Inspection on 14/02/08 for Lime Tree House

This inspection was carried out on 14th February 2008.

CSCI found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Lime Tree House 09/01/09

Lime Tree House 16/07/08

Lime Tree House 04/09/07

Lime Tree House 12/10/06

Lime Tree House 17/05/06

Lime Tree House 14/12/05

Lime Tree House 07/06/05

Lime Tree House 19/10/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

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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 Chris Taylor Key Unannounced Inspection 09:30 14th February 2008 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.V360765.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.V360765.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 Dinka.rch@gmail.com Roseville Care Home Ltd Position 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.V360765.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 04/09/07 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. Each resident and prospective resident is given information about the home in written documents called the statement of purpose and the service user guide. The fees for the home range from £395 to £435 per week. This information was provided on the day of the inspection. Lime Tree House DS0000061499.V360765.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This is what was used to write this report. • Information known about the home since the previous inspection including information from specific incidents reported, complaints and concerns and information passed to the Commission for Social Care Inspection by other professionals and organisations. Twenty-two (22) surveys were sent to people who use the service and five were returned. Eighteen surveys were sent to relatives and eight were returned. Six surveys were sent to GPs and health professionals and none were returned. A visit to the home which was unannounced. This lasted seven hours and included talking to staff about their jobs and the training they have completed. A tour of the premises was made and the records the home is required to keep were looked at. Time was spent talking to the people who live at the home and observing staff as they carried out their work. Four people’s files were looked at in detail. • • • What the service does well: The relationships witnessed between staff and the people who live at the home appeared relaxed, warm and genuine. People who live at the home can choose how they spend their day. Although there is a shortage of staff they always attempt to provide an activity every day. One survey commented that; “ visitors are always made welcome and offered refreshments”. Lime Tree House DS0000061499.V360765.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: For any improvements to be made the way in which this home is managed needs to change. The appointment of the new manager should help this but this person needs to be well supported and monitored by the Registered Provider. Additionally the registered providers need to ensure they meet their legal responsibilities to complete and submit documentation required by law. In order that the service people receive improves management need to ensure that requirements made at inspections are completed within the prescribed timescales. Many of the requirements made at this visit were made at the previous inspection. Admissions to the home must only take place after a full assessment of the persons needs. This will assist the home in deciding whether they have the skills and expertise to meet the person’s needs prior to them moving in. Each person must have a care plan that has been agreed with them. It should include information about all areas of the person’s life including health, personal, cultural and social care needs. The plan must identify the support staff has to provide to meet people’s needs whilst making sure people retain independence. This will make sure the person receives support to meet their individual and specific needs. To make sure support changes with the person’s needs care plans must be reviewed every month. To ensure peoples’ safety and promote independence risk assessments must be completed, these must be discussed with people and reviewed regularly. 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 is minimised. All staff responsible for administering medication must follow the correct procedure at all times in order that people’s wellbeing and safety is maintained. The home needs to demonstrate that complaints are taken seriously, investigated thoroughly and resolved satisfactorily with the complainant. To make sure that any allegations of abuse or neglect are reported to the right agencies the procedure must be amended and staff must be informed of this. Lime Tree House DS0000061499.V360765.R01.S.doc Version 5.2 Page 7 The environment requires some major work carrying out and firm plans must now be made with time scales for completion. Additional staff need to be employed to ensure there are sufficient staff hours to meet people’s needs and to ensure the home is kept clean and maintenance jobs completed quickly. Staff must be provided with appropriate training, particularly statutory health and safety training, in order that they have the skills and knowledge to provide care and support safely. Managers need to implement a quality assurance system which gathers the views of service users, relatives and other professionals. This information should then be used in a development plan which aims to improve the service provided. 