Inspection on 17/05/06 for Lime Tree House

This inspection was carried out on 17th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 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 14/02/08

Lime Tree House 04/09/07

Lime Tree House 12/10/06

Lime Tree House 14/12/05

Lime Tree House 07/06/05

Lime Tree House 19/10/04

Similar services:

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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 David White Key Unannounced Inspection 17th May 2006 09:00 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.V294884.R01.S.doc Version 5.1 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.V294884.R01.S.doc Version 5.1 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.V294884.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th December 2005 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 each 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 monthly fees for the home ranged from £330 to £420. Lime Tree House DS0000061499.V294884.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report follows an unannounced site visit undertaken on the 17th May 2006. This visit was carried out by one Regulation Inspector and took 9 hours with 3 hours preparation time. Since the last inspection of the home there have been complaints from people previously associated with or working at the home relating to the care of services. This resulted in an unannounced random inspection of the home on the 13th April 2006 to inspect the care given to some service users’ and a planned meeting with staff currently working there on 27th April 2006 to find out if they had any concerns about care. These matters are referred to in the body of the report. The home was not able to return the requested information before this site visit due to the short timescales. It was therefore decided not to use service user surveys at this key inspection. The site visit comprised of a full inspection of the premises. The care records of four service users were looked at which included service users assessments, care plans and medication records. Staff rotas and health and safety documentation were inspected. Time was spent talking to three service users, three members of staff and the management of the home, observing the activity in the home and the interaction between service users and staff. Information was also used from the Regulation Inspector’s inspection record, which detailed the history of the home and relevant information about what had been happening in the home since the previous inspection visit. The focus of the inspection was on a number of key standards, inspecting the case records of a number of service users to establish whether they corresponded with their experiences of life in the home. The newly appointed manager and owner of the home were available throughout the inspection and the findings were discussed at the end of the inspection. Lime Tree House DS0000061499.V294884.R01.S.doc Version 5.1 Page 6 What the service does well: What has improved since the last inspection? All staff have received health and safety, moving and handling, fire safety and first aid training to help meet the health, welfare and safety needs of service users. Staffing levels had improved to ensure that service users needs were met. Care reviews had taken place for service users whose needs had changed and whose needs the home was having difficulty in meeting. An activities programme had been developed to promote meeting the social and leisure needs of the service users. Service users had been asked for their views on the care and services offered by the home and these had been listened to and acted upon so enabling them to have a say in decision making about the home. The manager had introduced a monitoring system for staff who administer medication in the home to promote their skills and knowledge and safeguard service users from being at risk from poor medication practices. Lime Tree House DS0000061499.V294884.R01.S.doc Version 5.1 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Lime Tree House DS0000061499.V294884.R01.S.doc Version 5.1 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.V294884.R01.S.doc Version 5.1 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 and 6 Quality in this outcome area was poor. This judgement has been made using available evidence including a visit to this service. Detailed information about service users’ was not always obtained before they were admitted to the home and so could not ensure that service users’ needs would be met properly. EVIDENCE: Previous concerns had been raised that some service users’ living at the home were inappropriately placed. A random inspection of the home was carried out on 13th April 2006 to look at the concerns raised. At the random inspection a requirement was made about the home needing to carry out proper preadmission assessments and obtain detailed information to make sure they could meet prospective service user needs as the failure to do this in the case of two people who had previously lived in the home had led to their needs not being fully met. Lime Tree House DS0000061499.V294884.R01.S.doc Version 5.1 Page 10 In the past pre-admission assessments had been carried out by previous managers of the home. As part of her role the recently appointed manager will be doing the pre-admission assessments along with another suitably qualified member of staff. At the inspection the care records including the pre-admission assessment of a recently admitted service user was inspected. The assessment had limited information about the needs of the service user and no risk assessments were in place to reduce risks from falls and pressure ulcers. There was a lack of medical information and it was unclear as to what medication was being prescribed and by whom. Some medication had been prescribed by a psychiatrist because of mental health problems, however there was little information about the nature of the problems and any possible follow-up care required. The manager was in discussion with the GP about a review of the current medication