CARE HOMES FOR OLDER PEOPLE
Lime Tree House 264 Washway Road Sale Cheshire M33 4RZ Lead Inspector
Elizabeth Holt Unannounced Inspection 20th April 2007 10:00 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 DS0000038981.V336385.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 DS0000038981.V336385.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Lime Tree House Address 264 Washway Road Sale Cheshire M33 4RZ 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) 0161 973 7956 0161 973 5777 limetreehouse@tiscali.co.uk Mountlands Trust Ltd Mrs Julie Brearley Care Home 4 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Lime Tree House DS0000038981.V336385.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 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. 31st January 2006 Date of last inspection 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 referred 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 Houses fees range from £50.00 to £250.00 per day however as a Registered Charity people pay within their means Lime Tree House DS0000038981.V336385.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on Friday 20th April 2007 from 10.00 until 15.00 hours. During the inspection time was spent talking to some of the people who were living there, the manager and some of the staff about day to day life in the home and to establish what the home was like for the residents. Information was gathered as part of the inspection process, which included a questionnaire completed by the manager, which gave information about the residents, the staff and the building. Information held by the Commission, for example notifications of significant incidents was also reviewed. A tour of the premises was undertaken and examination of documents and care files for the individual residents. Four resident/relatives questionnaires were returned to the Commission. 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. Since the last inspection no complaints have been received by the Commission and none have been directly to the home. What the service does well:
The home ensures prospective people are properly assessed before an offer of a place is confirmed. The personal and social care needs are well documented and met with reference to the wishes and rights of each individual patient. One person said,” the staff are very patient and kind and nothing is too much trouble.” Care plans were reviewed on a daily basis and the people were involved in the care planning process. People living at the home were very positive about how their needs were met by the staff. People are served a nutritious, appealing and wholesome diet with alternative choices provided. Staff and the people at the home eat together to maintain a family atmosphere, which benefits the people living there. One resident said, “the food is always very tasty and I can choose what I feel like”. Lime Tree House DS0000038981.V336385.R01.S.doc Version 5.2 Page 6 People were able to raise any concerns by using a clear and readily available complaints procedure. The environment is well maintained, homely and attractive and is subject to ongoing improvement and regular safety checks, including fire safety checks, to meet the needs of the people accommodated. One person said, “my room is kept clean and is homely”. The minimum staff levels were 2 staff members to meet the needs of 4 people when the home is full. Staff spoken to and a review of the records showed that a good training programme was in place. Staff files contained the required information in line with the regulations to ensure the right staff are employed to look after vulnerable people. People who use the service benefited from being cared for by a committed and caring manager and well supported staff. One relative wrote,” Thank you so much for all the love and care you have shown Mum in the last few months. It is wonderful what you do and as a family we really appreciate it.” The people benefit from good arrangements for the safekeeping of money and valuables. What has improved since the last inspection?
The manager had updated the Statement of Purpose and had reviewed a number of the home’s policies and procedures since the last inspection. The manager has a clear and detailed training plan and audit. Staff had been provided with training in the form of a number of moving and handling workshops since the last inspection and some staff had completed Christian Science Nursing training. Since the last inspection the home had developed a system to report on the survey findings following the “patient satisfaction questionnaires”. Improvements had been made to the fire risk assessment and the home had acted upon the recommendation to access an official fire logbook to record fire safety checks. Lime Tree House DS0000038981.V336385.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Lime Tree House DS0000038981.V336385.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 DS0000038981.V336385.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): 3 (6 was not assessed as the home do not provide intermediate care). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective people can be confident that the home will assess their needs properly using a robust admissions procedure. EVIDENCE: The completed admissions enquiry forms for two people were reviewed and these included physical assessments of the person’s needs to support the comfort and dignity of the people. These forms contained sufficient information to establish the care plan. The Admissions Committee review all enquiries before a person is admitted to the home. Lime Tree House DS0000038981.V336385.R01.S.doc Version 5.2 Page 10 There are two categories of admission. People can be admitted for short term rest and study breaks and Christian Science Nursing Care. At the time of the inspection the home accommodated three people. The home does not provide intermediate care. Lime Tree House DS0000038981.V336385.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): 7, 8, 9 and 10 (Standard 9 was not assessed, as people who use this home do not take medications). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The personal and social care needs the people received is based on their individual needs. EVIDENCE: A care plan was available for each person accommodated. 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. A daily record of the person’s progress was also in place. Care plans were reviewed on a daily basis and the individuals were involved in the care planning process. Risk assessments concerning all aspects of risk to each individual, including the risk of falls had been completed. A risk assessment concerning the use of bed rails for one individual had been completed and this individual had signed the risk assessment to show their involvement.