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 House DS0000061499.V360765.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.V360765.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3. People who use this service experience poor quality outcomes in this area. Where peoples’ needs have not been assessed prior to admission it is less likely that their needs will not be fully met. This judgement has been made using available evidence including a visit to the service. EVIDENCE: There is a clear referral system. This happens in one of two ways. Care managers from the local authority contact the home with an assessment of the persons needs. The second way is when members of the public contact the home directly. The member of staff in charge at the time of the visit said that the manager completes preadmission assessments. One person said that their daughter had arranged her admission. She said she hadn’t had the opportunity to visit before she moved in but her daughter had and had chosen her room. Lime Tree House DS0000061499.V360765.R01.S.doc Version 5.2 Page 10 Two peoples’ files were looked at who had been admitted within the last 6 months. One person had a preadmission assessment partially completed. The information contained in this document would not provide sufficient information for staff to provide support according to the person’s needs and wishes. The other person had a fully completed pre admission assessment called Assessment for Good Care Planning. It included information about what support the person needs and information about social history and social interests. The previous acting manager completed this assessment. The format for the pre admission assessment is good and has appropriate headings to determine what support people need. If however this information is not completed then the home can’t determine whether they have the skills and expertise to meet the person’s need safely. The need to complete pre admission assessments was a requirement at the previous inspection. Lime Tree House DS0000061499.V360765.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. People who use this service receive poor quality outcomes in this area. A lack of good care planning and safe administration of medication places people at risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four people’s case records were looked at in order to check that a care plan had been formulated which helps staff provide support to people according to their needs and wishes. The two people who had recently been admitted had no care plans and no risk assessments. When staff were asked how they knew what support to provide to these people they said they asked them what help they needed. The other two files contained comprehensive care plans and risk assessments but they were both last dated in 2006. Nothing had been recorded since that Lime Tree House DS0000061499.V360765.R01.S.doc Version 5.2 Page 12 date so it couldn’t be established whether the person’s needs had been changed or been reviewed. Lack of proper care planning documentation mean that staff are using their own judgment based on limited verbal information to provide support. This has the potential to place people at risk of harm. Daily records provide little useful information and the majority of recordings said “ no change”. Staff are however meeting some of the needs of people despite a lack of good care plans and guidance. People looked clean and cared for. During the course of the inspection staff were observed working with people. Staff were kind and courteous, patient and helpful. People spoken with said that staff were respectful and kind. One Person said, “ staff are very kind, we have a good laugh with them”. Two people said that staff always knock on bedroom doors and are respectful of privacy”. One person said “ They know my ways, I like to spend the afternoon in my room and they respect that”. One person said that a new member of staff had helped him width his bath and didn’t know what to do so he had to manage himself. The storage and administration of medication was checked to make sure that medication is stored and administered safely. The medication trolley is locked and secured to the wall in the dining room. The medication fridge is now locked. A monitored dosage system is used and medication is stored in blister packs. Medication that can’t be stored in this way is kept in the shelves of the trolley’s doors. On the day of the inspection new medication stock had been started so it was difficult to complete an accurate audit. The previous month’s medication administration sheets were checked and there were a number of gaps with no signature, so it could not be established whether medication had been given or not. There was no system to check the stock of PRN analgesia. The member of staff in charge said that she had noticed that one person’s codeine medication is going missing so only one tablet is put in the trolley everyday. Two people keep their medication themselves; there is no recorded risk assessment to ensure this is safe practice. The home has in the past stored controlled drugs for which there is no additional lockable facility or