for this particular service user to clarify the situation. The continuing failure of the home to obtain detailed pre-admission information about prospective service users’ could not assure people that their needs would be met by the home. There was also no evidence on the assessment to show that the assessments had been discussed and agreed with the service user or their representative. Another service user was experiencing deteriorating mental health. A care plan review had been organised to discuss the changing needs of the service user and relevant care professionals and relatives had been invited to attend the review. Following a requirement made at the recent random inspection a care review had taken place for a service user whose needs the home were having difficulty in meeting. The statement of purpose providing information about the home had been updated and was made available to prospective and existing service users. The home does not provide intermediate care. Lime Tree House DS0000061499.V294884.R01.S.doc Version 5.1 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 and 10 Quality in this outcome area was good. This judgement has been made using available evidence including a visit to this service. The care provided to service users’ was generally good, however poor care planning systems and care practices in relation to one aspect of the medication procedures put one service user at risk of potential harm. EVIDENCE: The Commission had received information since the last inspection stating concerns about the quality of the care plans and the medication procedures that were being carried out at the home. The service users’ appeared well cared for and some made comments about the care they received. One service user said “I am very pleased with the care I receive” and another said, “the care was very good”. However despite positive comments from some service users’ about the care they received there were some aspects of care that needed addressing. Lime Tree House DS0000061499.V294884.R01.S.doc Version 5.1 Page 12 The care records of four service users’ were looked at. Two of the care records detailed how assessed needs were to met and a number of risk assessments including reducing risks from falls, prevention of pressure ulcers and nutritional screening had been carried out to promote the independence and safety of both service users’. One of the other care records contained a number of risk assessments but had no care plan in place to say what actions were needed to meet identified needs. One of the care records inspected was that of a service user who had been admitted to the home three weeks earlier. There was no evidence that any risk assessments had been undertaken and no care plan was in place. The care records were inconsistent in quality and in some cases information was difficult to access due to the amount of documentation within individual care records. It was clearly evident within the records that the assessed needs were not reviewed on a regular basis to reflect any changing needs. Despite the lack of information in some of the care records it was evident from talking to staff that they were aware of the needs of the service users’ and on the whole were meeting their needs. Throughout the day there were three handover periods when information is passed onto staff between shifts. The manager had also introduced a message book, which informed staff about important information they needed to be aware of and of any changes to care. The current care planning process is under review by the manager who acknowledged that the present systems needed improving. The daily records gave information about the care the service users’ had received and noted any changes in their condition. Referrals to GPs and other health professionals were recorded. Another service user was at risk from pressure ulcers and the care plan contained information about the moving and handling arrangements for the service user. Pressure care equipment was available and the district nurse visits to offer guidance and support to the service user and staff team. The home had a call bell system and service users’ spoken to said that call bell requests were attended to quickly. Call bells were accessible in all private and communal areas of the home. The medication system and facilities were inspected. Proper procedures were in place for the ordering, administration, receipt, storage and return of medication and a random check of the medication supplies tallied with the records. The Medication Administration Records were up to date and risk assessments were in place for those service users’ who self-medicated. All the care staff had received some medication training from Boots and the manager was in the process of arranging more in depth training for staff who administer medication in the home. The manager had introduced a monitoring system for supervising staff whilst they were carrying out medication duties with the aim of promoting good practices and reducing the risk of medication errors. Lime Tree House DS0000061499.V294884.R01.S.doc Version 5.1 Page 13 Service users’ were observed to be treated with respect and were addressed by their preferred names. One service user said, “ I feel my dignity had been maintained since I have lived at the home”. Lime Tree House DS0000061499.V294884.