilst this is good practice the form had not been completed by all the staff who deal with medicines. The controlled drugs record book was not being completed properly. The way of recording these medicines needs to be very robust, to comply with the law. The running total of boxed tablets needs to be carried over from one record chart to the next so that it is possible to check by counting back, that people are receiving their drugs properly. And one person had not had a prescribed high calorie drink for several days. Both the manager and senior carer told us separately that the local pharmacy had run out but that they had been delivered that day. Running out of prescribed items in this way is not satisfactory and the manager needs to take advice about what she should do if this were to happen again. We observed carers speaking with and responding to people living there. This was always done in respectful and sensitive manner. People told us that the care staff were very kind and thoughtful. They ask what I want. Another said they were well looked after. Care Homes for Older People Page 15 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Changes are being introduced to make peoples lives more varied and they are supported to live the life they choose. Evidence: People spoken with told us they were happy living at Lime Tree House. Comments include I like it here. Staff will do anything for you. My clothes are well cared for. Another said Im quite happy. I spend the majority of my time in my room, but I go to the lounge for activities. People told us that there had been more to do at the home recently. There are photographs displayed from two trips out, which had taken place in the summer and people commented on craft afternoons and enjoying a game of scrabble. A number of people living there are from the local community and are still involved in local activities and church groups. The diary of activities, kept by the home, shows that many people have regular visitors and go out from the house with them. The manager has introduced a rota system at the beginning of January, where care staff are rostered to organise and lead social activities each afternoon. This needs to become established, so that particularly Care Homes for Older People Page 16 of 33 Evidence: people with few visitors can lead an interesting life, where one day is different to another. The hairdresser visits weekly and a religious service is held at the home each month. Peoples social needs are looked into as part of the admission process. Staff need to look at how activities they provide can be tailored to peoples individual interests and backgrounds. The care plans identify peoples likes and dislikes and the times they like to go to bed and rise in the morning. Two people told us they had a key to their room, but did not feel the need to use it. People were seen in the lounge with hot drinks and glasses of juice. Residents meetings are held every other month and minutes from the last two were seen. These show that people had been consulted about new chairs purchased and people had commented on how the home was running, such as that the board on which the days menu choices were written was not always filled in. People had also been consulted about changes they would like to see on the menu. The menus looked at showed that suggestions made last autumn have been incorporated into the meal choices. People were asked about the meals they received. They were not particularly critical, but nor were they very enthusiastic. They made comments like on the whole its satisfactory and its alright. There is a four week menu and people have a choice of main meal at both lunch and teatime. People are asked in advance of each meal as to what they would like. Home baking was seen in the pantry though we were told that fresh fruit is not regularly offered to people living there. The dining room is pleasantly set out. People tend to sit at the same table and the order the tables are served changes each week. The meal alternatives on the day of the visit were gammon and egg with chips and green beans or cheese and onion flan. People had water with their meal. Although each table had a cruet, people werent offered sauces. We were told that staff know which meals people like sauces with and put them on the tables at those times. At other times people are able to ask. One person needed their meal cutting up and a carer offered to do this. The individual may prefer this to be done before the plate is given to them, so that they are not identified as having this care need. Their ability to cut up different sorts of foods could be discussed with them so that their independence is promoted, but then they receive discreet help when necessary. Another person had been identified as having a small Care Homes for Older People Page 17 of 33 Evidence: appetite but their meal seemed to be the same size as other peoples. When their plate was taken away they appeared to have eaten very little, and a normal portion size may have overfaced them. Peoples meals need to suited to the individuals assessed needs and requirements. Care Homes for Older People Page 18 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst people know how to make a complaint and report that they feel very safe, some systems in place to protect them are not as robust as they could be. Evidence: The homes complaints process is displayed in the entrance area of the home and is also given to people when they move to the home. This document, like the Statement of Purpose could also be offered in a larger print to make it easier for some people to read. People told us that they would definitely report any concerns to the manager or a member of staff. They felt confident that issues would be addressed properly. One person commented Im sure she, (the manager), would sort a problem out for me. The manager keeps good records of negative comments and complaints made to her and how she has addressed them. The manager told us in her AQAA that the home has received eight complaints in the past year and these are all recorded. The Commission has not received any complaints about the service. The manager has a copy of the multi agency policy for safeguarding vulnerable adults and she told us that all staff have attended safeguarding adults training, almost a year ago. The home has made two safeguarding referrals to the local authority in the past year though one of these was not reported as quickly as it might have been. Care Homes for Older People Page 19 of 33 Evidence: One worker spoken with knew that they must immediately report any incident to whoever was in charge, when they witnessed or were told that someone may have been mistreated. They were less clear though about the need to report if they had been told about an incident in confidence. They also said that they couldnt recall attending any safeguarding adultds training. The manager needs to ensure that all staff working at the home are very clear about their responsibilities in keeping people safe and she needs to be satisfied that her staff have understood what has been discussed in the training session. Alert staff contribute to keeping people safe. Some recruitment processes at Lime Tree House need to be more robust as this will also contribute to