Inspection on 09/01/09 for Lime Tree House

This inspection was carried out on 9th January 2009.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Lime Tree House 16/07/08

Lime Tree House 14/02/08

Lime Tree House 04/09/07

Lime Tree House 12/10/06

Lime Tree House 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 19/06/2009.

CARE HOMES FOR OLDER PEOPLE Lime Tree House Chantry Green, Main Street Upper Poppleton York YO26 6DL Lead Inspector Stevie Allerton Key Unannounced Inspection 9th January 2009 09:50 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.V373796.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.V373796.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 Dinka.rch@gmail.com Roseville Care Home Ltd Manager 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.V373796.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th July 2008 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. 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 £415 to £515 per week. Lime Tree House DS0000061499.V373796.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was carried out by one inspector over the course of a day. The home last had a full inspection in July 2008 and a random inspection was carried out in September, specifically to look at staffing levels. Before this visit, we looked at the information we already had about the home. This included looking at any notified incidents or accidents, the improvement plan that had been submitted by the provider after the last inspection, and other information passed to CSCI. We looked at written records, looked round the house and spoke to the staff and visitors as well as the people living there. Four people were case tracked, and other files were looked at. Case tracking is how we decide if people receive good quality care that meets their individual needs. Where appropriate, issues relating to the cultural and diverse needs of residents and staff were considered. Using this method, all twenty-one key standards from the Care Homes for Older People National Minimum Standards, plus other standards relevant to the visit, were able to be assessed. We found that a lot of improvements had been made and that more of the key standards were being met, with the result that people were receiving a better service. What the service does well: People feel they are well looked after by the staff and are treated with respect. Relationships between people and the carers looking after them are warm and friendly. People said, the staff are very good and look after me well, and this home has a lovely atmosphere. A relative said, I value how the staff have always allowed my mother to do her own thing and remain an individual. The home is ideally situated in the centre of the village, and there is a lot of community input, from relatives, friends, and former neighbours. The new care plans are much more person-centred, individual to each person and identifying all of the areas where someone may need assistance. There was good evidence in the care plans of how the staff promote independence in Lime Tree House DS0000061499.V373796.R01.S.doc Version 5.2 Page 6 self-care, and try to maintain peoples dignity. There is also a specific care plan for the control of pain, where needed, which is good practice. What has improved since the last inspection? What they could do better: The revised Statement of Purpose should reflect the facilities and services actually provided by the home. There is currently a risk that new people admitted could be disappointed with the standard of service provided, as it is not yet as described in the Statement of Purpose. Care staff do not use the care plans to guide them on a daily basis and rely on the verbal passing-on of information from senior staff if someones needs have changed. This could mean that things get missed and peoples needs are not fully met. People have their social and recreational needs identified, but unless they are able to fulfil these themselves, staff still have little opportunity to contribute to meeting these needs. This means that those who rely on staff as a source of social contact and activity are not having their needs fully met. A key worker system, whereby each person living at the home has a named member of staff who co-ordinates aspects of their care, would be of benefit to those who live there. The key workers could identify where peoples bedrooms need attention and request that redecoration happens as part of a rolling programme. Lime Tree House DS0000061499.V373796.R01.S.doc Version 5.2 Page 7 Kitchen hygiene records require greater attention, to provide evidence that food temperature control, etc, is being undertaken. Staff could receive a greater depth of training, once the basic required courses have been completed, to achieve more National Vocational Qualifications (NVQs). 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.V373796.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.V373796.