controlled drugs book. When creams are prescribed there is no record made on the medication administration sheet that they have been applied. The drug returns record was looked at. Amongst the drugs returned there were three which if not taken would seriously affect the person’s health. The member of staff in charge could not offer an explanation as to why these drugs had not been given. The member of staff in charge said that she was aware that staff occasionally take medication out of the blister packs and put them in pots, this is known as “potting up”. This practice is very unsafe as there is a high risk of errors being Lime Tree House DS0000061499.V360765.R01.S.doc Version 5.2 Page 13 made and service users who are not aware of the medication they are taking could be administered the wrong medication. Lime Tree House DS0000061499.V360765.R01.S.doc Version 5.2 Page 14 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): Standards 12, 13, 14 and 15. People who use this service experience good outcomes in this area. People have choice about how they spend their days. Better efforts to identify people’s preference and interests would ensure individual’s social, cultural and recreational interests are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home doesn’t employ a specific activities organiser but there is one member of care staff who takes on this responsibility. People said that entertainers, singers and keyboard players often came to the home and that the local vicar held a service once a month for those wanting to take part. Library books, newspapers and talking books for people with eyesight problems were evident throughout the home. A large screen TV means that service user have a good view of the television wherever they sit in the lounge. Also in the lounge is a computer available for service users. Although there appears to be plenty to do a lack of good care planning means that the social, cultural and recreational interests of people are not always Lime Tree House DS0000061499.V360765.R01.S.doc Version 5.2 Page 15 identified. This makes it difficult to plan and provide opportunities which relate directly to the needs and preferences of the people living at Limetree House. Information provided from surveys indicated that two people said that there were usually activities available and two said that there were only sometimes activities available. One person commented, “ more afternoon activities would be appreciated” Staff were seen spending time chatting to people. During the afternoon a few people were joining in a game of bingo. One person said she enjoyed reading and that the library delivers books at regular intervals. People spoken to said that they could get up and retire whenever they wanted and were free to spend their day as they choose. One survey commented that; “ visitors are always made welcome and offered refreshments”. Meals are provided in the dining room and in people’s bedrooms if the choose. Dining tables were set with tablecloths, cutlery and condiments. There is a choice of menu at each mealtime and people make this choice after breakfast and for the evening meal after lunch. There was a mixed response about the quality of meals. Some people said that the food was of good quality and others said that it was not so good recently. One person said that there were still occasions when food was served on cold plates which means that hot food cools off quite quickly. Another commented on the quality of food stating “ it depends which cook is on”. Lime Tree House DS0000061499.V360765.R01.S.doc Version 5.2 Page 16 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): Standard 16 and 18. People who use this service experience poor outcomes in this area. People cannot be confident that their complaints will be investigated properly. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is provided with other useful information when arrangements are made to move into the home. There has been a history of anonymous complaints made to the Commission for Social Care Inspection. The responsible individual has been asked to investigate these complaints and forward the outcome of the findings to the Commission. The responsible individual has not provided details of how each complaint was investigated, what the findings were, what necessary action has been taken and whether the complainant, if known, was satisfied with the outcome. The accumulative evidence suggests that the home does not accept complaints in a positive manner or investigates them properly and to the satisfaction of complainants. If this is so then it places people who live at the home in a vulnerable position, unable to speak out when things are going wrong. Lime Tree House DS0000061499.V360765.R01.S.doc Version 5.2 Page 17 There were no records relating to complaints made and investigation outcomes available in the home to inspect. The staff member in charge explained that she didn’t have access to this information as the responsible individual kept it. The home has a policy and procedure with regard to safeguarding adults and the prevention of abuse. This procedure was incorrect and needs amending to accurately reflect national good practice and local multi agency agreements. Staff confirmed that they had received training in how to recognise abuse and neglect and were able to give examples of practice