Inspection on 12/10/06 for Lime Tree House

This inspection was carried out on 12th October 2006.

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 House 09/01/09

Lime Tree House 16/07/08

Lime Tree House 14/02/08

Lime Tree House 04/09/07

Lime Tree House 17/05/06

Lime Tree House 14/12/05

Lime Tree House 07/06/05

Lime Tree House 19/10/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Lime Tree House Chantry Green, Main Street Upper Poppleton York YO26 6DL Lead Inspector Donna Burnett Key Unannounced Inspection 12th October 2006 09:15 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 House DS0000061499.V314874.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 House DS0000061499.V314874.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lime Tree House Address Chantry Green, Main Street Upper Poppleton York YO26 6DL 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) 01904 795280 Roseville Care Home Ltd ****Post Vacant**** Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Lime Tree House DS0000061499.V314874.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th May 2006 Brief Description of the Service: Lime Tree House provides personal care and accommodation for up to 26 older people and is owned and managed by Roseville Care Homes Ltd. The home is a large detached property set in private gardens in the village of Upper Poppleton on the outskirts of York off the A59 York to Harrogate Road. There is parking to the front and side of the home. The village offers amenities within walking distance. The home caters for up to 26 older people, with various needs relating to old age. Service users accommodation is over two floors and has a passenger lift and stairs to access the first floor. Communal areas such as the lounge and dinning room are all on the ground floor. Each resident and prospective resident is given information about the home in written documents called the statement of purpose and the service user guide. On the date of this inspection the registered provider said that the fees for the home ranged from £339 to £420 per week. Lime Tree House DS0000061499.V314874.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report follows an unannounced site visit, which took place on 12th October 2006. The visit was carried out by one Regulation Inspector and lasted seven hours. Four hours were spent preparing for the visit. A questionnaire was completed and returned to The Commission for Social Care Inspection prior to the visit, which provided information about the service, which is referred to and included in the main body of the report. Surveys were sent to ten members of staff and two were returned. Three General Practitioners were sent comments cards and one replied. Two Social Services Care Managers were spoken to and their comments about the service are included in the report. The site visit included a tour of the premises in order to check the suitability and safety of the environment. Time was spent talking to several residents and visitors to the home as well as the owner, deputy manager and several members of staff. Staff were observed interacting with the residents and carrying out their usual daily routines. A sample of residents and staff files were looked at as were a selection of records, policies and certificates pertaining to health and safety. What the service does well: Prospective residents are given the opportunity to try out the home before going to live there. The environment is homely and one resident described it as ‘very comfortable’. Residents are very much encouraged and supported to maintain their independence for as long as possible. Residents commented that it was ‘difficult to fault the place’ and that staff ‘look after you well’. Lime Tree House DS0000061499.V314874.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The home has had a number of managers over the past year and the post is currently vacant. The deputy manager is currently overseeing the running of the home but, in the absence of a senior member of staff, is not being adequately supported or supervised in her new role. There is no management cover when she is not on duty and there is a risk of being unable to maintain the improvements that have been made to the service over the past few months. A system for checking that medication is being given as prescribed must be introduced so that mistakes can be detected easily and the risk of errors Lime Tree House DS0000061499.V314874.R01.S.doc Version 5.2 Page 7 happening is removed. All staff responsible for administering medication must follow the correct procedure at all times in order for resident’s wellbeing and safety to be maintained. 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 House DS0000061499.V314874.R01.S.doc Version 5.2 Page 8 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 House DS0000061499.V314874.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 6. Quality in this outcome area is good. Detailed information about service users is obtained before being admitted to the home and ensures that their needs will be met properly. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the last inspection a requirement was made that service users only be admitted on the basis of a through assessment. Inspection of service users records and discussions with a newly admitted service user found that the home had addressed shortfalls in this area so that it was only admitting people whose care needs it could meet. The deputy manager assesses every prospective service user before being invited to live at the home to make sure that the service can provide the help that is required. Carers spoken to felt they had the experience required to deliver the care people need. Prospective service users are encouraged to spend some time visiting or staying at the home to ‘test-drive’ the service before making a decision about whether to live there or not. Lime Tree House DS0000061499.V314874.R01.S.doc Version 5.2 Page 10 The risk assessments looked at explained what to do to minimise the risk of harm to both service users and the staff providing the care in order to maintain peoples safety. The home does not offer intermediate care. Lime Tree House DS0000061499.V314874.