Inspection on 15/11/05 for Lime Tree Court

This inspection was carried out on 15th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Lime Tree Court 07/06/07

Lime Tree Court 09/02/06

Lime Tree Court 16/03/05

Lime Tree Court 15/06/04

Lime Tree Court 12/03/04

Similar services:

The Maypole Nursing Centre

The Briars

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Lime Tree Court Church Street Twyford Bucks MK18 4EX Lead Inspector Mrs Rosemarie James Unannounced Inspection 15th November 2005 09:50 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 Lime Tree Court DS0000022988.V266027.R01.S.doc Version 5.0 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. Lime Tree Court DS0000022988.V266027.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Lime Tree Court Address Church Street Twyford Bucks MK18 4EX 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) 01296 730556 01869 278100 georgierixon@hotmail.com Mrs Georgina Rixon Mrs Georgina Rixon Care Home 23 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Lime Tree Court DS0000022988.V266027.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 23 residents, no more than twelve of whom may have dementia. Date of last inspection Brief Description of the Service: Lime Tree Court care home is situated in the peaceful and pleasant village of Twyford, in Buckinghamshire. The home is located at the end of a quiet country lane and is close to the church. The home is registered for the care of 23 older persons, some of which have a dementia type illness. The building and gardens are enclosed providing security for service users but allowing them to mobilise freely within the grounds. The garden areas are well maintained and contain patio areas for service users to sit and enjoy the outdoors. Local amenities include the church, a village shop and a public house, all of which are visited by service users in the company of staff. Lime Tree Court DS0000022988.V266027.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out on the 15th November 2005 commencing at 9.50am. The lead inspector was Mrs Rosemarie James. The inspection consisted of following up on the two points requiring attention from the last inspection, meeting with some of the residents and some of the staff, a brief tour of the home and looking at a variety of documentation. The opportunity was taken to meet with a relative who was visiting the home at the time of the inspection. Some of the comments he made included: “We are so happy with the way she is looked after here, within half an hour of visiting this home for the first time we knew it was the right place for her. The care the staffs have for the residents shines out here”. “The more we visit here the more we like it”. The inspector would like to thank the manager and the staff for the hospitality shown to her during the inspection and thanks go to to the residents for allowing the inspector into their home. What the service does well: What has improved since the last inspection? Lime Tree Court DS0000022988.V266027.R01.S.doc Version 5.0 Page 6 The home has revised their recruitment procedures to ensure all appropriate paperwork is in place before employment commences. All corridors on the ground floor have been painted. New dining chairs and two specialist lounge chairs have been purchased. 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. Lime Tree Court DS0000022988.V266027.R01.S.doc Version 5.0 Page 7 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 Lime Tree Court DS0000022988.V266027.R01.S.doc Version 5.0 Page 8 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): 2,3, & 6 All residents have a contract that details the terms and conditions of their residency at the home. The manager carries out all pre admission assessments to ensure the home is able to meet a prospective residents needs. EVIDENCE: All residents have a contract that details their terms and conditions of residency. The manager stated that in all the years she has owned the home she has never had a contract returned that a resident and/or their relative has not been happy with and signed. Copies of the contracts are kept at the providers home so were not available for inspection purposes. The contents of the contract are reviewed periodically and this last happened in 2002. The manager carries out all pre admission assessments. The manager chooses to do this herself because she feels her experience allows her to make a Lime Tree Court DS0000022988.V266027.R01.S.doc Version 5.0 Page 9 decision on not only can the home meet identified needs but if the potential resident will fit in to the current resident group. The manager stated that all her residents come from the John Hamden Unit or are known to social services. The manager has developed good working relationships with staff at the John Hamden Unit and will liaise with them directly to get a good understanding of the needs of potential residents. The pre admission documentation of the latest two residents to be admitted was looked at. There was evidence of comprehensive hospital documentation and very informative care manager reports. This information helped form the initial care plan. A recent development has been to obtain a pen picture of residents, which helps give the staff a real insight into who the resident is that they are looking after. The inspector recommends this practice is developed further to include all residents living at the home. It is confirmed that the home does not provide an intermediate care facility. Lime Tree Court DS0000022988.V266027.R01.S.doc Version 5.0 Page 10 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): 8&9 The home has good support from a variety of healthcare professionals, which ensures the healthcare needs of the residents are well met. The home needs to develop its medication policy