CARE HOMES FOR OLDER PEOPLE
Lime Tree House 264 Washway Road Sale Cheshire M33 4RZ Lead Inspector
Helen Dempster Unannounced Inspection 31st January 2006 1:00 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.V276156.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 DS0000038981.V276156.R01.S.doc Version 5.1 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 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.V276156.R01.S.doc Version 5.1 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. 2nd September 2005 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 House DS0000038981.V276156.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and was the home’s second inspection of the year. It started at 1pm and finished at 4pm on 31st January 2006. Time was spent discussing welfare matters relating to the patients the home supported and examining documentation in relation to the running of the home, staffing, care planning and the patients’ satisfaction. 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. The inspection only looked at a limited number of standards, so this report should be read together with the earlier report to get a full picture of how the home is meeting the needs of the patients staying there. What the service does well:
The patients’ personal and social care needs are well documented and met with reference to the wishes and rights of each individual patient. Care plans were reviewed on a daily basis and patients were involved in the care planning process. Patients are served a nutritious, appealing and wholesome diet with alternative choices provided. Staff and patients eat together to maintain a family atmosphere, which benefits patients. Patients 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 patients’ needs. Patients benefited from being cared for by a committed and caring manager and well supported staff, which was given good access to training. The patients benefit from good arrangements for the safekeeping of money and valuables. Lime Tree House DS0000038981.V276156.R01.S.doc Version 5.1 Page 6 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 DS0000038981.V276156.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Lime Tree House DS0000038981.V276156.R01.S.doc Version 5.1 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 the following standard(s): N/A EVIDENCE: These standards were assessed at the last inspection and will be reassessed at subsequent inspections. Lime Tree House DS0000038981.V276156.R01.S.doc Version 5.1 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 the following standard(s): 7 The patients’ personal and social care needs are well documented and met with reference to the wishes and rights of each individual patient. Detailed risk assessments protected patients. EVIDENCE: Care plans are held in individual binders and were 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. In response to a requirement made at the previous inspection, 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 also been completed and this individual had signed the risk assessment to denote their involvement. In December 2005, just prior to
Lime Tree House DS0000038981.V276156.R01.S.doc Version 5.1 Page 10 the inspection, the manager had attended a 4 day moving and handling and risk assessment course. She said that she had found the course to be very useful in developing risk assessment skills. 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.V276156.R01.S.doc Version 5.1 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 the following standard(s): 15 Patients are served a nutritious, appealing and wholesome diet with alternative choices provided. EVIDENCE: When the inspector arrived at the home the 3 patients accommodated were enjoying lunch. Choices, including a vegetarian choice, were offered at every meal. Copies of each patient’s 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. Staff and patients eat together to maintain a family atmosphere, which benefits patients. Lime Tree House DS0000038981.V276156.R01.S.doc Version 5.1 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 the following standard(s): 16 and 18. Patients were able to raise any concerns by using a clear and readily available complaints procedure. Furthermore the staff were familiarity with, and training in, the protection of adults from abuse all of which promoted the patients welfare. EVIDENCE: The home’s complaints procedure was held in the “Information for guests” booklet, a copy of which was held in each room. The home had not received any complaints. As part of the monthly visits, the Registered Individual, who was at the home at the time of inspection, talks to patients to establish whether they have any concerns or comments. The home’s policy on the protection of adults from abuse was readily available at the home. In response to a requirement made at the previous inspection, the manager had obtained a copy of Trafford Council’s Protection of Adults from Abuse Policy, attended training in the implementation of the policy on 27/01/06 and provided staff with guidance in its implementation. The manager had also amended the induction procedure for new staff to include adult abuse awareness, and was in the process of booking other staff on Trafford Council’s Protection of Adults from Abuse training course. Lime Tree House DS0000038981.V276156.R01.S.doc Version 5.1 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 the following standard(s): 19. The environment was well maintained, homely and attractive and was subject to ongoing improvement and safety checks to meet patients’ needs. EVIDENCE: The home provides patients with a clean, tidy, attractive and homely environment. All bedrooms were single with en-suite facilities. In response to a requirement made at the previous inspection, the home had obtained the advice of the local fire service concerning the use of Doorguard magnetic hold offs on fire doors. Lime Tree House DS0000038981.V276156.R01.S.doc Version 5.1 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 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): 30. Patients benefited from being cared for by well- supported staff, who were given good access to training. EVIDENCE: The manager had a clear and detailed training plan and audit. Staff had been provided with training in moving and handling since the last inspection and food hygiene training had been booked to take place in March 2006. Lime Tree House DS0000038981.V276156.R01.S.doc Version 5.1 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 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 and 38. Patients benefited from the home being run by a committed and caring manager, security of their money and valuables and consistent fire safety checks. However, Fire safety could be enhanced by reviewing the fire risk assessment. EVIDENCE: The manager demonstrated that she had a good knowledge of the National Minimum Standards and Regulations, which she uses as a working tool. Her interactions with patients and staff were seen to be caring and professional. She holds the registered managers award and was clearly committed to continual improvement. She was found to exceed the minimum standard. The home uses a patient satisfaction questionnaire, which is given to each patient to complete when they are due to leave the home. The manager also had a one to one discussion with each patient before they leave the home to
Lime Tree House DS0000038981.V276156.R01.S.doc Version 5.1 Page 16 obtain their opinions of the care provided. It was evident that the manager acted on feedback before the patient returns for another stay. One example was seen when viewing a satisfaction questionnaire from a patient who suggested that nuts were provided for vegetarians and this had been addressed. The need to extend this good practice into collating, analysing and reporting on survey findings was discussed and a requirement was made accordingly. The patients are accommodated for short stays at the home. An inventory of their possessions was made on admission and examples were seen. The home had a safe and patients were encouraged to place valuables in the safe for safekeeping. A record of money and valuables held on behalf of patients was held and receipts for purchases made on their behalf were also held. Patients pay their accommodation bill by cheque or cash and were provided with an invoice and receipt. Fire safety checks of the fire alarm, means of escape and emergency lighting were being made and recorded consistently. Staff were involved in monthly fire drills and signed the record to denote their involvement. A recommendation was made to the effect that the home obtains an official fire logbook from the local fire service to record these checks on one record. The fire risk assessment was in place and was dated August 2003. It was last reviewed in January 2004. A requirement was made to the effect that it was reviewed and the date and details of the review are recorded and signed by the person conducting the review. Lime Tree House DS0000038981.V276156.R01.S.doc Version 5.1 Page 17 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 2 X 3 X X 2 Lime Tree House DS0000038981.V276156.R01.S.doc Version 5.1 Page 18 Are there any outstanding requirements from the last inspection? No. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP33 Regulation 24 Requirement The home must review and develop their quality assurance system to provide a verifiable method, which involves patients, to audit the service and report on the findings. The fire risk assessment must be consistently reviewed and the date and details of the review must be recorded and signed by the person conducting the review. Timescale for action 29/05/06 2 OP38 23 28/02/06 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 OP38 Good Practice Recommendations It is strongly recommended that the home obtain an official fire logbook from the local fire service to record fire safety checks together on one record. Lime Tree House DS0000038981.V276156.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection CSCI, Local office 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
© 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 DS0000038981.V276156.R01.S.doc Version 5.1 Page 20 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