that would constitute abuse. They all said they would report any suspicions to the manager or Registered Provider and if it involved either of these people the police or Commission for Social Care Inspection. Lime Tree House DS0000061499.V360765.R01.S.doc Version 5.2 Page 18 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): Standards 19 and 26. People who use this service experience poor outcomes in this area. People do not live in a well-maintained environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The accommodation is arranged over two floors with a vertical passenger lift. The redecoration required identified at the previous inspection had not been addressed. The entrance hall had stained and torn wallpaper and the carpet was stained. The bathrooms were poor, with cracked tiles and stained baths and toilets. The dining room had ripped wallpaper and stained carpet. Where new ceiling lights had been fitted the ceiling had not been re painted leaving black marks where the old lighting had been. Radiator guards in the lounge and dining room were loose and hazardous. A sample of bedrooms was looked Lime Tree House DS0000061499.V360765.R01.S.doc Version 5.2 Page 19 at. Many of the bedroom carpets were stained and wallpaper scuffed or torn. The Registered Provider informed the CSCI that quotes for the work have been received and work is due to commence in during Spring 2008. Generally there was an improvement in the cleanliness of the home and there were no dust or offensive odours. A new ground floor bathroom has been fitted. The flooring is marble and creates a slipping hazard when wet. There is a heated towel rail fitted to the wall which was not guarded. There are no grab rails fitted to assist people whilst getting in and out of the bath or when drying. One person said they had no alterative but to hold onto the towel rail for support. The bath has a Jacuzzi, staff were unaware of the need to clean the pipes out with a specific solution in order to prevent the risk of legionella. The decoration in the bathroom had not been completed; there were a number of paint tins left on the floor. These were removed by the end of the visit. In the vestibule just outside the bathroom was the casing for a light switch, the wires were exposed only covered with tape. The handyman said that the wires weren’t live but it was made safe and covered by the end of the visit. A number of fire doors were wedged open and would fail to close in the event of a fire. Safety film had been fitted to low-level windows. The laundry area has been the subject of previous requirements because it is too small for the amount of laundry generated from the home. There is not enough space for soiled laundry to be separated from other laundry, or space to iron and air clean clothes. There is no laundry worker employed and only 20 hours of specific domestic/ housekeeping. This is not enough for a home this size. There has been no update for staff with regard to infection control training. However, there was evidence of gloves, aprons and antiseptic wipe in bedrooms, bathrooms and on the corridor. Yellow clinic waste was stored safely for collection. Following action taken by the Environmental Health Agency the kitchen is now kept clean with a cleaning rota. An additional member of staff has been recruited as a kitchen cleaner. Care staff are still expected to clean and help out in the kitchen as part for their duty and at busy times of the day this could compromise the time spent supporting residents. The member of staff in charge said she and concerns about infection control when staff were working in the kitchen and then responding to the call bell to assist people with personal care. Lime Tree House DS0000061499.V360765.R01.S.doc Version 5.2 Page 20 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): Standards 27, 28, 29 and 30. People who use this service experience poor outcomes in this area. There are insufficient staff for the home to provide a good standard of care for people who use the service. A lack of up dated health and safety staffing places people at risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A new member of staff has been employed to reorganise the records required for the home. Each member of staff now has an individual file and any information the home has such as application forms, reference, Criminal Records Bureau check (CRB) and training records has been collated. A number of records were missing particularly for longstanding staff where CRB’s had not been sent for. These have now been sent for and evidence was seen to confirm this. Two new members of staff have been recruited since the last inspection and although they both had a CRB, one person had no references. It is important that before a member of staff commences work the home can be assured that they are suitable; obtaining CRB and two references is an essential part of this process. Staff recruited in the last six months complete the Skills For Care Common Induction Standards as well as a home specific induction. The audit of training Lime Tree House DS0000061499.V360765.R01.S.doc Version 5.2 Page 21 carried out has been completed and identifies that there are gaps in staff updating statutory training such as moving and handling, first aid, fire safety and medication training. A programme of training to rectify this is