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Daily routines enable service users’ to have control over their lives. EVIDENCE: Previous to this inspection concerns were raised that no activities were in place for the service users’. The home had introduced an activity programme that according to the staff was popular with service users’. Service users spoken to were able to confirm that activities were on offer and that they were given the option of not joining in if they did not want to. One of the activities involved the use of old photographs to recall past memories and encourage discussion and took into account the age group of the service users’. Other activities were also available such as bingo and quizzes and entertainers visit the home. Monthly pub visits were planned for Sunday lunches out and trips to the local garden centres were made in accordance with service users’ wishes. Church services were held at the home on a monthly basis. Lime Tree House DS0000061499.V294884.R01.S.doc Version 5.1 Page 15 Visiting arrangements were flexible and service users spoken to were able to confirm that they can see family and friends whenever they want. Service users preferences about their daily routines were recorded within their care records and adhered to. Each service user spoken to was able to confirm that they could get up in a morning and go to bed whenever they wished and arrangements were flexible around routines such as bathing. There were mixed comments about the meals. One service user said, “the meals were good, there were lots of choice” and “it was always warm”, whilst another said that “there could be more choice and sometimes the plates were cold”. There were at least two choices on the menu at each mealtime and an alternative meal was offered if the options available were not wanted. The menu board was outside of the kitchen displaying the menu choice for that particular day. The cook was spoken to and she was fully aware of the special dietary needs of the service users. Two service users’ were diabetic and the cook ensured that they were given the same amount of menu choice as the other service users’. Lime Tree House DS0000061499.V294884.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users’ knew how to make a complaint but the lack of a system for recording, investigating and acting on complaints could not ensure that concerns were dealt with properly. The lack of adult awareness training for staff and inaccurate adult protection guidance potentially puts service users’ at risk of harm. EVIDENCE: The home had a complaints procedure that provided very little information to complainants and did not explain clearly and in sufficient detail what would happen when a complaint was made and the timescales for completion of any investigations and actions undertaken. The owner of the home said that the home had not received any complaints since the previous inspection. However there were no complaints records available and the home had no system in place to record any complaints made. Service users’ did say that they would speak to the manager or owner if they needed to raise any concerns. Staff said that they would report any allegation or suspicion of abuse to the management and the management of the home had dealt properly with one incident involving some monies going missing. However none of the staff had attended abuse awareness training and there were no plans in place for this to happen and whilst the home had their own adult protection procedure, this was not in accordance with local NYCC policies and procedures for the protection of vulnerable adults. Lime Tree House DS0000061499.V294884.R01.S.doc Version 5.1 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 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment was comfortable, however improvements were needed to ensure the safety of the service users’ EVIDENCE: Since the last inspection the Commission had received issues of concern about the cleanliness of the home. On the day of inspection the home was warm and bright and apart from one part of the downstairs corridor was free from offensive odours. Bedrooms and communal areas were clean and tidy and furniture and fittings were well maintained. During a tour of the environment it was observed that service users’ had personal belongings in their bedrooms. Service users’ looked comfortable and could sit in lounge areas if they chose to do so. Lime Tree House DS0000061499.V294884.R01.S.doc Version 5.1 Page 18 Service users accommodation is over two floors, which can be accessed by a passenger lift and ramped access was available to the external door. This meant that service users’ who had difficulty with mobility or who used a wheelchair had access to all parts of the home. Lifting and hoisting equipment was also available to assist service users’ with their mobility. The home had a sufficient number of toilets and bathrooms for the number of service users’ living in the home and these were situated near to service user bedrooms and communal areas. The home was decorated to a good standard and it was observed that decoration work was taking place in an unoccupied bedroom in preparation for someone moving into the home. The owner of the home discussed the plans for the future development of the home to improve the living environment for service users’. Maintenance records were available at the time of inspection. In the kitchen there was a cleaning schedule, which had been signed upon completion of tasks. There were records of fridge and freezer and food temperature testing. However the flooring in the kitchen was badly stained and was in need of cleaning or replacement. The management said this matter was being addressed. The home had laundry facilities and the washing machine used to wash service users personal clothing had a sluicing programme. There was also a sluicing sink and sufficient supplies of aprons and gloves. Clinical waste was disposed of in a proper manner. There were some issues of concern with the environment. The hot water temperatures in each bathroom exceeded 43 degrees. The temperature of the water in one bathroom was recorded at 54.2 degrees. This was discussed with the management immediately and a plumber was contacted and the necessary work was carried out at the time of inspection to regulate the temperatures. A further check of the hot water temperatures was made after the work was completed and found to be satisfactory. The management said that there was a constant problem with the water temperatures and that this would be looked into. An immediate requirement was issued at the time of inspection in relation to this matter. There was an offensive odour in one part of the downstairs corridor. This was discussed with the management of the home and it was explained that this was an ongoing problem. It was agreed that the matter needed to be resolved and plans have been put in place to deal with this issue. An environmental health officer undertook a recent visit to the home and made a number of requirements relating to health and safety in the home. Some of these requirements had been addressed and the management of the home had made arrangements for an independent consultant to address the remaining issues. Lime Tree House DS0000061499.V294884.R01.S.doc Version 5.1 Page 19 The timescale for meeting these requirements had not yet elapsed and it was the intention of the environmental health department to carry out a further visit to the home to look at the progress made in meeting the requirements. Lime Tree House DS0000061499.V294884.