protecting people from harm. Care Homes for Older People Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a warm comfortable house, which has been adapted to meet their needs. Evidence: Lime Tree House is a mature detached house with a single storey extension at the rear of the property. It provides a large lounge and dining area and some people also choose to sit in the large reception area, where they can watch people come and go. The home was noted to be clean, warm and comfortable, with no unpleasant smells. Most of the private rooms are on the ground floor. A vertical passenger lift aids access to the first floor and the manager told us that peoples needs are taken into account when deciding who should have a first floor room. Eight of the rooms have an en-suite toilet and wash handbasin. And one room is suitable for two people to share, although currently just one person has that room. Those rooms looked at had personal items which made the room feel more like home. One person in a larger room had a lot of their own furniture. People have their own television and at least one individual has their own telephone. In the last year the reception area and lounge have been redecorated and new seating purchased. People living there trialled several different types of chairs so that they could choose the ones they liked the most. Other areas, including bedrooms, are Care Homes for Older People Page 21 of 33 Evidence: redecorated as part of a planned refurbishment programme. The home has a hoist to help with moving and handling people, when their assessed needs require it. The bedrooms have call bells and one was pulled and responded to in less than a minute. The person we were talking with said that that was about how long staff generally took to respond. Although the manager tells us that the call bells in the lounge are not fixed to the walls and can be placed, for example, next to a person, people spoken with in the lounge told us they thought the call bells were fixed to the wall. One person said they would get up and use it on another persons behalf if necessary, in order to summon help. The manager needs to make sure carers use these appropriately so that people can call for help independently. The manager makes sure that appropriate aids are available and used to make sure that people living in the home are protected against infection, however we noticed that the door to the laundry room does not lock. The manager needs to carry out her own risk assesment and take advice if necessary to determine whether the home needs to keep the room more secure in order to protect people from harm. Care Homes for Older People Page 22 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst people are supported by staff who are properly trained and supported, the records dont always evdence this well. Some recruitment processes need to be more robust in order to keep people safe. Evidence: People spoken with on the day of the site visit agreed that they were treated well by staff. People told us that the staff are very good and very kind and thoughtful. Another said I have no complaints about the staff. One visitor said the staff group are very nice and kind and felt many had worked at the home for some time. They felt this stability contributed to peoples quality of life. On the day of the visit there were four care staff, two kitchen staff and a domestic working during the morning. The maintenance man was also present for part of the day. One of the kitchen staff is responsible for serving peoples breakfasts and drinks, when they are ready for them. This allows care staff to concentrate on providing care. Three carers work the late shift and two through the night. These numbers are for 26 people. Care staff are also responsible for the laundry services. One person told us that the staff know what they are doing, but they thought sometimes they were short of time. On the day of the visit care staff didnt appear too rushed, though carers were busy providing care and didnt appear to have much spare Care Homes for Older People Page 23 of 33 Evidence: time to sit and chat with people. Two recruitment files for staff who have started work in the last year were looked at. These files were disorganised and it was difficult to be sure that all the recruitment checks had been returned and had been checked, before they started working at the home. One persons file contained a character reference but we could not see one from their previous employer though the manager told us afterwards that the second reference was in the file. Because the agency doesnt keep a copy of letters sent out requesting references it was difficult to be certain that the reference had even been requested. The second person started work about a week before their full police check had been returned. A PoVAfirst check had been completed, which confirms that an individual isnt barred from working with vulnerable people because of a previous offence. However this check is not as thorough as a Criminal Records Bureau (CRB) check and the manager needs to ensure that, prior to the return of the CRB, the individuals work is being supervised at all times and she should be able to evidence this. Staff are employed for a six month probationary period and records of a meeting with the individual at the end of this period were seen. The manager has a training programme, however it is not up-to-date so we cant be sure that people are attending refresher training in a timely way. One persons file was looked at, which showed that she had attended training in Dementia Care, Health and Safety and Infection Control in the past year. The manager has completed extra training so that she can provide up-to-date knowledge and skills in Moving and Handling. She told us that this training will be provided in the coming weeks to all staff. Care staff have attended training in safeguarding Vulnerable Adults, but this should be provided for all staff at the home. The manager contacted us in the days following the visit to confirm that staff had attended fire safety training in the past year, and more was being arranged. The home also continues to encourage and support staff to attain a National Vocational Level 2 Qualification in Care. This nationally recognised award helps staff to know what good care is, and how to deliver it. Care Homes for Older People Page 24 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. After a number of staff changes, the home now has a committed manager who is making changes to improve the way the home operates and making sure people living there are contributing to that process. Evidence: The general manager has been in post for about six months. She is very experienced and has attained extra qualifications to help her in her role. She has also managed other care homes prior to Lime Tree House. She is in the process of applying to the Care Quality Commission to be registered, to confirm her suitability to manage a care home. This process needs to be completed as the service has been without a registered manager for several years. People spoken with knew who the manager was and felt she was very approachable and available to speak with. This could be seen on the day of the visit. People told us that they saw her regularly around the home. And because