Inspection on 04/09/07 for Lime Tree House

This inspection was carried out on 4th September 2007.

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 12/10/06

Lime Tree House 17/05/06

Lime Tree House 14/12/05

Lime Tree House 07/06/05

Lime Tree House 19/10/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Lime Tree House Chantry Green, Main Street Upper Poppleton York YO26 6DL Lead Inspector Chris Taylor Unannounced Inspection 4th September 2007 09:30 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.V345868.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lime Tree House DS0000061499.V345868.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lime Tree House Address Chantry Green, Main Street Upper Poppleton York YO26 6DL Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01904 795280 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.V345868.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 01/12/06 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 the first 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. The fees for the home range from £395 to £435 per week. This information was provide on the day of the inspection. Lime Tree House DS0000061499.V345868.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is what was used to write this report. • Information known about the home since the previous inspection including information from specific incidents reported, complaints and concerns and information passed to the Commission for Social Care Inspection by other professionals and organisations. Information from a random inspection which was carried out on 1st December 2006. A visit to the home which was unannounced. This lasted seven hours and included talking to staff and the manager about their jobs and the training they have completed. A tour of the premises was made and the records the home is required to keep were looked at. Time was spent talking to the people who live at the home and observing staff as they carried out their work. Four people’s files were looked at in detail. • • • What the service does well: What has improved since the last inspection? What they could do better: For any improvements to be made the way in which this home is managed needs to change. The home needs to appoint a manager who is experienced, Lime Tree House DS0000061499.V345868.R01.S.doc Version 5.2 Page 6 skilled and knowledgeable about older people and most importantly managing a care service. This person needs to be well supported and monitored by the responsible individual. Additionally the registered providers need to ensure they meet their legal responsibilities to complete and submit documentation required by law. Admissions to the home must only take place after a full assessment of the persons needs. This will assist the home in deciding whether they have the skills and expertise to meet the person’s needs prior to them moving in. Each person must have a care plan that has been agreed with them. It should include information about all areas of the person’s life including health, personal, cultural and social care needs. The plan must identify the support staff has to provide to meet people’s needs whilst making sure people retain independence. This will make sure the person receives support to meet their individual and specific needs. To make sure support changes with the person’s needs care plans must be reviewed every month. To ensure peoples’ safety and promote independence risk assessments must be completed, these must be discussed with people and reviewed regularly. A system for checking that medication is being given as prescribed must be introduced so that mistakes can be detected easily and the risk of errors is minimised. All staff responsible for administering medication must follow the correct procedure at all times in order that people’s wellbeing and safety is maintained. This has been identified as an improvement in previous inspections. In order that people can confidently express their concerns about the home the manager and responsible individual must make changes in the way they respond to complaints. They need to regard complaints positively and a means to ensure that service provided is what people want and need. They need to demonstrate that complaints are taken seriously, investigated thoroughly and resolved satisfactorily with the complainant. To make sure that any allegations of abuse or neglect are reported to the right agencies the procedure must be amended and staff must be informed of this. The environment requires some major work carrying out and firm plans must now be made with time scales for completion. In order that people live in a home where the risk of cross infection is minimised an effective infection control system must be implemented and additional staff training provided. The home must be cleaned thoroughly. The deployment of staff must be reviewed to ensure there are sufficient staff hours to meet people’s needs and to ensure the home is kept clean and maintenance jobs completed quickly. Lime Tree House DS0000061499.V345868.R01.S.doc Version 5.2 Page 7 Staff must be provided with regular formal supervision in order for the manager to monitor their practice and to support them to do their job well. Managers need to implement a quality assurance system which gathers the views of service users, relatives and other professionals. This information should then be used in a development plan which aims to improve the service provided. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Lime Tree House DS0000061499.V345868.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lime Tree House DS0000061499.V345868.