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is adequate. The care provided to service users is good, however poor practices in relation to medication procedures puts service users at risk of potential harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the last inspection a requirement was made to have in place for each person a care plan, which describes how their health, safety and welfare needs are to be met. Service users plans looked at had been improved on greatly since the last inspection and were in sufficient detail for care staff to know what help to give. Care plans were being regularly reviewed so that changes in need were recorded and communicated to the staff delivering the care. There was evidence of good communication and relationships with other professionals and agencies, which ensures that service users health, social and personal care needs are addressed. Lime Tree House DS0000061499.V314874.R01.S.doc Version 5.2 Page 12 Service users are assessed for their risk of pressure sores and appropriate measures taken to maintain healthy skin. Equipment to assist in the prevention of pressure sores is available. Dietary needs are assessed so that nutritional intake and weight can be monitored and maintained. Service users can either access a visiting optician or go to one outside of the home if they prefer. Staff members accompany and support service users to attend hospital appointments if family are unavailable. Medication is administered by specific staff who have been appropriately trained in the safe administration of medication. Staff spoken to were aware of their limitations and knew not to give out medication until they had received the relevant training. A recent medication error was reported to the Commission for Social Care Inspection prior to this inspection. Records showed that the manager at the time had dealt with the incident appropriately and steps taken to minimise the risk of the same error recurring. The way in which medication was being administered and recorded was found to be unsafe in that two of the three medicines checked did not tally with the amount of tablets that should have been left in the bottles. It could not be determined whether certain medication had been given or not although the service user involved was not experiencing any ill effects that would have been expected if the medication had not been given as prescribed. A member of staff who returned a survey, however, expressed concerns that a particular service user was without prescribed medication for ‘quite a few days’. Both staff members who returned surveys also had concerns about other members of staff giving out medication without following the correct procedure and potentially putting service users at risk of harm. Service users who wish to self medicate are supported to do so safely and have the facilities to store their medication securely. Lime Tree House DS0000061499.V314874.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is good. Service users are helped to maintain control of their own lives and spend their time as they wish. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users preferences about their daily routines were recorded within the care records looked at and were adhered to. Service users spoken to said they could choose whether to join in activities and outings or not. Library books, newspapers and talking books for people with eyesight problems were evident throughout the home and some service users were enjoying a game of dominoes. There was a computer for anyone wishing to access the Internet or use the E-mail facility and the owner stated that help is available for service users needing to learn how to use it. A screen magnifier is available for visually impaired service users. The home welcomes entertainers who provide stimulation and social contact for people living at Lime Tree House. Communion is brought into the home once a month by the local vicar for those wishing to maintain their religious beliefs. One service user spoken to preferred to go out to Chapel instead and was supported to do so. Occasional outings are arranged either to the pub or more recently, the seaside. Many service users spoken to were in regular, close contact with family members, day centres, clubs and the local community. Lime Tree House DS0000061499.V314874.R01.S.doc Version 5.2 Page 14 Visitors spoken to and health and social care professionals who commented felt welcome and able to visit in private. Service users spoke of being allowed choice and this was evident during the inspection. They were offered a choice of meals, when to get up, how to spend their time and where to spend it. Service users spoken to confirmed that they could bathe or shower when they wanted. Some people had chosen not to be ‘checked’ and looked in on during the night and this was clearly documented and respected. The experienced cook who was spoken to showed good awareness of the individual likes and dislikes of the service users. Although menus were in place, specific requests were being catered for as was evident during the inspection. All service users spoken to were complimentary about the food which looked appetising and was nicely presented. Fresh, varied, local produce is used and the budget is unrestrictive meaning that service users can have the food they want. Drinks and biscuits were offered regularly throughout the day. A residents meeting some months ago identified that service users disliked cold plates and it was apparent during the inspection that food was being delivered on warm plates as requested. The dining area was a pleasant environment in which to enjoy a meal and the use of glasses, matching crockery and condiments was homely. Lime Tree House DS0000061499.V314874.