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): People who use the service experience adequate quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service. People have their needs thoroughly assessed and have opportunities to visit and assess the suitability of the home prior to coming to live there. However, there is a risk that new people admitted could be disappointed with the standard of service provided, as it is not yet as described in the Statement of Purpose. EVIDENCE: We were provided with a copy of the new Statement of Purpose, which is an ambitious document. It covers all of the areas required by the standards, however, the service is not currently providing training as described under the Staffing heading, or the level of activities described under the Social Activities and Hobbies heading; there was also no evidence that bi-monthly staff and residents meetings take place as described under the Quality Assurance heading. Lime Tree House DS0000061499.V373796.R01.S.doc Version 5.2 Page 10 We spoke to some relatives, who confirmed that their mother had come for visits prior to being admitted, stayed for a meal, etc. They chose this home because of its homely atmosphere and the fact that it wasnt too big. They were happy because it suited their mother. We case tracked a person who was recently admitted, three months ago. In conversation with her she pointed out that it had been a positive choice on her part to come to live at Lime Tree House, and that helped her to accept and adjust to her new circumstances. She had undergone full assessment (assessments and care plans are based on the Activities of Daily Living model) and signed her own care plan. A copy of the contract was present in her file. Lime Tree House DS0000061499.V373796.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): People who use the service experience adequate quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service. People have their personal & health care needs assessed and set out in a care plan, which is individual to them. This should mean that staff know at all times how to meet someones needs. However, care staff do not use the care plans to guide them on a daily basis and rely on the verbal passing-on of information from senior staff if someones needs have changed. This could mean that things get missed and peoples needs are not fully met. EVIDENCE: The designated manager was seen giving medication at lunchtime. Some good practice was seen regarding the security and safety of medication. The medication records were looked at and they gave no rise for concern. Following the inspection, an incident occurred where a staff member made a serious error with Warfarin. Appropriate action was taken by senior staff. We case tracked four people with a range of needs. Their care plans & records were looked at and they were spoken to about their care, where possible. Staff were also spoken to regarding the delivery of care. Lime Tree House DS0000061499.V373796.R01.S.doc Version 5.2 Page 12 Where people are highly dependent on staff for all their care needs, all of the equipment required to be in place as detailed in the care plans was in situ, for example, a hoist, profiling bed, bed rails & bumpers (including a risk assessment for bed rails). One person said that he didnt like being at Lime Tree House, feeling that the decision has been taken out of his hands by his family, and that affected his view of the care and services provided. Care plans identify where men would prefer a male carer for assistance with personal care, but there arent any on the staff team. However, there was good evidence in the care plans of how the staff promote independence in self-care, and try to maintain peoples dignity. Care plans showed that people were being supported to attend hospital for appointments and tests. There was evidence that people sign their own care plans where they are able. One ladys care plan highlighted that she was at risk of falls due to her visual impairment. There was a risk assessment for falls, for mobility and for pressure care. It was clear that she had an active Methodist faith. There was also a specific care plan for the control of pain, which is good practice. She felt that the staff looked after her very well and were good at meeting her needs. One person said that she had good support from the staff when she needed it, but was mostly self-caring. It was evident that all of the care plans, based on Roper, Logan & Tierneys Activities of Daily Living, were tailored to each person, to reflect their assessed needs. The care plans were much more person-centred than the previous models used. The designated manager was seen during the inspection to be very hands-on and visible to the people in the home. She showed a good level of communication skills with one person with dementia who was worried, taking time to sit and talk with her. One lady was in hospital and volunteer drivers from Red Cross had been organised, to ensure that she had regular visits from her sister, who also lives at the home. This was reflected in the care records. We spoke to the staff about care delivery. The Statement of Purpose says that there is a key worker system in place. However, staff said that this was not yet the case, although it is being discussed. They do not really use the care plans yet – all assessment and developing of the plans is being done by senior staff. Staff are informed verbally and by use of the daily notes, during shift handover, of any changes to peoples health & well-being and subsequent changes to the plan of care. Lime Tree House DS0000061499.V373796.R01.S.doc Version 5.2 Page 13 There was an outbreak of gastric upset at the time of inspection, that began at the home the previous evening, 6 people being affected by morning. Infection Control at the Health Authority had been notified and staff had put all of the recommended measures in place. Those who were affected were being looked after in their rooms, to prevent possible cross-infection, and good hygiene practice was seen. No further cases were reported during the course of the day and the staff were hopeful that it had been isolated. Relatives of two people were spoken to. One said they were very happy with the care provided, the staff were very caring and their mother liked them. Any suggestions they make to the home about their mothers care are acted upon. Another person said they valued how the staff have always allowed their mother to do her own thing and remain an individual. She has dementia now, but they are happy to continue looking after her and the family are happy with that. Their mother had always been well-fed, clean and well, despite past shortages of staff. Lime Tree House DS0000061499.V373796.