Inspection on 07/06/07 for Lime Tree Court

This inspection was carried out on 7th June 2007.

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 09/02/06

Lime Tree Court 15/11/05

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 Andy McGuckin Unannounced Inspection 07/06/2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lime Tree Court DS0000022988.V330931.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lime Tree Court DS0000022988.V330931.R01.S.doc Version 5.2 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.V330931.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 23 residents, no more than twelve of whom may have dementia. Date of last inspection 9th February 2006 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.V330931.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced “Key Inspection”. It was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s manager, and any information that the CSCI has received about the service since the last inspection. The inspector useed the following methods on which to make a judgement. Visit to the property Inspection of core documentation Consultation with service users, relatives and professionals associated with home. Discussion and feedback from staff Discussion with the registered manager Tour of the building and grounds Direct observation From the evidence seen by the inspector and comments received, the inspector considers that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs . No complainant has contacted the Commission with information concerning a complaint made to the service since the last inspection. The inspector would like to thank the proprietor, staff and service users for their help in the inspection process. The home charges a weekly fee of £451.79p there are no extra costs. What the service does well: Comprehensive information is available to inform care staff of the needs of its service users. Lime Tree Court DS0000022988.V330931.R01.S.doc Version 5.2 Page 6 Service users are encouraged to maintain contacts from their community, family and friends. Staff are available in sufficient numbers to provide a good service to residents. The home is well managed and supported by an experienced senior staff team with the back up of the proprietor. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Lime Tree Court DS0000022988.V330931.R01.S.doc Version 5.2 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.V330931.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5,6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides information to prospective service users to enable them to make an informed decision as to the suitability of the home in meeting their needs. EVIDENCE: The home provides prospective service users and their families with a Statement of Purpose and a Service User Guide. These documents contain core information as to what the home is able to offer and what is not. It details whom it can care for and whom it cannot. A copy of the homes terms and conditions of residence state what is expected from the prospective resident and what will happen if there is a problem on either side. A copy of Lime Tree Court DS0000022988.V330931.R01.S.doc Version 5.2 Page 9 the written contract and the Statement of Purpose are given to the resident or their representative on acceptance to the home. A full assessment of the prospective service users is undertaken prior to admission and where appropriate interested professionals are included in this assessment. Service user are encouraged to visit and stay in the home prior to admission and many have had respite care at the home prior to coming full time. The home has a waiting list to which prospective residents are added. Allocation of placements, take place as and when vacancies arise. The home does not provide an intermediate care provision. Lime Tree Court DS0000022988.V330931.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Documentation relating to the care of residents was inspected and found to contain comprehensive information regarding the care needs of its residents. EVIDENCE: The inspector viewed six care plans at random. Information contained in the care plans was presented in a way which would enable carers to be fully informed as to the care needs of the residents. Plans were presented in plain English and were accurate and up to date. Information was kept on file as to the history of the service user prior to coming to the home. This information included past work history, family history and hobbies and pastimes. The home is to be commended for this initiative. Lime Tree Court DS0000022988.V330931.R01.S.doc Version 5.2 Page 11 At present no service users self medicate. The inspector was informed that this was service user choice and that people had been given the option to manage their own medication. The inspector was concerned regarding the management of medication as there was no recognised dosage system to assist those giving out medication to monitor any errors. The proprietor was adamant that the homes system was robust and that it is monitored and reviewed. Medicines are checked in and out and the GP from the local surgery visits every Monday to do an in house surgery. A copy of the homes medication policy was made available to the inspector. All staff are given 12 weeks distance learning which covers a range of topics including the safe handling of medication. The proprietor accepted that we had a difference of opinion. The inspector could find no evidence that the current system was not working. The home has access to other healthcare professionals including alternative health therapists. The home has a robust procedure for the distribution, storage and recording of medication. Some residents manage their own medication with minimal supervision from the carers. The inspector witnessed staff treating residents with respect and dignity in a relaxed and happy manner. Staff, obviously enjoy working in this home which means the residents are being cared for by people who genuinely care. Many staff within this