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3. People who use this service experience poor quality outcomes in this area. Where peoples’ needs have not been assessed prior to admission it is less likely that their needs will not be fully met. This judgement has been made using available evidence including a visit to the service. EVIDENCE: There is a clear referral system. This happens in one of two ways. Care managers from the local authority contact the home with an assessment of the persons needs. The second way is when members of the public contact the home directly. The manager said that regardless of where the referral comes from she would visit the people either at their own home or in hospital and complete the home’s assessment to make sure that the home would be suitable. A return visit by the person in order for them to get a feel for the home is encouraged Lime Tree House DS0000061499.V345868.R01.S.doc Version 5.2 Page 10 but can’t always be possible. Sometimes relatives visit instead. Two service users said that they had been provided with information about the home before they moved in and this had been useful. Four people’s files were looked at to establish whether this process had been followed. Two people had lived at the home for quite a while and both local authority and the home’s own assessment had been completed thoroughly providing staff with the right kind of information to support people safely and in a way that they want. The other two files were for people admitted in March and April 2007. One of the files had a pre admission assessment partly completed and one had the front sheet with basic contact information completed but nothing else. One of the files had a local authority assessment which would give some guidance to staff. The format for the pre admission assessment is good and has appropriate headings to determine what support people need. If however this information is not completed then the home can’t determine whether they have the skills and expertise to meet the person’s need safely. One service user under the age of 65 years had been admitted. The home is only registered for people over the age of 65 years. The manager was not aware of the details of the certificate or that this information related to whom she is permitted to admit. Lime Tree House DS0000061499.V345868.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. People who use this service receive poor quality outcomes in this area. A lack of good care planning and safe administration of medication places people at risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four care plans were looked at. Two had no information other than basic contact details. One included a local authority care plan. The two remaining files contained very good detailed information particularly about peoples’ social and emotional needs. There were also good risk assessments for moving and handling, nutrition, self-medication and falls. However files were very disorganised and didn’t run in any logical order that would assist staff in identifying what was most up to date. Some documents were signed and dated some were not. Some files contained review sheets and some did not. Reviews were not held every month. Care plans were not signed by the person. Lime Tree House DS0000061499.V345868.R01.S.doc Version 5.2 Page 12 Those which had no care planning documents mean that staff are using their own judgment based on limited verbal information to provide support and this has the potential to place service users at risk of harm. Individual exercise books are used for daily records. The content of daily records gave a good impression of how people spend their day and would be useful to track any changes. However, these daily records also contained important information about changes in people’s care routines for instance when medication had to be discontinued and instructions for specific care practice. In the main these were dated but not always signed or initialled by the person making the record. Staff are however meeting some of the needs of service users despite a lack of good care plans and guidance. People looked clean and cared for. During the course of the inspection staff were observed working with people. Staff were kind and courteous, patient and helpful. People spoken with said that staff were respectful and kind. One Person said, “staff are good to us, they can’t do enough”. Staff said that they covered issues of privacy and dignity during induction. They were able to give examples of good and bad practice. The Commission for Social Care Inspection had received an anonymous complaint about the call bell system being broken. A random inspection was carried out in December 2006 and found that this to be correct. Because the call bell system wasn’t working people had to sometimes wait for long periods of time before staff came to assist. This compromised the safety of people. Appropriate action was taken to repair the system and additional staff were on duty during the interim. On the day of the inspection the call bell system was operating. People said that generally when they called for assistance staff came swiftly although this did depend on how many staff were on duty. There have been a number of complaints made to the Commission for Social Care about mistakes made in administering medication. Assurances had been given by the responsible individual in response to these complaints, that these had been resolved and a system was in place to monitor. The manager reported that staff who administer medication have received accredited training in the