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. Abuse awareness training for staff and adult protection guidance helps to safeguard service users from harm. The openly displayed complaints policy encourages service users and their representatives to comment on aspects of the service that they are not happy with. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection when the home was required to provide a more robust complaints procedure, the complaints policy has been revised and updated. It is now displayed throughout the home with a copy in service users rooms. It is clear for anyone wishing to make a complaint what to do, who to report it to and the timescales within which to expect a response. Complainants are offered the opportunity to make either verbal or written complaints. Service users spoken to felt staff were approachable and most were confident that any complaint or concern they might have would be taken seriously. There have been no complaints since the last inspection. All staff have recently attended training in the Protection of Vulnerable Adults as a result of a lack of knowledge in this area and a requirement, which was made at the last inspection. A copy of the Multi Agency Adult Protection Policy and Procedure is available to be referred in the event of an allegation of abuse. Service users are now better protected from harm by staff who know how to deal appropriately with any suspicion or allegation of abuse. Lime Tree House DS0000061499.V314874.R01.S.doc Version 5.2 Page 16 Two service users choosing to look after their own money were being assisted to do so safely. Lime Tree House DS0000061499.V314874.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 , 25 & 26. Quality in this outcome area is good. Service users live in safe, comfortable surroundings, which allow independence to be maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is well maintained and appropriate for the needs of the people living there. Grab rails, raised toilet seats and other aids which maximise independence are unobtrusive and do not detract from the homely atmosphere. The home has a no smoking policy which service users are made aware of before being admitted. For service users wishing to smoke, there is a sheltered area outside which allows them to continue to enjoy a cigarette in some comfort without compromising the health and welfare of other people living in the home. Lime Tree House DS0000061499.V314874.R01.S.doc Version 5.2 Page 18 Clinical waste is disposed of safely and appropriately to avoid the risk of contamination and infection. Appropriate measures have been taken since the last inspection to eliminate offensive odours and ensure a more pleasant environment in which to live. The kitchen floor, which was found to be in a poor state of repair at the last inspection, has been suitably cleaned and repaired so as to be more hygienic. Water temperatures had previously been too high and posed a risk of scalding. This is now managed by regular checks and adjustments to temperatures as and when necessary. The laundry is barely adequate given the size of the home and is not a pleasant environment for staff to work in. Dirty laundry, wet laundry and clean laundry are all within close proximity of each other, which is unavoidable given the size of the room but means that clean laundry is at risk of being contaminated by soiled laundry. The laundry room should be reorganised so as to minimise the chances of clean and dirty laundry being mixed up, or alternatively plans made to extend/move the laundry to be more spacious. A number of documents were looked at which showed that equipment was being serviced regularly and maintained in good, safe working order. Lime Tree House DS0000061499.V314874.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is good. Service users are cared for by carefully recruited staff who have the skills and competencies to deliver the care required. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff spoken to felt there was sufficient staff on duty to meet the needs of the service users. Service users spoke of not having to wait long to be attended to. Staffing levels have increased since the last inspection and staff spoken to felt confident that staffing levels would increase further should the needs of the service users increase. Service users with additional needs were identified and extra help and support brought into the home specifically for those people. The home does not use agency staff and relies on the good will of its own staff to cover for holidays and sickness. This gives consistency for the service users and reassurance that the staff delivering their care, know them well. Some staff felt that certain carers were ‘stressed’ due to the pressure of working so many extra hours and that this sometimes has a negative impact on the service users. The ratio of care staff trained to NVQ level 2 is below minimum requirements but staff spoken to, commented on and were positive about the recent amount of training that has been going on. Although the home has made good progress on the amount of training available to staff, steps should be taken to show an ongoing commitment to the care that service users receive by supporting staff to undertake formal caring qualifications. Lime Tree House DS0000061499.V314874.R01.S.doc Version 5.2 Page 20 Four staff files were looked at which found good recruitment practices being followed. Satisfactory Criminal Records Bureau checks had been carried out prior to employing staff to make sure that no one with a criminal record was working at the home. Two references had been obtained for the staff whose files were looked at to check on the suitability of the applicant before being offered a job. Induction training for new staff covers basic health and safety, food hygiene and abuse awareness. A number of staff are undertaking distance learning courses through York College. The deputy manager is undertaking relevant training to be able to become sufficiently skilled to then apply to become the registered manager of the home. All staff have recently had training on the Protection of Vulnerable Adults and other recent training includes moving and handling, first aid, food hygiene and infection control. Lime Tree House DS0000061499.V314874.