being prepared and negotiations with training providers are being carried out. A number of training resources have been purchased for in house training. There have been a number of changes to staffing arrangements in order to meet the requirements of the Environmental Health Agency. The cook’s hours have been reduced in order to employ a kitchen cleaner. This means that care staff are required to cover the reduction in the cook’s hours. This has a particular impact during the early part of the evening when there are only two members of staff on duty. They are required to attend to people needing to prepare for bed, serve the evening meal and supper, clear up after this and give out evening medication. The staff member in charge said this is where mistakes are made with medication. She said that there are too few staff on duty and this means that people have to wait for assistance. She also said that there are four people who use the service who need two members of staff to support them with personal care. Whilst staff are attending to these people there are no other members of staff to attend to the rest of the home. There are four members of staff on duty during the morning and the workload is same as the evening shift. There is no handover at shift change because this usually happens during breakfast, lunch or teatime. Comments received from surveys in response to questions about whether staff were available include: “ Depends which staff are on” “ Not enough staff” “ Time is a factor, short/understaffed” “ She needs some one to help her walk. This doesn’t happen as often as we would like due to a lack of staff” “ I feel the carers do their best but are understaffed” “ I feel if there was more staff the residents would get better care” There has been no additional domestic staff employed. There are only 20 hours per week allocated to a domestic; the care staff are required to use their time to ensure the home is kept clean and to do the laundry. The home does not use agency staff but relies on the good will of existing staff to cover for holiday and sickness. This provides a consistent service for people but means that sometimes staff work long periods without a break which could mean staff are tired and don’t report for worked refreshed from their previous shift. One person said “ The staff put in so many extra hours” Lime Tree House DS0000061499.V360765.R01.S.doc Version 5.2 Page 22 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): Standard 31, 33, 35, 36 and 38. People who use this service experience poor outcomes in this area. Management of the home is poor. People living and working at the home would benefit from management which had appropriate skills, knowledge and experience. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered Provider has been acting as manager of the home since November 2007. The poor practices described earlier in this report and the failure to meet with previous requirements is evidence that there is a lack of sound leadership and management of the home. The Registered Provider was not present on the day of the visit but the member of staff in charge said that Lime Tree House DS0000061499.V360765.R01.S.doc Version 5.2 Page 23 she had been offered the post of manager. This person has experience of managing care homes in the past. The improvements needed in the home are reliant on an experienced manager and financial resources to improve care planning, staffing levels, training of staff and improvements to the environmental standards of the home. There is no formal staff supervision system where staff meet individually with their manager to discuss performance and to plan training and support. Although the member of staff in charge said that she had completed some appraisals and she is planning now to implement regular supervision with staff. Staff spoken to confirmed they had received a recent appraisal. If the Registered Provider appoints a manager then she is required to carry out Regulation 26 visits. Regulation 26 requires the Registered Provider to visit the home once a month to carry out monitoring about standards in the home and to gain the opinions of those people living at the home. A report should be produced and provided to the Commission. A number of issues arose during the visit which should have been notified to the Commission for Social Care Inspection in accordance with Regulation 37. These include medication errors and instances when people have needed to attend hospital as a result of a fall. The member of staff in charge wasn’t aware of any quality assurance system or a development plan for the home. A number of health and safety records were checked. The fire fighting and fire detection equipment had been serviced on 12/02/08 and had recommended that although the fire safety panel was safe it needed to be replaced. Staff said that until this maintenance service had taken place the fire alarm had not been working properly. There was a note on the front of the fire safety file which gave staff instructions to disconnect the fire alarm if it couldn’t be silenced. It also stated that if this were the case the fire alarm would be disabled and would not work in the case of a fire. Health and safety training for staff is out of date. Staff have not had Fire Safety training for over 12 months. Lime Tree House DS0000061499.V360765.R01.S.doc Version 5.2 Page 24 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 1 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 1 X X X X X X 1 STAFFING Standard No Score 27 1 28 1 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 x 1 2 X 1 Lime Tree House DS0000061499.V360765.