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels had been increased and staff had received some basic health and safety training so that service users’ needs were being met, however inadequate recruitment practices and the lack of abuse awareness training potentially placed service users’ at risk from harm. EVIDENCE: Previous to the inspection some concerns had been raised about low staffing levels, a lack of staff training and poor recruitment procedures. Staff spoken to said that there had been some improvements in the staffing levels and this had “made the job easier to do and had allowed more time to do activities with service users”. The duty rotas showed that on a morning there were four members of staff, in an afternoon three staff, in the evening two staff and at night there were two staff on duty. Service users’ said they felt that their care needs were being met and that staff were easily accessible. The home had a call bell system and service users’ said that call bell requests were “responded to quickly”. The home did not use agency staff. Lime Tree House DS0000061499.V294884.R01.S.doc Version 5.1 Page 21 One cook worked six days a week and another cook covered the extra day. The cleaner was employed five days of the week. Staff carried out cleaning duties on a weekend and the manager had introduced a cleaning schedule so that staff were clear about what was expected of them. Staff said that the recruitment of extra staff and increased staffing levels meant they could carry out the cleaning duties without this impacting on the care they were giving to the service users’. The staff records of two recently appointed members of staff were looked at. One staff record did not contain evidence that an application form had been obtained. In both of the staff records the CRB (Criminal Record Bureau) certificates had been obtained from previous employers and not at the time of recruitment. This was not good practice and did not sufficiently protect service users’ from risk of harm. An immediate requirement was issued at the time of inspection in relation to this matter. Staff were given induction when they start work at the home and a newly appointed member of staff confirmed that they had been inducted. Although there were no training records available, staff were able to confirm that they had recently received training in moving and handling, health and safety, fire safety and first aid training and this was confirmed by those staff spoken to. Plans were in place for staff to undertake the Safe Handling of Medications course. None of the staff had received abuse awareness training and were in need of updated food hygiene and infection control training. The manager was making arrangements for staff to do some NVQ training. Lime Tree House DS0000061499.V294884.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Problems with the previous management of the home have meant that the health, welfare and safety needs of the service users’ have not always been met. EVIDENCE: The home has had three different managers within the last four months. This contributed towards a fall in the standards of the home and led to problems with the hot water temperatures, staff training, health, safety practices, record keeping and service users’ involvement in decision making about the home. The management situation was not helped in that the responsible individual for the home did not have any experience in care matters. Lime Tree House DS0000061499.V294884.R01.S.doc Version 5.1 Page 23 The most recently appointed manager had only been in post for two weeks. She was previously the deputy manager in another care home and has 30 years of experience in care settings. The manager had completed the Registered Manager’s Award and was hoping to do further training relevant to her job. An application for the manager to be considered for registration must be submitted to the Commission. Within a short space of time the manager had made changes to improve the lives of the service users’. There was a wider range of activities on offer at the home and mealtimes had been changed at the service users’ request. The manager was keen to develop staff training programmes and was reviewing the home’s current pre-admission assessment and care planning documentation. A service user and staff questionnaire had been carried out to seek their views about the care and services offered at the home and the manager had acted on the information received. The manager had held a recent staff meeting but meetings with service users’ needed to be held on a more regular basis. More arrangements needed to be in place to enable service users’ and others to affect decision making about the running of the home. The recent progress made to the home by the current manager needs to be continued to maintain and improve existing standards. Service users’ monies were discussed and the financial systems used by the home were looked at. Each resident’s money was held individually and there were receipts from monies spent. A receipt was also given to people who deposit monies for service users’ personal use in the home. Only small amounts of monies were held in the home and these were stored safely. A random check of the monies tallied with the records. Service users could have access to their monies at any time. Despite the improvements in some aspects of the home as