Inspection on 10/04/06 for Lime Tree Manor

This inspection was carried out on 10th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 Manor 25/06/07

Lime Tree Manor 06/10/05

Lime Tree Manor 13/04/05

Lime Tree Manor 19/10/04

Lime Tree Manor 27/04/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Lime Tree Manor 171 Adeyfield Road Adeyfield Hemel Hempstead Hertfordshire HP2 5JU Lead Inspector Jeffrey Orange Unannounced Inspection 10th April 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lime Tree Manor DS0000019450.V288689.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 Manor DS0000019450.V288689.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Lime Tree Manor Address 171 Adeyfield Road Adeyfield Hemel Hempstead Hertfordshire HP2 5JU 01442 217 755 01442 263 040 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) Wilton House Limited Siji Sebastian Care Home 110 Category(ies) of Dementia - over 65 years of age (26), Old age, registration, with number not falling within any other category (110), of places Physical disability over 65 years of age (110) Lime Tree Manor DS0000019450.V288689.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: There are none Date of last inspection 6th October 2005 Brief Description of the Service: Lime Tree Manor is a care home providing personal care and accommodation for 110 older people some of whom may have physical disabilities and up to 26 of whom may also suffer from dementia. Detailed information about the services offered, including the latest report by the Commission for Social Care Inspection can be obtained from the home on request. Fees for services range from £2080 to £2424 per month. Additional charges are made for newspapers, toiletries, chiropody and hairdressing services. This information was correct at 10.04.2006. The home is owned by Wilton House Limited and is situated on the Adeyfield Road, a residential area of Hemel Hempstead, within easy reach of shops and facilities with good public transport links. The home is arranged over three floors in five units. Each unit has dining and lounge facilities, kitchenettes and assisted bathrooms and toilets. All the home’s bedrooms are single accommodation with en-suite facilities. There is a passenger lift and the home has a reception area, benches to sit on at the front of the home and two enclosed garden areas to the rear accessible to residents. Parking is available to the front of the building. Lime Tree Manor DS0000019450.V288689.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report has been drawn up following a visit to the home by three inspectors and makes use of information provided by residents, relatives and staff and from looking at some of the home’s records. It also draws on any information received about the home since the last inspection in October 2005. It is expected that later this year a series of questionnaires will be sent out to a sample number of people involved with Lime Tree Manor, asking about their experience of the home. It is also hoped that it will be possible, with the agreement of residents, for inspectors to attend one of the home’s forums to meet residents and relatives. What the service does well: What has improved since the last inspection? The majority of requirements made following the previous inspection in October have been met. Training for staff in a number of key areas such as handling medication, has been improved and this should benefit residents in having a workforce that has the skills necessary to maintain a good standard of care practice for them. The home has improved the maintenance and service records for equipment provided in the home for the safety and support of residents, this increases confidence in the condition and safety of items like hoists and bath aids. Lime Tree Manor DS0000019450.V288689.R01.S.doc Version 5.1 Page 6 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 Manor DS0000019450.V288689.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 Manor DS0000019450.V288689.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): 3, 4 & 5 (Standard 6 does not apply to this home) Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. There is a good system of pre-admission assessment in place to ensure that the care needs of people who may want to move into the home are fully understood and can be fully met. Staff are provided with the necessary training and support to give them the knowledge and skills that they need to be able to meet the varied care needs of residents. The written material available to prospective residents and their relatives, together with opportunities to visit the home and discuss care needs with senior staff should enable those considering living in Lime Tree Manor to make a well informed decision about its ability to meet their needs. EVIDENCE: “My son looked around several homes, and thought this one was the best for me” was one comment made by a resident, and several relatives spoken to Lime Tree Manor DS0000019450.V288689.R01.S.doc Version 5.1 Page 9 confirmed that they had visited the home and received the basic information that they needed in order to make an informed decision about Lime Tree Manor and whether it was suitable. Care plans were examined and a robust and thorough assessment process was seen to be in place to ensure that only those people whose care needs could be appropriately met were admitted. Staff spoken to were very positive about the standard of training they receive, which includes for example specialist