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): People who use the service experience adequate quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service. People have their nutritional needs met and are able to have choices in what they eat. People have their social and recreational needs identified, but unless they are able to fulfil these themselves, staff still have little opportunity to contribute to meeting these needs. This means that those who rely on staff as a source of social contact and activity, are not having their needs fully met. EVIDENCE: Some people are able to go out on their own and use the local facilities in the village. A lot of people are from the local area & have kept up their social contacts. Two of the people case tracked have an active Methodist faith and are able to attend church, as friends will collect & escort them. One lady also still attends W.I. meetings. One person had a birthday on the day of the site visit. The chef had made a cake for tea and there was a card & gift from the home. Birthdays are always celebrated. The Statement of Purpose states that social activities & hobbies will be supported. Activities are recorded in the daily notes. There were some Lime Tree House DS0000061499.V373796.R01.S.doc Version 5.2 Page 15 organised activities over the Christmas period, carol singers and a party, for example, but not much since then. There is no-one designated to lead activities. Many people spoken to were able to direct their own level of social activity, or have family that provide social opportunities. For those unable to do this, eg, if they have dementia or are very frail, staff acknowledged that they were not able to provide much in the way of activities, either in or outside the home, other than giving some one to one time during manicures, etc. Two of the people case tracked said that there was not much to do; one said if it wasnt for outside visitors she would not be able to get out at all. One suggested that the occasional quiz would be good. One relative said that the residents had not been able to get out over the past year, due to lack of staff. During the visit, a local historian called in to the home to arrange to give a presentation about the history of the village, illustrated with old photographs. People were asked if there were residents meetings. One person said that they did have them sometimes but they felt they werent much use. Records show that the last one had been over six months ago, although the new Statement of Purpose states that they are held every two months. The lunch time meal was fish & chips or steamed fish, which was well presented and looked appetising. We were provided with 4 weeks menus, which showed quite a good range of choices. One man called in the Managers office after tea to complain that it had been a poor birthday tea (assorted sandwiches plus the birthday cake) and that people expected to have pork pies & sausage rolls as well. The provider explained that they had felt that wasnt a good idea given the current gastric upset. People varied in their opinion of the food – some said that it had improved, particularly desserts, others said they hadnt noticed any improvement at all. The dining-room tables were set nicely, and numbered. Staff now serve different numbered tables in rotation first, which people said was much fairer. The days menu was displayed on the chalkboard in the dining-room. Lime Tree House DS0000061499.V373796.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): People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service. People are confident that their concerns will be listened to. Peoples money is looked after safely, if they cannot manage this themselves. The training that staff are about to receive will raise their awareness of adult protection issues and give people greater protection from abuse EVIDENCE: The complaints policy is referred to in the new Statement of Purpose. This was seen on display in the hallway. Some relatives were asked whether they felt the procedure was usable, and they said they had no problem about raising any concerns with the staff and had confidence that the issues would be resolved. Records showed that minor problems were being recorded along with the action taken to deal with them, which is good practice. Staff were asked if they had had any training yet in the protection of vulnerable adults (POVA). They had not, but thought that there was some coming up soon. The manager later provided information on the planned training programme for February and March, which showed that POVA training would be held on 6 February. There is a system for looking after the personal allowance for people who cannot do this themselves. This was looked at for three people, good records were in place and each persons money is kept separately. Lime Tree House DS0000061499.V373796.