home has worked in the home for a number of years. There is a very low turnover of staff. Evidence was found at the inspection that the wishes of residents following serious illness or death are being recorded and acted upon. Questionnaires sent out to residents, relatives and professionals involved with home were returned in large numbers. The overwhelming comment was that this is a good home where people feel valued, consulted, respected and encouraged. The home should be commended for these positive comments. Healthcare professionals feel that residents health and wellbeing is being promoted and monitored appropriately. Evidence was found that the local healthcare practice has regular contact with the home and that the relationship between the home and the practice is good. A small but representative sample of the many comments received from residents follows: “ I do not believe that they care service could be improved in any way “ Lime Tree Court DS0000022988.V330931.R01.S.doc Version 5.2 Page 12 “ I am almost certain that she has survived to this grand old age of 95 because it runs in her family, but because she has received the care of friendly, caring staff “ “ Lime tree court was always clean and tidy and welcoming “ “ Delighted they have introduced a no smoking policy for staff who used to use the room near the entrance for the purpose “ “ There is always a senior member of staff on site and available to speak to “ “ My mother spent the last years of her life at Lime Tree Court she died at the home in 2007 after receiving very loving care from everyone there during her last few days. My mother was always happy at the home “ My mother is always clean and tidy when we see her and her room is always spotless “ “ The staff at Lime Tree Court are very caring, courteous and pleasant, always happy to help “ “ When I had to put my mother in a home it was the worst thing I thought I would do. They have made it so pleasant for myself, and family. I am just so thankful I found such a wonderful home “ Lime Tree Court DS0000022988.V330931.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home provides a high level of one to one staff time to enable residents to enhance their social, cultural, and recreational needs. EVIDENCE: The home has many residents who require a high level of one to one care and this aspect is well catered for. For those residents who are more able and independent the inspector would like to see some pre planned regular activities. Residents should be encouraged to take an active part in the selection of these activities. Informal activities include residents making mobile art- work to hang over the bed of residents who are bed bound. This is a very thoughtful and appropriate activity and the home should be commended for this initiative. Lime Tree Court is very welcoming to all who come to visit and acts as a hub of the community. Residents maintain their friendships and new friendships are Lime Tree Court DS0000022988.V330931.R01.S.doc Version 5.2 Page 14 encouraged and promoted. Residents have visitors and friends at any reasonable time of the day and can entertain in their own room or in the main house its self. Visitors are asked to sign the visitor’s book. Residents are encouraged to have as active an involvement in maintaining their life-style as they are willing or able. The home has a well-equipped and hygienic kitchen. Food is bought and prepared using fresh ingredients. Resident are asked to select from a menu, which changes weekly on a rota basis and offers a good selection including vegetarian, salad, sandwich or omelette. Residents dine in a light airy diningroom, some residents choose to eat at a small table next to their chair. For residents requiring assistance with eating staff are available to assist or supervise. Residents can dine in their room if they wish. Guests are also welcome to join the residents. Lime Tree Court DS0000022988.V330931.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home provides service users and concerned individuals with sufficient information to make comments or complaints in a non-threatening manner. EVIDENCE: Feedback from service users and their representatives indicated that, where there is cause for complaint or dissatisfaction, the home has formal processes for it to deal with them. The homes complaints procedure was viewed and found to be satisfactory. The home ensures, where possible, that residents’ legal rights are protected and that residents are not exposed to any form of abuse. Due to the relatively small size of the home and coupled with fact that both the Senior staff and Proprietor are very hands on the home is able to deal with any concerns at source and ensure that complainants are satisfied. The home has had no complaints recorded since the last inspection. Many letters of thanks and satisfaction have been received by the home. Lime Tree Court DS0000022988.V330931.R01.S.doc Version 5.2 Page 16 No complainant has contacted the Commission with information concerning a complaint made to the service since the last inspection. Lime Tree Court DS0000022988.V330931.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,2021,22,23,24,25,26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The inspector toured the building and was shown recent improvements to the home. Feedback from service users indicated that they were pleased with the work done. EVIDENCE: The inspector had difficulty finding the entrance to the home as there was no obvious signage to inform visitors where to go. On the day of the inspection a back door was being used as the main way into the home. The inspector was informed that the normal entrance is a door to the side of the building which opens up into a hallway this provides a much more appropriate introduction to the home. The inspector would recommend that a notice is put up to assist visitors new to the home to find the entrance. Lime Tree Court DS0000022988.V330931.R01.S.doc Version 5.2 Page 18 The home is maintained to a satisfactory standard. The home is