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32, 33, 35, 36 & 38. Quality in this outcome area is adequate. Service users are kept safe and their opinions valued despite many changes with the management of the home over several months. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The deputy manager is currently running the home in the absence of a registered manager. Staff spoken to were clear about the lines of accountability and felt that the home had seen a ‘80-90 improvement’ due to the efforts of the previous manager. They felt the deputy manager was approachable and seemed confident that she would be able to maintain the current good work going on in the home. One staff member who returned a survey, however, was concerned that ‘since the old manager left, things are slipping’ due to the ‘inexperience’ of the deputy manager. Due to the registered providers lack of experience of care work it is imperative that Lime Tree House DS0000061499.V314874.R01.S.doc Version 5.2 Page 22 someone senior, with knowledge of care work, supports the deputy manager in order to maintain improvements to the service. Since the last inspection, steps have been taken to get the views of service users and their families in order to improve the service further. Questionnaires and residents meetings have encouraged comments and feedback and there was evidence through records and discussions with service users and staff that changes have been brought about to benefit the people living at the home. The Quality Assurance policy was on prominent display in the reception area along with the complaints procedure so that it could be easily accessible to all interested parties. Service users who choose to look after their own money have the facilities to keep the money safe in their room in a lockable drawer. Assistance is given to allow autonomy and choice whilst minimising the risk of money going missing or being spent unwisely. Money looked after by the home for safekeeping is secured safely with restricted access to reduce the risk of errors and mishandling. Money is kept in individually named wallets and good records kept of all transactions. Two wallets were checked at random and found to be in order. Fire notices were prevalent throughout the home and in service users rooms. Fire equipment had been recently serviced to ensure it was working safely. A number of staff had received first aid training and recent training had been provided covering food hygiene and infection control. Food in the kitchen was stored correctly so that the risk of food poisoning was low. Water-soluble bags were being used for foul laundry so that it did not have to be touched and could go straight into the washing machine without the risk of spreading infection. Window restrictors were observed so that service users could not fall out of windows and intruders could not get in. Random hot water temperature checks were found to be within safe limits. Accidents and incidents were being recorded and reported appropriately and action being taken where possible to reduce the chance of specific accidents recurring. A number of policies and procedure relating to health and safety were looked at and were easily accessible to all staff. Staff are required to look at the policies and procedures every three months and they sign to say that they understand the content and know what to do to ensure the safety of the service users. (Refer to page 13 for shortfalls with regards to the safe administration of medications.) A selection of reports and certificates were also looked which confirmed compliance with gas, electric and health and safety legislation. Lime Tree House DS0000061499.V314874.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 3 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 X 3 2 X 3 Lime Tree House DS0000061499.V314874.R01.S.doc Version 5.2 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. Standard OP9 Regulation 12(1) 13(1)(2)( 6) 17(1) Schedule 3(i) 18(2) 9(2i) Requirement A system for checking that medication is being given as prescribed must be introduced so that errors can be detected easily and the risk of errors is removed. The deputy manager must receive formal, professional supervision. Without this support, the deputy manager is at risk of not being able to maintain the good work and improvements that have been made to the service over the past few months. Timescale for action 12/01/07 2. OP36 12/01/07 Lime Tree House DS0000061499.V314874.R01.S.doc Version 5.2 Page 25 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. Refer to Standard OP26 Good Practice Recommendations The laundry room should be reorganised so as to minimise the chances of clean and dirty laundry being mixed up, or alternatively plans made to extend/move the laundry to be more spacious. The ratio of care staff trained to NVQ level 2 is below minimum requirements. Although the home has made good progress on the amount of training available to staff, steps should be taken to show an ongoing commitment to the care service users receive by supporting staff to undertake formal caring qualifications. 2. OP28 Lime Tree House DS0000061499.V314874.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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 House DS0000061499.V314874.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!