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service. The premises reflect the aims set out in the Statement of Purpose. People live in a comfortable and pleasing environment with their own possessions around them. The home is clean, hygienic and safely maintained, although some areas do need redecorating. EVIDENCE: A tour of the premises was carried out. A new floor covering has been fitted in the ground floor bathroom because the previous floor constituted a slip hazard when wet. Six bedrooms were seen. Mobility and handling equipment needed for certain people were in place. Handling belts have been purchased and staff had recently had instruction on how to use them. The provider supplied us with dates for staff training in February and March, which include Manual Handling, Health and Safety and Food Hygiene. Lime Tree House DS0000061499.V373796.R01.S.doc Version 5.2 Page 18 Bedrooms are individual in character, and personalised by the occupants. However, one person asked how often the rooms are decorated, as she had been there for six years and hers had never been done. She was unable to see this herself due to visual impairment, but her family regularly commented that the room was looking shabby. This query was passed to the provider. An inspection of the laundry showed that appropriate bags were in use for soiled linen, and good hygiene practices were in place. Protective aprons and gloves, paper towels, soap and hand gel were in strategic places around the home and easy for staff to access. The provider was full of praise for the staff, who had put all hygiene precautions in place as soon as the gastric outbreak started, even prior to informing the Health Authority. The kitchen was in a reasonably clean condition. A new kitchen assistant had been recruited and was undergoing induction on the day of inspection. Part of her role will be to clean the kitchen. The kitchen was rather dark as only one light was working. The provider said that this was in hand and a new light fitting had been ordered. Maintenance records were accessible and showed that mechanical and electrical systems in the home are being checked. Lime Tree House DS0000061499.V373796.R01.S.doc Version 5.2 Page 19 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): People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service. Significant efforts have been made to ensure that staff are a well-trained team, which will improve the quality of care given to people. This needs to be ongoing and include more people to achieve National Vocational Qualifications (NVQ) targets. Recruitment practices are good, and demonstrate that people are properly checked for their suitability to work in the care setting. EVIDENCE: On the day of inspection, the provider was on duty together with the designated manager and another 2 care staff. There should have been three care staff but one was sick. The rotas showed that the home generally aims to have four staff on the morning shift, and three during the afternoon and evening, two at night. Relatives and people who live in the home were spoken to about staffing levels and asked if they had noticed a difference in the last few months. All except one person said that, although they hadnt really noticed much effect on basic care, which had always been good, they thought the staffing had got better. What they had noticed was the lack of social activities while staffing was short. One person said they felt that it had been very unsettled over the past year, a dreadful upheaval with so many staff changes. They thought it was settling Lime Tree House DS0000061499.V373796.R01.S.doc Version 5.2 Page 20 down now. Another person felt the staff looked after her very well and she was quite happy with the care they provided. Relatives said that they thought staff were very good, very caring and felt happy about raising any concerns about their relatives care with them. One relative said that they had also felt personally well supported by the staff. The provider expressed a view that she has a good core of staff that provide some stability to the team, and some very good carers. She thought that she could see some staff developing their practice through supervision and were now taking pride in their work. Three staff files were looked at: a newly recruited care assistant, the new manager, and the newly recruited handyman who has not yet started work. All the files contained the correct documentation and were well organised. The care assistants induction record showed that this started mid-December and she was having fire training today. She was spoken to, and confirmed that she had had induction training, during which she had read the care plans. Another care assistant was spoken to, who had been working there for seven months. She felt that the home was much better organised now with the new manager. She enjoyed working here. She said that she hadnt read any care plans because there was no time to do this. She relies on information from the senior on duty at handover, regarding any changes to peoples care. A training matrix has been developed and was on display on the office wall -this highlights large gaps in training. This was discussed with the provider, who acknowledged the need to organise first aid, dementia care and POVA training. Some training had already been planned to take place during January and February between staff at Lime Tree House and another service owned by the provider. Following the site visit this was confirmed in writing, stating that the following training has been organised: Fire Training, Medication Training, POVA, Infection-Control, Health and Safety, Manual Handling, Dementia Awareness, Challenging