CARE HOMES FOR OLDER PEOPLE
Lime Tree House 264 Washway Road Sale Cheshire M33 4RZ Lead Inspector
Helen Dempster Unannounced 2 September 2005
nd 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 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 F55 F05 s38981 lime tree house v235535 020905 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Lime Tree House Address 264 Washway Road Sale Cheshire M33 4RZ 0161 973 7956 0161 973 5777 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Category(ies) of registration, with number of places Mountlands Trust Ltd Responsible Individual - Marylyn Pickersgill Mrs Julie Brearley CRH Care home NM Care home - non-medical 4 Lime Tree House F55 F05 s38981 lime tree house v235535 020905 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Care provided to service users who are aged 18 years and over on admission. All service users must be willing to rely on bible based healing known as Christian Science. There is a maximum of four (4) service users requiring Christian Science nursing care and/or Christian Science care and/or rest and study. Date of last inspection 10 February 2005 Brief Description of the Service: Lime Tree House provides short-term residential accommodation with Christian Science nursing care for up to four (4) people (who prefer to be refered to as patients) within the category of old age (OP). They may also admit Adults aged 18 years and over. Lime Tree House is a private Christian Science respite care home that is owned by Mountlands Trust Limited. Mrs Julie Brearley is the registered manager. It provides a service for Christian Scientists who require non-medical nursing care. The premises is a large bungalow, with pleasant grounds which are enclosed to afford the patients privacy. The home is situated on the main road in Sale. The home is in easy reach of all amenities of Altrincham and Sale. The home has access to the local transport network and is near to the main motorway links in the area. Lime Tree House F55 F05 s38981 lime tree house v235535 020905 stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced. It started at 11.00am and finished at 3.30pm on 2 September 2005. The Registered Manager and a sample of patients and staff were spoken with. Christian Science is one of the religious non-medical forms of treatment today that relies on spiritual means through prayer to heal illness, injuries and other conditions. Lime Tree House provides Christian Science Nursing Care in accordance with Article VIII Sc31 of the Manual of the Mother Church by Mary Baker Eddy. What the service does well:
Prospective patients’ needs assessments were comprehensive and contained their views on care and informed the care plan. Patients said that their needs were met. Care plans were reviewed on a daily basis and without exception, all patients praised the way in which the manager and staff met their personal needs and cared for them in the manner in which they wished to be cared for. This is commendable. The home had a policy on privacy and dignity. During the induction process, staff were instructed on the core principles of dignity, choice, privacy, fulfilment, rights and independence, and how these would be put into practice when caring for patients. The home’s policies have a strong emphasis on the rights of the patients. All patients had their own telephone in their bedrooms, their preferred form of address was used and patients saw visitors, including their Christian Science Practitioner, in the privacy of their own bedroom. Patients expressed their satisfaction with the care at the home. One person said that they can do what they like when they like and that nothing is too much trouble for the staff. Wholesome food with menu choices is offered at the home. Staff and patients eat together to maintain a family atmosphere. Patients said that the meals served were of a very high standard. This is commendable. The complaints procedure was clear and readily available to patients. The home provides patients with a clean, tidy, attractive and homely environment. All bedrooms are single with en suite facilities. Patients said that they thought the home was “lovely”. Minimum levels of 2 staff met the needs of the 4 patients, though sometimes there was one member of staff to each patient. Staff were well supported,
Lime Tree House F55 F05 s38981 lime tree house v235535 020905 stage 4.doc Version 1.40 Page 6 supervised and trained. Patients spoke highly of the staff. Two of the patients said that staff were so supportive of them that nothing was too much trouble and the waking night worker was happy to just read to a patient who could not sleep. The safety and welfare of patients is maintained through robust health and safety procedures. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Lime Tree House F55 F05 s38981 lime tree house v235535 020905 stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Lime Tree House F55 F05 s38981 lime tree house v235535 020905 stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 6 Prospective patients’ needs assessments were comprehensive and informed the care plan. EVIDENCE: The home used an admissions enquiry form for the prospective patient to gather information regarding basic care needs. This form also included information regarding Christian Science activities, the room number and arrival date. The manager stated that when this form is returned, the organisation’s committee review the information supplied and if considered suitable, the prospective patient is invited to visit the home. The manager stated that there are 2 categories of admission. These are short term rest and study breaks and Christian Science Nursing Care. At the time of inspection, all 4 patients were in receipt of Christian Science Nursing Care. Examples of the admissions enquiry forms were seen and were found to contain sufficient information to inform the care plan. Patients confirmed that the manager obtained information sensitively and the home did meet their needs well. The home does not provide intermediate care.