safe administration of medication. During the tour of the premises prescribed cream was found on the bedside table of a service user. The service user said a member of staff had applied the cream. The cream was not prescribed for this service user but for someone else living in the home. The storage and administration of medication was checked to make sure that medication is stored and administered safely. Medication is stored in a locked Lime Tree House DS0000061499.V345868.R01.S.doc Version 5.2 Page 13 medication trolley which when not being used is secured to the wall. There is a separate fridge for medication which needs storing at a lower temperature. This fridge does not have a lock so is accessible to anyone. A monitored dosage system is used and medication is stored in blister packs. Medication that can’t be stored in this way is kept in the shelves of the trolley’s doors. There were some discrepancies between the records kept to record when medication has been given and the stock check of how much medication for each individual should remain. In three random checks medication had been signed as given but the amount of medication remaining indicated that it had not been given. One person’s medication dosage had been altered by hand to increase but the dosage within the blister pack had been given as originally prescribed. The only record to validate the increase was found in the person’s daily records and the record made no reference to what medication was to be increased just recorded “doctor been out has said to up her medication”. The manager was instructed to contact the GP in the inspector’s presence to clarify the correct dosage and obtain an up to date prescription. When creams are prescribed there is no record made on the medication administration sheet that they have been applied. The medication errors were so serious an immediate requirement notice was issued. People can register with the GP of their choice; this was evident from records checked. District nurses attend to people when necessary and chiropody and opticians are available either to come to the home or community. People spoken to confirmed this. Lime Tree House DS0000061499.V345868.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15. People who use this service experience good outcomes in this area. People have choice about how they spend their days. Better efforts to identify people’s preference and interests would ensure individual’s social, cultural and recreational interests are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home doesn’t employ a specific activities organiser but there is one member of staff who takes on this responsibility. People said that entertainers, singers and keyboard players often came to the home and that the local vicar held a service once a month for those wanting to take part. Library books, newspapers and talking books for people with eyesight problems were evident throughout the home. A large screen TV means that service user have a good view of the television wherever they sit in the lounge. Also in the lounge is a computer available for service users to use and the manager said she did assist people to email friends and family. Trips out are arranged occasionally and some people with more independence attend social clubs in the local village. Lime Tree House DS0000061499.V345868.R01.S.doc Version 5.2 Page 15 On the day of the visit the radio was playing in the entrance hall where some people choose to sit. The station was playing mostly modern music which was not really appropriate for the people living at the home and two service users commented on the “racket” and that it was “too loud”. Although there appears to be plenty to do a lack of good care planning means that the social, cultural and recreational interests of people are not always identified. This makes it difficult to plan and provide opportunities which relate directly to the needs and preferences of the people living at Lime Tree House. Staff were seen spending time chatting to people. The hairdresser was in on the day of the visit and people were enjoying having their hair done. In the afternoon people sat outside with staff and a member of staff played a children’s’ board game with people. Although this was not age appropriate people did enjoy the game. Some people spoken to had ideas about activities but didn’t know how or feel able to bring this to the attention of the member of staff responsible for arranging activities or the manager. People spoken to said that they could get up and retire whenever they wanted and were free to spend their day as they choose. Meals are provided in the dining room and in people’s bedrooms if the choose. Dining tables were set properly with tablecloths, cutlery and condiments. There is a choice of menu at each mealtime and people make this choice after breakfast and for the evening meal after lunch. Lunchtime was relaxed and unhurried although it was served quite early at 11.45am. Staff supported those people who needed help sensitively and discreetly. Following the meal coffee was served. One person said “that was a lovely meal” and other similar comments were heard. Two people made comments that the plates are often cold which means that hot food cools off quite quickly. Lime Tree House DS0000061499.V345868.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 16 and 18. People who use this service experience poor outcomes in this area. People cannot be confident that their complaints will be investigated properly. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is provided with other useful information when arrangements are made to move into the home. The manager produced two complaints procedures. One was very clear about how people can make complaints and what the time scales for investigating and providing an outcome are. The other did not and stated that all complaints must be made in writing. The manager was advised to ensure the first version is distributed. Two people said that they felt confident that any complaints would be taken seriously. Two people said that they had made complaints which they felt had not been investigated. One person said, “My complaint was ignored”. There have been four complaints made to the Commission for Social Care Inspection, two of which have been made anonymously. A random inspection was carried out as a result of one complaint. Another complaint was made because the caller didn’t know what the complaints procedure was for the home. The two remaining complaints were with regard to staffing levels and medication errors; these were anonymous. The responsible individual was Lime Tree House DS0000061499.V345868.R01.S.doc Version 5.2 Page 17 asked to investigate these complaints and forward the outcome of the findings to the Commission. The responsible individual has not provided details of how each complaint was investigated, what the findings were, what necessary action has been taken and whether the complainant, if known, was satisfied with the outcome. The accumulative evidence suggests that the home does not accept complaints in a positive manner or investigates them properly and to the satisfaction of complainants. If this is so then it places people who live at the home in a vulnerable position, unable to speak out when things are going wrong. There were no records relating to complaints made and investigation outcomes available in the home to inspect. The manager explained that she didn’t have access to this information as the responsible individual kept it. The home has a policy and procedure with regard to safeguarding adults and the prevention of abuse. This procedure was incorrect and needs amending to accurately reflect national good practice and local multi agency agreements. Staff confirmed that they had received training in how to recognise abuse and neglect and were able to give examples of practice that would constitute abuse. They all said they would report any suspicions to the manager or responsible individual and if it involved either of these people the police or Commission for Social Care Inspection. Lime Tree House DS0000061499.V345868.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26. People who use this service experience poor outcomes in this area. People do not live in a well-maintained environment. Infection control management is poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The accommodation is arranged over two floors with a vertical passenger lift. The entrance hall had stained and torn wallpaper and the carpet was very dirty. As a result of this first impression a thorough tour of the premises was made, checking every room with the exception of those bedrooms where people were asleep or out of the home. Lime Tree House DS0000061499.V345868.R01.S.doc Version 5.2 Page 19 Generally the home was not very clean, many areas needed redecorating and carpet needed either cleaning or replacing. The bathrooms were poor, with cracked tiles and stained baths and toilets. There was a pole across a low windowsill over the bath which was loose. And another low windowsill on the landing did not have safety glass or safety film fitted. An immediate requirement was left for this to be sorted out quickly. Many of the bedroom carpets were stained and wallpaper scuffed or torn. A number of cobwebs were seen around the home and vases of artificial flowers were dirty and dusty. The dining room had ripped wallpaper and stained carpet. Where new ceiling lights had been fitted the ceiling had not been re painted leaving black marks where the old lighting had been. The kitchen was dirty; the floor stained and paint work dirty and greasy. There were flies in every room. The conditions found of the environment pose a health and safety risk in terms of infection and physical hazards such as tripping. The Environmental Health Agency had recently visited and left notices for immediate improvement in the cleanliness of the kitchen and to eradicate the high number of flies in the home. Outside is an accessible garden with raised beds. This area is very pleasant and is used a lot in fine weather and enjoyed by people who live there. The laundry area has been the subject of previous requirements because it is too small for the amount of laundry generated from the home. There is not enough space for soiled laundry to be separated from other laundry, or space to iron and air clean clothes. There is no laundry worker employed and only 20 hours of specific domestic/ housekeeping. This is not enough for a home this size. One service said that a relative completed their laundry because they would not be confident that the home would make “a good job of it”. Staff said that they had training about infection control. Although there were gloves and aprons available they were located in the staff office. There was no hand washing facilities for staff in either bedrooms or bathrooms. Staff did not routinely carry antiseptic gel. A recent outbreak of Diahorrea and Vomiting was not reported to the appropriate bodies without a prompt from the Commission for Social Care Inspection. The follow up visit from the Community Infection Control nurse found the infection control within the home to be poor and had contributed to the spread of infection during the recent outbreak of diahorrea and vomiting. The home has arrangements for the collection of clinical waste and this is collected in yellow bags. These are stored in specially designated bins outside. This bin was overflowing and one member of staff said that there had been no collection last week. An immediate requirement notice was left for a collection to be arranged without delay. Lime Tree House DS0000061499.V345868.