and improve its medication administration procedures to ensure safer management of medication at the home. EVIDENCE: The home is fortunate in having a very supportive GP who holds a weekly surgery at the home every Monday morning. The home goes through the practice for they’re out of hours support. The doctor’s records are held at the home. For reasons of confidentiality access by the staff to these records is limited to management only. The pharmacy is situated at the GP surgery. Any newly prescribed medication or medication changes are written down by the GP on the homes headed notepaper and the entries signed by him. This information is then faxed through to the surgery where the prescriptions will be filled. A copy of these doctors ‘instructions’ are kept on file in the home to back up the changes / amendments made to the Medication Administration Records (MAR). These records were made available for inspection purposes. Lime Tree Court DS0000022988.V266027.R01.S.doc Version 5.0 Page 11 On receipt of the medication into the home, staff signs to say they have received it. The doctor reviews medication regularly. In support of the GP, additional healthcare support is provided by DN’s, CPN’s (the home have direct access to these professionals), dieticians, physiotherapist, chiropodist (every 5 weeks), optician, dentist and the falls risk assessment team. The home keeps records of any contact made with healthcare professionals and these records were seen during the inspection. Medication is administered from the original containers, which are held in a secure medication trolley. An examination of this did not identify any poor storage practices. The pharmacy carries out twice-yearly checks on medication storage and administration practices at the home. A number of residents are on Temazepam night sedation. The MAR records show two staff signatures but there was no record of stock held which would be considered good practice. Advice was given on introducing this practice and a recommendation at the end of the report made. There was evidence of correction fluid being used on the MAR sheets to correct errors. This is not acceptable practice and errors should simply be marked through with a line and an explanation given on the back of the MAR sheet. Gaps were also noted on the Administration records. The manager has been advised to introduce a code system where staff can record why a medication has not been given. A requirement has been set to this effect. All staff that has the responsibility for the administration of medication has undertaken a 12-week distance-learning course in safe administration practice. At the time of the inspection one resident was applying her own eye drops and this was the only self-medicating that was taking place. The selfadministration policy does not include a clause that says a risk assessment must be in place to help decide whether self-medication is safe. A requirement to do this has been made. The home does not have a homely remedies policy and they have been asked to liaise with the GP to do this. Since visiting the home the proprietor has spoken with the homes GP who would rather the home did not carry a stock of over the counter medication. He has however agreed to review all residents MAR sheets at his next visit and mark any where Paracetamol should not be given. This will enable the home to hold a small stock of these tablets for administration should a resident have a headache for example. Standard 7 was not assessed at this inspection. However, the inspector met with the majority of the residents who certainly looked well cared for. All were dressed in appropriate colour coordinated and well-laundered clothes, hair was well groomed and attention to detail was evident like varnished nails for the ladies. One resident has his own unique bell, which he rings whenever he wants attention from the staff. Staff were heard and observed to interact well with the residents particularly those with dementia explaining in an easy to Lime Tree Court DS0000022988.V266027.R01.S.doc Version 5.0 Page 12 understand manor when the staff wanted a resident to do something or they were about to do something with the resident. Lime Tree Court DS0000022988.V266027.R01.S.doc Version 5.0 Page 13 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 & 15 The variety of social events programmed to take place at the home ensure the residents lifestyle matches their expectations and preferences, and satisfies their social and religious needs and interests. An experienced and committed catering team ensures residents enjoy a good and healthy diet in appropriate surroundings. EVIDENCE: The home has an activities organiser who works in the home 4 days a week. She organises a variety of social events and a weekly activity list is posted up in the home. On the day of the inspection, colouring, movement to music and needlework (aprons being made) were programmed to take place and the inspector observed this. Games were also played that included: an odour game, cards, draughts and dominoes. Other events planned for the week were: cooking, a quiz, reading, music and ball games. The activities organiser has a well-stocked activities cupboard, which the inspector was shown. The cupboard contained a variety of board games, skittles and beauty treatment facilities – several of the ladies had nicely painted nails. Christmas activities had already been planned and the programme was on display in the home. The residents can expect to enjoy making Christmas Lime Tree Court DS0000022988.V266027.R01.S.doc Version 5.0 Page 14 cards, table decorations and napkin rings, a craft fayre, Christmas bingo and residents Christmas party. In addition to this a professional singer has been booked, a church service with carol singing and the residents have been invited to