the manager also works two shifts as a care worker she has direct contact with people and is able to informally Care Homes for Older People Page 25 of 33 Evidence: monitor her staff and how the home is running. People living at Lime Tree House and their relatives were asked to complete a questionnaire last Autumn to give their views on how the home is performing. The responses from residents were very positive. Relatives views also were generally positive though one person said that communication between the home and family members could be improved. Others though wrote I feel my relative is in safe hands and if there are problems, then the home will contact me. And we are very happy with the care and support. The manager should consider asking health and social care professionals their views about the home too, to find out how they think it could be improved. Some peoples personal monies are managed by the home. Although records are kept, the manager showed us new documentation she planned to introduce in the coming weeks, which will provide better records and evidence that peoples monies are being safeguarded. People also told us that they had a lockable drawer in their room where they could keep personal items safe and secure. The new manager has prioritised ensuring peoples care records more accurately reflect the care that people want and need. And that this care is being provided properly. This is demonstrated by the improved care records and peoples positive comments about the service. There is however still work in progress to make sure some of the other records and health and safety processes are well maintained. These help to show the home is running well and peoples health and safety are protected. The home has health and safety procedures in place and staff are provided with training to help make sure they work in a safe, consistent way. However we identified these issues that need addressing: Records detailing fire safety checks at the home stated that some of these checks are either being carried out very infrequently, or not at all. The fire risk assessment has not been reviewed for more than a year. The manager contacted us within two days of our visit to tell us she had spoken with the fire safety officer and had implemented changes already, on their advice. A requirement was made about fire safety records at the last inspection a year ago. Whilst hot water temperatures from wash hand basins are monitored each month, the temperatures of water from bath taps are not checked. We found a thermometer in the bathroom, and the manager told us that staff check the temperature before assisting with a bath. This though isnt recorded anywhere. Systems need to be in Care Homes for Older People Page 26 of 33 Evidence: place to demonstrate that the home is minimising the risk of people getting scalded. One person has bedrails on their bed. Whilst this decision has been risk assessed and the rails are checked each month, we saw that the rails were fitted in such a way that the person could get their head trapped between the head of the bed and the bedrails. The manager immediately arranged for these to be adjusted, however there needs to be systems in place to make sure they stay positioned correctly every day and the home needs to be able to evidence these checks. Some kitchen record keeping has improved, but the manager needs to carry out her own spot checks to ensure improved practises are being maintained. We saw several prepared foods stored in the refrigerator, which had not been covered and labelled so it was unclear when they would need to be thrown out. And an ingredient in the pantry, used when baking cakes, had a use by date in 2008. Good food hygiene practises are needed to protect people from the risk of food poisoning. A requirement about poor record keeping in the kitchen was also made at the last inspection. Care Homes for Older People Page 27 of 33 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 33 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, Care Homes 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 8 13 Advice must be sought 05/02/2010 about the individual identified as at risk of weight loss, but whose weight currently cannot be monitored. This is to check that the home is doing all it can to maintain the individuals wellbeing. 2 9 13 Advice must be sought as to what must be done if there is a delay in obtaining prescribed medicines because the dispensing pharmacist is waiting for fresh stock. This is to ensure people receive their medicines as prescribed. 05/02/2010 3 9 13 The controlled drug record 05/02/2010 book must state the details of each time the drug is administered to an individual, and by whom.The Page 29 of 33 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 stock balance also needs to be recorded after each administration. This is to comply with the Misuse of Drugs Act 2001 4 18 13 All staff employed at Lime 28/01/2010 Tree House must be very clear about what they need to do if they are told about, or witness an incident where an individual may have been mistreated This will contribute to keeping people safe. 5 38 13 Bed rails need to be fitted to 26/02/2010 the bed, checked and maintained according to MRHA (Medicines and Healthcare products Regulatory Agency) guidelines. This is to ensure people who are assessed as needing bedrails are kept safe. 6 38 13 Prepared foods must be 26/02/2010 covered and labelled to say when they were prepared so it is clear when they need to be discarded. Good food hygiene practises help to keep people safe. 7 38 23 More robust fire safety 05/02/2010 systems, including reviewing Care Homes for Older People Page 30 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 the homes risk assessment, as advised by the fire officer must be established and maintained. This is to protect the health and welfare of people at the home 8 38 13 Checks of all hot water outlets to which people living there have access to should routinely be carried out, and recorded. This is to minimise the risk of people being scalded. 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 05/02/2010 1 9 Carrying forward the number of boxed tablets from one medication record sheet to the new one would provide more accurate records of drugs stored at the home and enable staff to check that the actual number of tablets is the same as the calculated number, according to the record sheet. This in turn would help to check that people are receiving their medicines according to their prescription. Recruitment files should be put together in such a way that it is easy for the manager and other authorised people to be certain that all the checks have been carried out before an individual starts working at the home. The records to show that staff have attended different training sessions should be kept more up-to-date, to show that people have attended in a timely way. Dry cooking ingredients should not be kept after their use by date. Good food hygiene management helps to promote Page 31 of 33 2 29 3 30 4 38 Care Homes for Older People 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 peoples well-being. Care Homes for Older People Page 32 of 33 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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