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes 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 OP3 Regulation 14 Requirement Service users shall not be admitted to the home unless a preadmission assessment has been carried out to determine what the service users needs are and that the home has the capacity to meet those needs. Previous timescale 14/10/07 not met All service users must have a plan of care that details how the individual’s needs in all activities of daily living are to be met. Where possible service users or someone who represents them must be involved with the development of the plan. The care plan must be reviewed at least once a month, updated to reflect changing needs and current objectives for health, social and personal care. Service user plans must be dated and signed. Previous timescale 12/10/07 not met Lime Tree House DS0000061499.V360765.R01.S.doc Version 5.2 Page 26 Timescale for action 07/04/08 2. OP7 15 07/04/08 3. OP7 13 Risk assessments must be completed in full. They must indicate clearly how any remaining risk is to be managed. Service users wishes to be independent must be considered Previous timescale 12/10/07 not met A safe system of recording, handling, safekeeping, safe administration and disposal of medication in the home must be implemented. Previous timescale 12/01/07 and 04/09/07 not met. 07/04/08 4. OP9 13(2) 17(1),Sch edule 3(i) 07/04/08 5. OP16 22 (3) and (4) All complaints must be recorded, investigated and resolved satisfactorily. Previous timescale 12/10/07 not met. 07/04/08 6. OP18 13(6) The Adult Protection procedure must be reviewed to ensure it meets with North Yorkshire Social Services multi disciplinary guidelines. Previous timescale 12/10/07 not met. 07/04/08 7. OP19 23 (2) (b) The registered person must submit a maintenance programme including timescales with regard to the interior and exterior of the home being brought into a good state of repair, furnishing and décor. The Registered Provider must now rectify the following: • Peeling paint work in the 07/06/08 Lime Tree House DS0000061499.V360765.R01.S.doc Version 5.2 Page 27 • • • • • ground floor bathroom Radiator guards not fixed to the wall in the dining room and lounge. Wallpaper torn off in downstairs hallway. Ceiling stained in dining room Wallpaper torn in dining room Carpet stained in dining room. Previous timescale 12/10/07 not met. 8. OP26 16 (2) (e) and (j) 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. Staff must complete training with regard to infection control. Previous timescale 12/10/07 not met. Sufficient staffing levels must be provided to meet service users needs and to ensure the home is kept clean. Previous timescale 12/10/07 not met. Staff must be provided with training which ensures they have the skills and knowledge to carry out their role competently and safely. Written references must be obtained as part of the recruitment process prior to the offer of employment. DS0000061499.V360765.R01.S.doc 07/06/08 9. OP26 13(3) 07/05/08 10. OP27 18 (1) (a) 07/04/08 11. OP30 18 (c) (i) 07/06/08 12. OP29 19 (1)(c) 07/04/08 Lime Tree House Version 5.2 Page 28 13. OP31 9 A person who is competent and 07/04/08 has appropriate skills, knowledge and experience must manage the home. Previous timescale 12/10/07 not met. The registered provider must ensure that the Annual Quality Assurance Assessment is completed and returned to the Commission for Social Care Inspection within specified timescales. Previous timescale 12/01/08 not met. The home must ensure any matters listed under regulation 37 are reported to the CSCI. A formal quality assurance system must be implemented ensuring the views of service users are taken into consideration. The results must be published as an annual development plan which should be made available to service users and the CSCI. Previous timescale 12/01/08 not met. Unguarded heated towel rail must be disconnected or fitted with a protective guard. Staff must receive fire safety training when the next report for duty. Fire doors must not be held open by unauthorised means. 14. OP31 14 07/04/08 15. 16. OP37 37 24 (1) (2) and (3) 07/04/08 07/08/08 OP33 17. 18. 19. OP38 OP38 OP38 13 (4) (a) 33 (4) (d) 23(4)(a) 15/02/08 14/02/08 14/02/08 Lime Tree House DS0000061499.V360765.R01.S.doc Version 5.2 Page 29 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 OP12 Good Practice Recommendations Individual service users should be asked their choice about the types of hobbies, social activities and leisure interests they would like to engage in. Their care plan and the activities programme should reflect this. Care staff must receive formal supervision at least 6 times a year. This should cover all aspects of practice, philosophy of care in the home and career The Jacuzzi bath must be appropriately cleaned to reduce the risk of legionella. 2. 3. OP36 OP38 Lime Tree House DS0000061499.V360765.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle upon Tyne NE1 1NB 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. 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