undergoing a refurbishment at present and new flooring, wardrobes, and screens have been provided. Bedrooms inspected were clean and odour free. Where rooms were being shared screening was available to assist privacy. The home has two lounges. The main lounge has information as to the day of the week and the date. This information was a day old on the day of the inspection. It is important that this information is kept up to date and is accurate. When pointed out this was quickly rectified. The kitchen was well equipped and clean on the day of the inspection. Fridges were well stacked with fresh ingredients and the inspector was informed that all the equipment was in working order. The home employs a gardener who on the day of the inspection was working to clear and prune the garden. The garden provides a pleasant area for residents to relax or have private time in. many of the bedrooms open up on to the garden. A new fence and gates are to be added shortly. Resident’s who require specialist equipment, are assessed by the appropriate professional and equipment is installed in the residents own room. The home is fully accessible for those with a mobility problem. Service users benefit from rooms which are large light and airy. Small items of furniture and personal belonging were much in evidence and all residents have personalised their rooms to their own requirements. Feedback from residents was that they were very happy with their rooms. Lime Tree Walk provides a safe comfortable environment, which is clean, pleasant and hygienic. Lime Tree Court DS0000022988.V330931.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Interviews with staff and reading core documentation relating to staff recruitment and supervision gave evidence to this judgement. EVIDENCE: The home employs staff in sufficient numbers to meet the care needs of the current resident group. The inspector witnessed care being given in a happy and relaxed manner with good interactions between staff and service user. The inspector spoke to four members of staff evidence was found at the inspection that staff, are being well trained and supported and supervised. Many staff at the home have been there for a number of years. The home has a system whereby carers can be promoted to senior positions without being taken away from their care role. All staff are given the opportunity to attend a 12 week distance learning course which covers a range of topics relevant to care work. This is provided as extra training to the mandatory and induction training given to all staff. Staff spoken to valued the training opportunities given to them. Lime Tree Court DS0000022988.V330931.R01.S.doc Version 5.2 Page 20 Staff felt very supported by the senior care workers and the proprietor. The home was described as a happy place to work where staff support each other and service users are treated with dignity and respect. The working conditions at Lime Tree Walk are such that they are able to maintain a stable staff group with a low turnover. Comments from staff include: “ Working here is just like family “ “ Staff and management are all very supportive “ “ It’s a very rewarding job “ “ very good range of training “ “ Good induction and ongoing support “ The home has robust recruitment policies and the inspector viewed a random selection of staff files, which were found to be satisfactory. Lime Tree Court DS0000022988.V330931.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37,38. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Evidence was found to back up this judgement by feedback from service users and their representatives and the inspection of core documentation. EVIDENCE: The homes proprietor is often on hand to assist care staff and service users and has a good rapport with both staff and residents. Senior care staff assist her in the management of the home. The proprietor has many years Lime Tree Court DS0000022988.V330931.R01.S.doc Version 5.2 Page 22 experience in the care of the elderly and has a management qualification and is registered with the Commission for Social Care Inspection ( CSCI ) The home has robust policies and procedures to ensure that residents are safeguarded from physical, financial and emotional harm. All staff have been trained in adult abuse procedures and the home is subject to external financial audit. The inspector did not require the home to provide accounts. The manager provides the staff with regular supervision and support and evidence was found at inspection that training is being actively encouraged. All records inspected were found to be accurate and up to date. Information was presented in such a way as to enable those caring for residents to do so with as much information as was required. Good communication was found through both formal and informal methods. From the evidence seen by the inspector and comments received, the inspector considers that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. No complainant has contacted the Commission with information concerning a complaint made to the service since the last inspection. The health and safety of both the residents and staff were found to be being safe guarded. Lime Tree Court DS0000022988.V330931.R01.S.doc Version 5.2 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 3 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 4 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 Lime Tree Court DS0000022988.V330931.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP12 OP13 OP14 Good Practice Recommendations The home should involve the residents in the drafting of a regular activities programme. The home should provide signage to enable visitors new to the home to gain easy access. Information relating to the day and date which is meant to inform service users, should be kept accurately Lime Tree Court DS0000022988.V330931.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V330931.R01.S.doc Version 5.2 Page 26 - 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. 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