dementia care training and this was supported by those training records seen. Lime Tree Manor DS0000019450.V288689.R01.S.doc Version 5.1 Page 10 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, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The standard of care plans is good and the health care needs of residents are well understood, recorded and provided for. Less good are some aspects of medication recording and storage although improvements are acknowledged since the previous inspection. Some care practices seen suggest that care is not always given in a way that genuinely respects the dignity and respect of residents. EVIDENCE: Care plans were seen and specific care issues were followed up. Records were found to be accurate, comprehensive and well completed. Visiting health professionals were asked about their experience of Lime Tree Manor and were very positive about the assistance they receive and the standard of care they observe. Lime Tree Manor DS0000019450.V288689.R01.S.doc Version 5.1 Page 11 Some medication was being stored above recommended temperatures, which could affect its effectiveness. There were some medication records and controls that were not consistent or sufficiently robust although some progress has been made in improving the overall standard of medication practice. Staff do not always wait after knocking before entering residents’ rooms and were seen to interrupt private conversations to address routine care issues. Staff helping residents at meal times, by for example assisting them eat or transferring them to the dining room, did not always do so in a way that respected the residents’ dignity with appropriate communication throughout the process. Lime Tree Manor DS0000019450.V288689.R01.S.doc Version 5.1 Page 12 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): 12, 13, 14, & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The quality of the activities on offer is good and there are opportunities for residents to maintain their preferred religious observance, if that is their choice. The quality of the food is generally quite good although comments were again made about food being presented less hot than some residents would choose. There is an underlying sense of frustration and dissatisfaction amongst residents and their relatives with their ability to communicate easily and effectively with some staff and this adversely affects the residents’ overall experience of the home. If this could be addressed satisfactorily, the quality in this outcome area would be good. EVIDENCE: The great majority of residents spoken to were enthusiastic and complimentary about the range of activities available and were seen to be enjoying those on offer during this inspection visit, including making Easter baskets. Lime Tree Manor DS0000019450.V288689.R01.S.doc Version 5.1 Page 13 “By the time I get my food it is often only warm and I have to ask for it to be warmed up” was one comment made about the food, although in general comments were quite positive. Nearly all relatives and residents spoken to throughout this inspection expressed some degree of concern over language and comprehension problems with some of the home’s staff team. They also often spoke highly of the standard of care they received despite any communication problems. There is ample evidence of resident’s being able to bring personal possessions with them into Lime Tree Manor. Lime Tree Manor DS0000019450.V288689.R01.S.doc Version 5.1 Page 14 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 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The complaints policy and procedure together with staff training in the recognition of adult abuse and the correct response if it is suspected should provide confidence in this service for residents, their relatives and those who care for them. EVIDENCE: Induction training for all staff includes adult abuse issues and the appropriate action to take if it were suspected. The home has a robust complaints procedure and those residents and relatives spoken to during this inspection visit confirmed that they felt confident that any complaint or concern raised would be dealt with. Lime Tree Manor DS0000019450.V288689.R01.S.doc Version 5.1 Page 15 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, 20, 21, 24 & 26 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The premises are clean and comfortable, well furnished and maintained to provide a pleasant environment for residents. The number and location of communal areas and toilet facilities meet the needs of residents well. The various lounges provide a range of places where residents can be quiet, watch television, enjoy company or take part in activities as they choose to. EVIDENCE: Residents were seen to be making use of the various lounges available to them and many commented that they would use the garden when the weather improved. Lime Tree Manor DS0000019450.V288689.R01.S.doc Version 5.1 Page 16 Bedrooms, seen with the permission of residents, were personalised and reflected the interests, taste and life history of the residents to whom they belonged. Although communal bathroom and toilet facilities were in general clean and well presented, one residents’ toilet had neither soap nor towels. Lime Tree Manor DS0000019450.V288689.R01.S.doc Version 5.1 Page 17 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): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. There are sufficient care staff, administrative support staff and management, with