detailed above, there were a number of areas of concern, which needed to be addressed. Appropriate arrangements had been made to keep records secure but the general standard of record keeping needed to improve. Water temperatures were monitored and recorded on a regular basis. However the management said that the water temperatures had been fluctuating and this needed reviewing. As previously mentioned earlier in the report under the heading of environment, a random check of hot water temperatures exceeded safe limits in four bathrooms. All staff had recently received moving and handling, health and safety, first aid and fire training but needed abuse awareness, food hygiene and infection control training. Lime Tree House DS0000061499.V294884.R01.S.doc Version 5.1 Page 24 A number of health and safety certificates were looked at and were satisfactory. There were individual risk assessments in place for most service users to promote their independence and safety and general risk assessments to promote health and safety in the home, however a risk assessment needed to be carried out in relation to moving and handling procedures. Staff also needed guidance on how to dispose of sharp materials properly. Accidents and incidents were recorded within an accident book. A few serious incidents had occurred in the home since the previous inspection but these had not been reported to the Commission. This was discussed with the owner and manager of the home at the inspection and clarification was given about the type of accidents and incidents that needed to be reported. Lime Tree House DS0000061499.V294884.R01.S.doc Version 5.1 Page 25 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 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 2 2 X X X X X 1 3 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X 1 1 h Lime Tree House DS0000061499.V294884.R01.S.doc Version 5.1 Page 26 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 New service users must only be admitted on the basis of a thorough assessment so that the home is clear that they are able to meet the individual’s needs. (This requirement remains outstanding from the previous inspection). Outcomes from assessments must have been agreed and discussed with service users. The registered provider is required to have in place a care plan for each service user which describes how their health, welfare and safety needs are to be met. Care plans must include risk assessments, which reduces the risks of falls and pressure ulcers. A system must be implemented to make sure Version 5.1 Page 27 Timescale for action 30/06/06 • 2. OP7 15 • 30/06/06 • • Lime Tree House DS0000061499.V294884.R01.S.doc 3. OP16 22 • that care plans are reviewed on a regular basis. The registered provider must ensure that the complaints procedure provides information about the stages and timescales of the process so that people making a complaint are aware of what will happen afterwards and when. The registered provider must have a system in place to record all complaints and details of the investigations, outcomes and any action taken as a result of this process. The registered provider is required to make arrangements for all staff to attend abuse awareness training and to be conversant with local authority procedures for reporting abuse issues. 31/05/06 • 4. OP18 13 • 30/06/06 • 5. OP19 16 6. OP25 13 and 23 The registered provider must give clear guidance to staff on how to deal with challenging behaviour exhibited by service users. The registered provider is 30/06/06 required to make arrangements to have the kitchen flooring thoroughly cleaned or replaced. The registered provider is 17/05/06 required to make sure that service users at not at risk of scalding. Urgent action needs to be taken to establish the problem with the hot water system and rectify it. DS0000061499.V294884.R01.S.doc Version 5.1 Page 28 Lime Tree House 7. OP26 16 8. OP29 19 9. OP31 8 10. OP37 13 An immediate requirement was issued. The registered provider is to make sure that all parts of the home are free from offensive odours at all times. The registered provider is required to make sure staff complete an application form and that as a minimum requirement, POVA first checks are carried out on all staff prior to them taking up their post. An immediate required was issued. The registered provider is required to submit to the Commission an application for registration of the appointed manager. • The registered provider must make arrangements to improve record keeping within the home. • 30/06/06 17/05/06 31/07/06 17/05/06 11 OP38 13 • The Commission must be notified of occurrences in the home in accordance with Regulation 37 of the Care Homes Regulations and recent guidance issued by the Commission. The registered provider 30/06/06 must arrangements for risk assessments to be carried out for moving and handling practices and provide clear guidance to staff on how to deal with the disposal of sharp materials. The registered provider is required to review the hot water systems in the home and the arrangements for the monitoring of hot water temperatures. Version 5.1 Page 29 • Lime Tree House DS0000061499.V294884.R01.S.doc • The registered provider must make arrangements for staff to attend food hygiene and infection control training. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3 Refer to Standard OP9 OP13 OP33 Good Practice Recommendations All staff who administer medications at the home should have further training. Arrangements should be made to enable service users to attend local religious services if they wish to do so to meet the individual religious denominations of the service users. The management of the home should continue to look at ways of actively seeking the views of service users, relatives and relevant others about the effectiveness of the care and services provided. Lime Tree House DS0000061499.V294884.R01.S.doc Version 5.1 Page 30 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.V294884.R01.S.doc Version 5.1 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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