attend the nativity plays of 4 local schools. The home has strong ties with the church next to the home. The inspector had the opportunity to meet with the cook. The kitchen appears well managed with comprehensive records maintained of food deliveries, food temperatures, menu choices, equipment temperatures and any visitors to the kitchen. A quality monitoring of the kitchens performance is undertaken every month. The menus are drawn up two weeks in advance to take account of residents’ likes and dislikes and seasonal availability of produce. Menu planning takes account of the need to provide the residents with 5 servings of fruit and vegetables a day. On the day of the inspection evidence was seen of fresh fruit and fruit juice being given and two vegetables served for lunch. Alternatives to the menu choices are on offer. During the colder months the residents have at least two hot meals a day. This can be three if a cooked breakfast is requested. Special diets are provided and at the time of the inspection three diabetics were being catered for. Some residents do need a soft diet and it is the homes practice to liquidise the food all up together. This was commented on by a relative. The home has in the past tried to separate out the different soft foods but found this was difficult to manage. It has been made a recommendation in this report that they do not give up on this idea and that it should be tried again. It is the homes practice that should a resident be off their food for two consecutive days, they are automatically put on a food and fluid chart. The main meal on offer at lunchtime on the day of the inspection was cheese and bacon pasties, mashed potatoes, peas and leeks with gravy. The pudding was jam roly-poly and custard. The inspector sampled the meal. It was hot, well presented and tasty, the residents appeared to enjoy it. Some residents enjoy a glass of sherry or Baileys after lunch. Lunch for the more able residents is taken in the dining room. Those that need help remain in the lounge where they are helped to eat by staff on a one to one basis. Lime Tree Court DS0000022988.V266027.R01.S.doc Version 5.0 Page 15 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, 17 & 18 Knowledge of the homes complaints procedure and the managers’ open door policy gives residents and visitors to the home confidence that any complaints will be taken seriously and acted upon. Service users are on the electoral role and have the support of their local clergy as an advocate to ensure their legal rights are protected. All staffs have had PoVA training to ensure the residents are protected from abuse. EVIDENCE: A copy of the homes complaints procedure is given to all residents and/or their relatives at the time the contract of residency is sent to them. The proprietor and staff also know their residents and their carers well and are confident that their open door approach would mean concerns are brought to them knowing they would be listened to. This was certainly the impression given to the inspector from a relative they met with during the inspection. According to the proprietor, in the homes long history there has only ever been one complaint, which was unsubstantiated. It is pleasing to be able to report that no complaints or concerns about the home have been raised with the Commission. Residents’ names are included on the electoral role and arrangements made for a postal vote as necessary. The home does not currently have any input from an advocacy service. In the managers’ opinion, the clergy fill this role. Lime Tree Court DS0000022988.V266027.R01.S.doc Version 5.0 Page 16 The inspector would like to see an advocacy service have some input into this home and a recommendation to this effect has been made. At the time of the inspection a group of staff were in the home receiving PoVA training. Once this has been completed all staff will be PoVA trained. A senior staff member has been trained to provide PoVA training in the home. All staff are given their own copy of PoVA policy and practice. The home also has a whistle blowing policy. PoVA forms part of the induction package for new staff. Copies of the PoVA policy for Buckinghamshire and Milton Keynes are held in the home, copies seen. Lime Tree Court DS0000022988.V266027.R01.S.doc Version 5.0 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 A proprietor who takes a pride in her home and the regular service of a handyman ensure Lime Tree Court is a safe and well maintained environment for the residents to live in. Standards of cleanliness are high in this home ensuring the residents live in a clean and hygienic environment. EVIDENCE: The original building was constructed 300 years ago and has many of its original features, which add to its charm. An extension to the original property was done in keeping with the original building. Although a thorough inspection of the building was not undertaken at this visit, all communal parts of the home, some bedrooms, the laundry and staff room were seen. Standards of decoration were good and there was evidence that residents are encouraged to bring in their own items of furniture and other personal belongings to help personalise their room. A request is made that periodic checks are made on bedroom curtains to ensure they are hanging correctly. The home has the Lime Tree Court DS0000022988.V266027.R01.S.doc Version 5.0 Page 18 services of a gardener and the layout of the garden has been designed with the disabled service user in mind. Appropriate aids and adaptations have been provided in the home including a stair lift; hoists on each floor and disabled bathing facilities. Standards of cleanliness at the home were high with no odours detected. Lime Tree Court DS0000022988.V266027.R01.S.doc Version 5.0 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 & 30 The homes recruitment policy and practices now ensure the protection of residents. The proprietor has a positive attitude to training encouraging and facilitating this to ensure a staff team competent to do so cares for the residents. EVIDENCE: The proprietor had learned a very valuable lesson with regard to staff recruitment following problems identified in the recruitment of an oversees member of staff at the last inspection. Because the home has such a good record of keeping its staff it is difficult to assess whether this standard was being complied with as no completely new appointments have been made (with the exception as detailed above) in the past 3 years. The exception to this is the transfer of two 18year olds who have worked at the home for a number of years in a non-caring role to the position of carer. The records made available for inspection showed that their PoVA checks and CRB were in place. Training at this home is encouraged and facilitated. At the time of the inspection 50 of the staff team were trained to NVQ Level 2. As already reported PoVA training for staff was taking place on the afternoon of the inspection. Following this, all staff at the home will have received this training. Lime Tree Court DS0000022988.V266027.R01.S.doc Version 5.0 Page 20 The proprietor is the nominated first aider having completed a four-day training course. All other staff has done the emergency first aid course. Distance learning has been under taken by all staff in medication administration and food hygiene. Eight staff members have done control of infection. Certificates detailing the training undertaken were seen on a staff file chosen at random to be looked at. Lime Tree Court DS0000022988.V266027.R01.S.doc Version 5.0 Page 21 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): 36 & 38 Staff receive regular supervision giving them support to carry out their duties and identifying their training needs. The homes policies, records and practices observed demonstrate that the health, safety and welfare of residents is promoted and protected. EVIDENCE: For reasons of confidentiality the supervision records of staff were not examined. The proprietor confirmed that supervision of staff does take place. 3 senior staff members share supervisor responsibilities. The proprietor in turn supervises them. Staff receive annual appraisals from either the proprietor or head of care that have both had appraisal training from Bucks CC. Maintenance contracts are in place for equipment and other facilities in the home. Extensive records of this are maintained and the file was made Lime Tree Court DS0000022988.V266027.R01.S.doc Version 5.0 Page 22 available for inspection purposes. The home has a comprehensive list of telephone numbers for staff to use as needed. Examples include: the gardener, hairdresser, wheelchair servicing, the stair lift, laundry equipment, the fire services, electrician and out of hours healthcare professionals to name a few of the many listed. This is good practice and empowers the staff to act in an emergency for example, should the proprietor/manager not be in the home. A fire drill was last carried out on the 7.11.2005 and the staff that participated was listed. Alarm call point and emergency lighting tests were being carried out at appropriate intervals. Records showed that there had been no staff accidents in the home since April 05. Individual record sheets are completed for every resident accident. These are currently held on individual resident files. While there is nothing wrong with this method of record storage practice, it can make auditing the accidents difficult. The inspector recommends all accident reports be held in a central file with copies in with resident records should the home wish to do this. Those records seen were informative and obtained all necessary information. The home has a first aid box. The home has a total no lift policy. Disabled bathing facilities are available and there are mobile hoists on both floors. All staff are trained in movement and handling. Infection control measures were in place by way of liquid soap, paper towels, protective clothing and yellow bags for clinical waste. Lime Tree Court DS0000022988.V266027.R01.S.doc Version 5.0 Page 23 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X 3 X 3 Lime Tree Court DS0000022988.V266027.R01.S.doc Version 5.0 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP9 OP9 Regulation 13(2) 13(2) Requirement Timescale for action 15/11/05 3 OP9 13(4)b The use of correction fluid on MAR sheets is to cease. A coding system is to be 30/11/05 introduced and used on MAR sheets for any occasion where a resident has not received their prescribed medication. The homes self-medication policy 30/11/05 must include the need to carry out a risk assessment before agreement on self-medicating is reached. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP9 OP12 OP14 Good Practice Recommendations It is recommended that stock monitoring of the drug Temazepam is routinely carried out. It is recommended that the homes new practice of obtaining pen pictures of residents is developed to include them all. It is recommended that an advocacy service be advertised DS0000022988.V266027.R01.S.doc Version 5.0 Page 25 Lime Tree Court 4 5 OP15 OP38 in the home. It is recommended that the home try again to present liquidised foods in a more attractive and appealing manor. It is recommended that copies of the residents’ accident reports be held in a central file. Lime Tree Court DS0000022988.V266027.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR 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 Lime Tree Court DS0000022988.V266027.R01.S.doc Version 5.0 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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