the necessary skills, training and support, to provide adequately for the well being of residents during the daytime. This is however not seen to be the case during the night-time, where the standard of care practice during the evening and night is thought by residents to be inferior to that they experience during the day. Recruitment and training practice is good, which should provide residents and their relatives with confidence that they are protected by the home’s policies and procedures in this respect. EVIDENCE: Residents and their relatives spoken to expressed concerns about the standard of care at night. “Day staff are much better than the ones we have at night”. Unacceptable delays in responding to call-bells during the night were mentioned by several residents, with distressing results for some. “I dread the night time”, said one resident. Recruitment and training records were examined and found to be robust and comprehensive, with a good range of accredited training, including training for caring for people with dementia. Lime Tree Manor DS0000019450.V288689.R01.S.doc Version 5.1 Page 18 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 * 38 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The manager and operations manager for Wilton House Limited work together to provide for the efficient and effective management and administration of Lime Tree Manor, which benefits residents, staff and those associated with the home. EVIDENCE: The registered manager holds the Registered Manager Award and is undertaking an advanced NVQ qualification at level 5. Quality assurance, health and safety and supervision records were seen and were satisfactory. Lime Tree Manor DS0000019450.V288689.R01.S.doc Version 5.1 Page 19 Previous requirements in respect of health and safety issues have been met. The manager was positive in her response to issues raised with her during this inspection visit and had already begun to address some of them before it ended. Residents and relatives were in general very supportive of the home and the way that it was run. “We are looked after very well” was one typical comment. Lime Tree Manor DS0000019450.V288689.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 2 X X 3 X 3 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Lime Tree Manor DS0000019450.V288689.R01.S.doc Version 5.1 Page 21 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 OP9 Regulation 13(2) Requirement Timescale for action 10/04/06 2 OP9 13(2) 3. OP10 12(4) The storage temperature of medication must be within the recommended range for it in every case. There must be no contradiction 10/04/06 between instructions for the administration of medication in respect of form FP10, the medication administration record and the label on medication. The registered manager must 10/04/06 ensure that staff ‘knock and wait’ before entering service users bedrooms. This requirement is carried over from the previous inspection and action must now be taken to meet it. The registered manager must 31/07/06 address concerns that have been raised over communication between staff and residents and take action if necessary to ensure that residents’ experience of living in the home is not adversely affected by an inability to communicate satisfactorily with staff. DS0000019450.V288689.R01.S.doc Version 5.1 4. OP12 12(2)&(3) Lime Tree Manor Page 22 5. OP15 12(4) The registered manager must ensure that staff assist service users with their meals in a discrete and sensitive manner. This requirement is carried over from the previous inspection and action must now be taken to meet it. All residents’ toilet facilities must have suitable soap and handdrying provision. In order that that the care needs of all residents are met at all times, the registered manager must take steps to ensure that the good standard of care experienced during the daytime does not deteriorate during the evening and night. 10/04/06 6 7 OP21 OP27 13(3) 18(1)(a) 10/04/06 10/04/06 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 OP9 Good Practice Recommendations The Registered Manager should seek advice from the home’s pharmacy on the storage temperature of Lactulose and whether alternative formulations or products are available with a higher permitted storage temperature than that currently specified. This should then be discussed with the general practitioner prescribing the medication. Staff should ensure that meals are always served at an appropriate temperature in line with the preferences of residents. The registered manager should consider facilitating additional language skills training for any members of staff for whom there is a need to enhance their ability to communicate adequately with residents. The registered manager should consider the introduction DS0000019450.V288689.R01.S.doc Version 5.1 Page 23 2. OP15 3 OP27 4 OP21 Lime Tree Manor 5 OP27 of softer paper towels for residents use, rather than those currently provided, in line with good practice guidance from the infection control service for Hertfordshire. The registered manager might consider the use of the existing “Home Visits By Manager” form, which appears in some care plans, to monitor night care in the home. Lime Tree Manor DS0000019450.V288689.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ 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 Manor DS0000019450.V288689.R01.S.doc Version 5.1 Page 25 - 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. 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