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30. People who use this service experience adequate outcomes in this area. Recruitment procedures help ensure that suitable people are employed. Staffing hours are not sufficient enough to ensure the home is run and maintained to a good standard. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager explained the recruitment process. She said that vacant posts were advertised and applicants were asked to complete an application form. Applicants were then given a formal interview with the manager and responsible individual. If successful references are sent for and a Criminal Records Bureau check. The records for the three most recently recruited staff were checked and the process had been followed correctly. None of the new staff had started work before all the checks had been returned. Staff complete an in house induction which takes four days to complete. It covers all the necessary areas but the short time it takes to complete indicates it is not in sufficient depth for staff to be competent. The manager explained that the induction programme was newly implemented and had replaced a longer more in depth competence based induction which she felt was more Lime Tree House DS0000061499.V345868.R01.S.doc Version 5.2 Page 21 thorough and would better equip new staff to do their job. There is a threemonth probation period during which all the statutory training with regard to health and safety, food hygiene, moving and handling and first aid are taken. Records confirmed this. One member of staff who had only worked in the home for a week was spoken to she said she felt the induction was fine but she had previously worked in a care setting and had completed statutory health and safety training prior to starting at Lime trees. On going training is available and staff confirmed they had attended training in dementia care, loss and bereavement and safe handling of medication. The rota indicated that there were sufficient care staff on duty to meet service users needs providing that is all that is expected of them. However because there is no laundry staff and only 20 hours per week allocated for domestic work staff take on additional house keeping duties which could take them away from caring for service users. There are usually four staff on duty in the morning, three in the afternoon and two during the early part of the evening with two staff on duty awake at night. Because the standard of the home’s cleanliness was poor it is clear that care staff do not have the time to carry out cleaning and laundry. Additional staff need to be employed to ensure both service users’ care needs and housekeeping tasks are completed. There are six and three quarter hours per day allocated to preparing meals. The home does not use agency staff but relies on the good will of existing staff to cover for holiday and sickness. This provides a consistent service for people but means that sometimes staff work long periods without a break which could mean staff are tired and don’t report for worked refreshed from their previous shift. Lime Tree House DS0000061499.V345868.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 31, 33, 35, 36 and 38. People who use this service experience poor outcomes in this area. Management of the home is poor. People living and working at the home would benefit from management which has appropriate skills, knowledge and experience. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The deputy manager is currently running the home in the absence of a registered manager. She has almost completed her registered manager award. Lime Tree House DS0000061499.V345868.R01.S.doc Version 5.2 Page 23 She has some difficulties in managing the home to an acceptable level and needs further support and guidance if she is able to improve the standards in the home. There are some significant gaps in the manager’s knowledge examples of which were her failure to instruct staff to contact the infection control nurse during a recent outbreak of diahorrea and vomiting and her lack of understanding of the home’s registration category’s. The registered provider failed to return the Annual Quality Assurance Assessment which is a requirement of the Commission for Social Care Inspection. Supervision and monitoring is not sufficiently good enough for the manager and the responsible individual to be confident that the home is operating at a safe level. An example of which were the medication errors found, the poor standard of care planning and environmental standards. There is no formal staff supervision system where staff meet individually with their manager to discuss performance, to plan training and support. Staff meetings are held regularly but the only minutes available were 12 months old. The manager said that she did work a variety of shifts so that she could monitor staff practice. The responsible individual visits the home and has recently chaired resident and staff meetings. The Responsible individual’s role is to support and monitor the manager and standards within the home. It is a requirement of the Care Homes Regulations 2001 Regulation 26 that the responsible individual visits the home