Lime Tree House DS0000038981.V336385.R01.S.doc Version 5.2 Page 12 On the day of the inspection the health care needs of the people accommodated was in line with their Christian Science beliefs. From observations made during the visit and discussions with the people living at the home, it appeared that the Christian Science Nurses and care staff treated the people with respect and dignity. In keeping with Christian Science philosophy, no medical intervention is provided at the home, therefore Standard 9, which concerns medication, was not applicable. Lime Tree House DS0000038981.V336385.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People living in the home can be assured that their expectations and preferences can be met. EVIDENCE: The people accommodated at the home said their relatives and friends were made welcome and encouraged to visit the home. The people living at the home could see their relatives in the communal lounge or in the privacy of their bedroom. The cook was interviewed and it was clear she enjoyed food planning, preparation and cooking. The inspector joined two of the 3 people accommodated and the staff for lunch. The meal was well presented and was very tasty. Choices, including a vegetarian choice, were offered at every meal. Copies of each persons daily menu choices were held on their personal file to enable staff to monitor their nutritional input. The choices were offered on the day before the menu is served. Care staff were sensitive to the needs of any people who required some assistance at mealtime. Meals were taken by staff and the people who live in the home together to maintain a family atmosphere.
Lime Tree House DS0000038981.V336385.R01.S.doc Version 5.2 Page 14 People spoken to said they were happy with the food provided and the homely atmosphere. One relative commented; …”which includes Debbie for the wonderful variety of food cooked and beautifully presented each day”. A schedule of activities was available which supported the healing process based on Christian Science. Staff did facilitate social and recreational activities that interested each individual. One person said she had enjoyed going on walks to the park and had assisted in cake making. Discussions with two of the people living at the home and the staff showed that the people could exercise some control and choice over their daily lives. One person was overheard being asked by a staff member if she felt like attending the Bible reading class on the morning of the visit. Two of the bedrooms viewed were seen to have some personal possessions in them. Care plans included a record of any activities carried out. Lime Tree House DS0000038981.V336385.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were able to raise any concerns by using a clear and readily available complaints procedure. The staff were familiar with the protection of adults from abuse all of, which promoted the welfare of the people accommodated. EVIDENCE: The home’s complaints procedure was held in the “Information for guests” booklet, a copy of which was held in each room. As part of the monthly visits, the Responsible Individual, talks to the people accommodated to establish whether they have any concerns or comments. The home’s policy on the protection of adults from abuse was available at the home. The manager and staff had received training in the Protection of Adults from Abuse. A discussion with a staff member highlighted the appropriate course of action she would take in the event of an allegation of abuse. Lime Tree House DS0000038981.V336385.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The environment was well maintained, homely and attractive and was subject to ongoing improvement and safety checks to meet the needs of the people living there. EVIDENCE: Lime Tree House is a large adapted bungalow in its own grounds. There is a lawned area at the front and rear of the property and a patio area with garden furniture where people can sit out. Parking is available at the front of the bungalow. The home provides people with a clean, tidy, attractive and homely environment. All bedrooms were single with en-suite facilities. People staying at the home were positive about the environment. “My bedroom is lovely and homely and I have enjoyed the warmth felt whilst I have been living here.”
Lime Tree House DS0000038981.V336385.R01.S.doc Version 5.2 Page 17 The laundry room is situated away from the food preparation areas and a sluicing facility was available on the washing machine. An up to date copy of the Guidance for Infection Control was available. There was evidence of a programme of redecoration and ongoing maintenance. Lime Tree House DS0000038981.V336385.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home benefited from being cared for by well-supported staff, who were trained and competent to do their work. EVIDENCE: The manager had a clear and detailed training plan and audit. Staff had done workshops in moving and handling since the last inspection and food hygiene training had taken place in March 2007. Minimum levels of 2 staff met the needs of the 4 people accommodated. In addition to these carers, a cook and a cleaner are also employed. On occasions, the staffing levels at the home can be one to each person. The people living at the home 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 the individuals. Two of the people living at the home said that staff were so supportive of them that nothing was too much trouble. The recruitment policy of the home is very specific, as the home only employs Christian Science Nurses to care for the people accommodated. 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 form, 2 references and CRB(Criminal Records Bureau) clearance checks was in
Lime Tree House DS0000038981.V336385.R01.S.doc Version 5.2 Page 19 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 DS0000038981.V336385.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has the systems in place to monitor the service based on people’s views. The people accommodated benefited from a committed and caring manager and the home was seen to promote safe working practices. EVIDENCE: The manager was fully aware of her responsibilities and was seen to be sensitive, caring and professional towards the people living at the home and towards the staff. Staff said the manager was “approachable” and “always willing to listen” to any issues they had. The home has the policies and procedures in place to safeguard the financial interests of the people living there.
Lime Tree House DS0000038981.V336385.R01.S.doc Version 5.2 Page 21 Procedures are in place to find out the views from the people who use the service what they think of it in the form of a patient satisfaction survey. Fire maintenance checks were being carried out in line with the guidance from the local fire service. The last fire drill was carried out on the 5/04/07 which included staff signatures to show their attendance. The pre-inspection questionnaire showed that health and safety checks were being carried out. Lime Tree House DS0000038981.V336385.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 N/A 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 4 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Lime Tree House DS0000038981.V336385.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Lime Tree House DS0000038981.V336385.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Old Trafford M16 9HU 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
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