Behaviour, and Food Hygiene. Lime Tree House DS0000061499.V373796.R01.S.doc Version 5.2 Page 21 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): People who use the service experience adequate quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service. Day-to-day operations of the home have improved, and the home is run in the best interests of people who live there. People are generally safeguarded by the record-keeping and written policies and guidance in place, although some areas for improvement in record-keeping were identified. Staff also need guidance in the new policies that have been put in place. Peoples health, safety and welfare are promoted and protected. EVIDENCE: We looked at the following documents and records: Statement of Purpose, Care Plans and Daily Records, Accident Records, Menus, Medication Records, Policies and Procedures, Complaints Records, Maintenance Records, Fire Records, Staff Files, Training Records, Staff Rotas and Service Users Financial Lime Tree House DS0000061499.V373796.R01.S.doc Version 5.2 Page 22 Records. They were generally in much better order than had been found in previous inspections. Two areas were not quite up to standard: • Fire records showed that call points were being tested in rotation throughout the home, however these tests had not been dated and it was difficult to establish whether they had been carried out on a weekly basis as required. • The chefs file that contains menus, records of fridge temperatures and kitchen cleaning schedules was in disarray, and it was impossible to establish whether food hygiene regulations were being met. Three peoples financial records were looked at. They showed a simple accounting procedure, monies were kept separately in a locked cupboard and peoples rights and best interests were being met. The provider is aware of the requirements of notifying the Commission under Regulation 37 of particular incidents. The regulation 37 notification was given to us on the day regarding the outbreak of gastroenteritis. Regulation 26 visits have now been instigated and the reports show that they look at a different set of standards each time. Management on-call arrangements appear to be improved. Some quality assurance questionnaires have been sent out, and were only just starting to arrive back, so no conclusions could yet be drawn from these. The provider said that they had had a Health and Safety inspector in regarding the bathroom floor and the hoists, and had acted on their recommendations. Environmental Health had also been and revisited the kitchen. The newly recruited handyman is a fire officer and it is hoped that he will take on the lead for fire safety in the home. The management consultants had been at the home on a daily basis until midDecember, and were now retained on a consultancy basis. The provider feels that the home has turned a corner. The new manager has a background in dementia care and is on three months trial. The provider said that they were currently priority-setting for the coming months. Lime Tree House DS0000061499.V373796.R01.S.doc Version 5.2 Page 23 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 2 X 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 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 3 17 X 18 3 3 X X 3 X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X 2 2 Lime Tree House DS0000061499.V373796.R01.S.doc Version 5.2 Page 24 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 OP1 Regulation 4 Requirement The provider must ensure that the revised Statement of Purpose reflects the actual service provided by the home. There is a risk that new people admitted could be disappointed with the standard of service provided, as it is not yet as described in the Statement of Purpose. 2 OP7 12 The provider must ensure that staff are provided with guidance on how to use the care plans on a daily basis. This is so that they become a useable document outlining the care needs for each person and that staff understand what is required of them. 3 OP12 16 The provider must provide better opportunities for people to engage in social activities and interests, so that they may lead fulfilling lives. 09/07/09 09/04/09 Timescale for action 09/04/09 Lime Tree House DS0000061499.V373796.R01.S.doc Version 5.2 Page 25 4 OP38 17 The provider must ensure safe working practices, with accurate records kept, in particular for fire safety and kitchen hygiene. This is so that peoples health, safety and welfare are promoted and protected. 09/04/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP19 OP28 Good Practice Recommendations Some bedrooms have not been decorated for some years and would be improved by redecoration. There should be a minimum ratio of 50 NVQ trained members of care staff (excluding the Manager). This is so that people are looked after by staff that have had more than a basic level of training. 3 OP30 The staff would benefit from extended induction training that follows Skills for Care standards, as well as ongoing refresher training in the basic subjects. The registered provider should make arrangements to have a Registered Manager in place. This is so that the home can be properly managed by a person with the right skills, and achieve some stability for the people living there. 3 OP31 Lime Tree House DS0000061499.V373796.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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.V373796.R01.S.doc Version 5.2 Page 27 - 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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