once a month to carry out monitoring about standards in the home and to gain the opinions of those people living at the home. A report should be produced and provided to the Commission. The responsible individual does not carry out regulation 26 visits. It is the inspector’s judgement that the responsible individual is not carrying out the role effectively given the amount of shortfalls found in this inspection. One person said that “the home has gone down hill since the previous manager had left” another said that “management isn’t very good there doesn’t seem to be anyone in charge, complaints are made but nothing seems to happen”. The manager wasn’t aware of any quality assurance system or a development plan for the home. A number of health and safety records were checked. The gas safety certificate was out of date. Lime Tree House DS0000061499.V345868.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 1 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 1 X X X X X X 1 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 2 2 X 1 Lime Tree House DS0000061499.V345868.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement Service users shall not be admitted to the home unless a preadmission assessment has been carried out to determine what the service users needs are and that the home has the capacity to meet those needs. 15 All service users must have a plan of care that details how the individual’s needs in all activities of daily living are to be met. Where possible service users or someone who represents them must be involved with the development of the plan. The care plan must be reviewed at least once a month, updated to reflect changing needs and current objectives for health, social and personal care. Service user plans must be dated and signed. 3 OP7 13 Risk assessments must be completed in full. They must indicate clearly how any remaining risk is to be managed. DS0000061499.V345868.R01.S.doc Timescale for action 04/10/07 2. OP7 12/10/07 12/10/07 Lime Tree House Version 5.2 Page 26 Service users wishes to be independent must be considered 4 OP9 12(1) 13(1)(2)( 6) 17(1)Sche dule 3(i) A system for checking that 04/09/07 medication is being given as prescribed must be introduced so that errors can be detected easily and the risk of errors is removed. Previous timescale 12/01/07 not met. 5. OP16 22 (3) and (4) 13(6) All complaints must be recorded, investigated and resolved satisfactorily. The Adult Protection procedure must be reviewed to ensure it meets with North Yorkshire Social Services multi disciplinary guidelines. The registered person must submit a maintenance programme including timescales with regard to the interior and exterior of the home being brought into a good state of repair, furnishing and décor. The plan must show how this will be maintained. The home must be cleaned thoroughly. 8. OP26 13(4)(a) The windows in the bathroom and landing must be fitted with either safety glass or safety film to avoid injury if a person fell against them. Effective infection control systems must be implemented. Evidence of staff training must be provided. The overflow of yellow clinical waste bags must be removed. DS0000061499.V345868.R01.S.doc 12/10/07 6. OP18 12/10/07 7. OP19 23 (2) (b) 12/10/07 11/09/07 9. OP26 13(3) 12/10/07 10. OP26 13 (3) 04/09/07 Lime Tree House Version 5.2 Page 27 11. OP27 18 (1) Staffing levels must be reviewed to ensure there are sufficient hours to meet service users needs and to ensure the home is kept clean. 12/10/07 12. OP31 9 A person who is competent and 12/10/07 has appropriate skills, knowledge and experience must manage the home. The registered provider must ensure that the Annual Quality Assurance Assessment is completed and returned to the Commission for Social Care Inspection within specified timescales. Care staff must receive formal supervision at least six times a year. Supervision should include: •All aspects of practice. •Philosophy of care in the home. •Career development needs. The responsible individual must carry out monthly visits for the purpose of monitoring standards in the home. Opinions of service users should be sought and a report into the findings of the visit written and forwarded to the CSCI. A formal quality assurance system must be implemented ensuring the views of service users are taken into consideration. The results must be published as an annual development plan which should be made available to service users and the CSCI. Evidence that gas services are regularly maintained must be made available. DS0000061499.V345868.R01.S.doc 13 OP31 14 12/01/08 14 OP36 18 12/10/07 15 OP32 26 12/10/07 16. OP33 24 (1) (2) and (3) 12/01/08 17 OP38 23(2)(n) 12/01/08 Lime Tree House Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP12 Good Practice Recommendations Individual service users should be asked their choice about the types of hobbies, social activities and leisure interests they would like to engage in. Their care plan and the activities programme should reflect this. The laundry room should be reorganised so as to minimise the chances of clean and dirty laundry being mixed up, or alternatively plans made to extend/move the laundry to be more spacious. The induction programme for staff should be reviewed to make sure it provides staff with a good grounding and basis to becoming competent in their jobs. 2. OP26 3. OP30 Lime Tree House DS0000061499.V345868.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Lime Tree House DS0000061499.V345868.R01.S.doc Version 5.2 Page 30 - 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. 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