Lime Tree House F55 F05 s38981 lime tree house v235535 020905 stage 4.doc Version 1.40 Page 9 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 standard(s) 7, 8, 9 and 10 The patients’ personal and social care needs are well documented and met with reference to the wishes and rights of each individual patient following a detailed assessment process. EVIDENCE: Care plans are held in individual binders and are indexed. Each care plan included personal details, personal assessment, past history, mobility, personal care, dressing/undressing, eating and drinking, living, working and recreation, communication, resting and sleeping and worshipping. Comprehensive daily records of the patients’ progress were also in place. These included all activities and nutrition. Patients weights were not recorded, as within the Christian Science philosophy, a persons weight and size is not considered relevant . Care plans were reviewed on a daily basis and patients were involved in the care planning process. Basic moving and handling plans were in place, but the need to complete risk assessments concerning all aspects of risk to each individual, including the risk of falls, was discussed. The need to complete a risk assessment concerning the use of bed rails for one individual was also discussed. A requirement was made accordingly.
Lime Tree House F55 F05 s38981 lime tree house v235535 020905 stage 4.doc Version 1.40 Page 10 At the time of inspection, dressings were being used for 2 of the patients. These dressings are used to soak up any body fluids and to keep the patient comfortable. In keeping with Christian Science philosophy, no medical intervention is provided at the home, therefore Standard 9, which concerns medication, was not applicable. The manager stated that if a patient wished to have access to medical services or medication then the staff would assist in access, but the patient would have to leave the home. One notable exception was the setting of broken bones, which would, in some cases, be permitted. Preventative measures, including pressure relief mattresses and aids, are used at the home. Patients also see a dentist, chiropodist and optician. The manager stated that psychological health is maintained through spiritual welfare and that while physiotherapy is not used, there is an emphasis on normal physical activities. The home had a policy on privacy and dignity. During the induction process, staff were instructed on the core principles of dignity, choice, privacy, fulfilment, rights and independence, and how these would be put into practice when caring for patients. The home’s policies have a strong emphasis on the rights of the patients. All patients had their own telephone in their bedrooms, the preferred form of address was used and patients saw visitors, including their Christian Science Practitioner, in the privacy of their own bedroom. Without exception, all patients praised the way in which the manager and staff met their personal needs and cared for them in the manner in which they wished to be cared for. This is commendable. Lime Tree House F55 F05 s38981 lime tree house v235535 020905 stage 4.doc Version 1.40 Page 11 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 standard(s) 12,13,14 and 15 Patients’ friends and relatives are made welcome when visiting and patients are served a nutritious, appealing and wholesome diet with alternative choices provided. EVIDENCE: Patients stated that their relatives and friends are made welcome at the home and that they can see visitors in the privacy of their own room. Patients expressed their satisfaction with the care at the home. One person said that they can do what they like when they like and that nothing is too much trouble for the staff. The cook was interviewed at the time of inspection. She showed the inspector the menu, which offers a nutritious and wholesome diet. Choices, including a vegetarian choice, are offered at every meal. Copies of each patient’s daily menu choices are held on their personal file to enable staff to monitor their nutritional input. The choices are offered on the day before the menu is served. Staff and patients eat together to maintain a family atmosphere. Patients said that the meals served were of a very high standard. This is commendable. Lime Tree House F55 F05 s38981 lime tree house v235535 020905 stage 4.doc Version 1.40 Page 12 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 standard(s) 16 and 18 The complaints procedure was clear and readily available to patients. The home needed to obtain a copy of Trafford Council’s Protection of Adults from Abuse Policy and provide staff with training in its implementation, to fully protect patients. EVIDENCE: The home’s complaints procedure is held in the in the “Information for guests” booklet, a copy of which is held in each room. The home had not received any complaints. The home’s policy on the protection of adults from abuse was readily available at the home. The need to obtain a copy of Trafford Council’s Protection of Adults from Abuse Policy and provide staff with training in its implementation was discussed and a requirement made accordingly. Lime Tree House F55 F05 s38981 lime tree house v235535 020905 stage 4.doc Version 1.40 Page 13 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 standard(s) 19 and 26 The environment is well maintained, homely and attractive and is subject to ongoing improvement to meet patients’ needs. However, some aspects of fire precautions needed validating by the fire authority. EVIDENCE: The home provides patients with a clean, tidy, attractive and homely environment. All bedrooms were single with en suite facilities. Patients said that they thought the home was “lovely”. The home had a copy of the Infection Control Guidance issued by Salford and Trafford Health Authority. The laundry is located away from food preparation areas and the washing machine has a sluicing programme. Many of the home’s fire doors were fitted with Dorguard magnetic hold offs. There was a need to check that these devices were approved by consulting with the local fire service. A requirement was made accordingly. Lime Tree House F55 F05 s38981 lime tree house v235535 020905 stage 4.doc Version 1.40 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 High levels of committed and well-supported staff were deployed appropriately to meet patients’ needs. This included staff receiving regular supervision and training. EVIDENCE: Minimum levels of 2 staff met the needs of the 4 patients. In addition to these carers, a cook and a cleaner are also employed. On many occasions, including the day of inspection, staffing levels at the home can be one to each patient. Patients spoke highly of the staff and staff expressed the view that they were deployed in such a way that they could provide individual attention to patients. Two of the patients said that staff were so supportive of them that nothing was too much trouble and the waking night worker was happy to just read to a patient who could not sleep. The recruitment policy of the home is very specific, as the home only employs Christian Science Nurses to care for the patients. The organisation has 3 flats near to the home to accommodate staff, many of whom live quite a distance from the home, including the USA. An application, 2 references and CRB clearance was in place for each staff member. Staff have an induction procedure, a contract, supervision every 2 months and an annual audit of training. Lime Tree House F55 F05 s38981 lime tree house v235535 020905 stage 4.doc Version 1.40 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 The safety and welfare of patients is maintained through robust safety procedures. EVIDENCE: The home has a health and safety policy which it complies with. A fire risk assessment was readily available and all fire safety checks were consistently completed. The most recent environmental health food safety report dated 31/08/04 stated “hazard analysis, high standard of compliance in all areas”. Evidence of undertaking annual safety checks e.g. of the boiler and central heating was in place. Lime Tree House F55 F05 s38981 lime tree house v235535 020905 stage 4.doc Version 1.40 Page 16 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 N/A 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4
COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 4 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x x x x x x 3 Lime Tree House F55 F05 s38981 lime tree house v235535 020905 stage 4.doc Version 1.40 Page 17 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 13 Requirement Risk assessments must be undertaken to assess all risks to each individual patient. This includes the risk of falls and the use of bed rails. The home must obtain a copy of Trafford Council’s Protection of Adults from Abuse Policy and provide staff with training in it’s implementation. The home must obtain the advice of the local fire service concerning the use of Doorguard magnetic hold offs on fire doors. Timescale for action 15/10/05 2. 18 13 15/11/05 3. 19 23 15/10/05 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 Good Practice Recommendations Lime Tree House F55 F05 s38981 lime tree house v235535 020905 stage 4.doc Version 1.40 Page 18 Commission for Social Care Inspection 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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