Inspection on 13/04/05 for Lime Tree Manor

This inspection was carried out on 13th April 2005.

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 10/04/06

Lime Tree Manor 06/10/05

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 HP2 5JU Lead Inspector Bijayraj Ramkhelawon Unannounced 13 April 2005 10:30 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 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 Version 1.10 Page 3 SERVICE INFORMATION Name of service Lime Tree Manor Address 171 Adeyfield Road Adeyfield Hemel Hempstead HP2 5JU 01442 217 755 01442 263 040 Telephone number Fax number Email 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 Care Home 110 Category(ies) of OP Old Age - 110 registration, with number PD(E) Physical Disability - over 65 - 110 of places DE(E) Dementia - over 65 - 110 Lime Tree Manor Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: Service users with dementia are to be accommodated on the dementia unit on the first floor and shall not exceed 26 in numbers. Date of last inspection 19 10 04 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 24 of whom may also suffer from dementia. 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. The ground floor consists of a front unit with 24 bedrooms and a back unit of 26 bedrooms. The first floor consists of a dementia unit of 24 bedrooms and a back unit of 26 bedrooms. The second floor consists of one unit of 10 bedrooms. 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. Lime Tree Manor Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a positive unannounced inspection and feedback received from service users, their relatives and visitors was excellent and the standard of care and practices observed were high. The majority of time was spent talking to residents, visitors and staff. Some time was spent in the office scrutinising care plans, staff files and other records. Discussions were held with the deputy manager and the Operations Director to whom the feedback of the inspection was given. What the service does well: What has improved since the last inspection? Since the last unannounced inspection in October 2004, the home has met most the requirements and all the recommendations. A lot of time has been spent in purchasing individual containers to enable service users to keep their personal allowances separate and not pooled together. The staff team appear to be more coherent and working as a team in achieving the aims and objectives of the home. One service user spoken to said “that there is nothing wrong with the home” and others echoed her views. Lime Tree Manor Version 1.10 Page 6 What they could do better: The home should identify and eliminate the lingering odour in the lounge and corridors especially on the ground floor. It should also explore the possibility of extra ventilation in these secluded areas. The staffing levels should be assessed and appropriately rostered compliment the needs of service users on the middle floor at peak times. to Repair work as identified in this report should be carried out and monitored to ensure that these are attended to within reasonable length of time. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Lime Tree Manor Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Lime Tree Manor Version 1.10 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 standard(s) 1,2,3,4 and 5 Adequate information was available to prospective service users and their relatives to assist them in their decision making process when chosing the home. Each service user has a detailed assessment of needs carried out by the home prior to an offer of placement is made. EVIDENCE: The home has a written ‘Statement of Purpose and a Service User Guide’ and both documents were available to prospective and current service users and their relatives. These were also kept in the reception area where these were accessible to visitors as well. Service users and relatives spoken to confirmed that they were encouraged to visit the home prior to admission. There was evidence in the care plans scrutinised that a senior member of staff had carried out a pre-admission assessment of needs of the service users either in their homes or places of residence. It was also noted that each service user has received a ‘Terms and Conditions of Residency’ which contained the rights and obligations of the service user and registered provider. Good observations were made of staff’s approaches and attitudes to service users and to the appropriateness of their delivery of care. Lime Tree Manor Version 1.10 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10,11 Service users health, personal and social needs are identified, planned for and delivered in an appropriate and respectful manner. EVIDENCE: Twelve care plans were inspected. These were comprehensive and had all the information required by this Standard including assessment of needs, risk assessments and how the needs of the service users were being met. The care plans were reviewed regularly and signed by the service users or their relatives. There were three service users with pressure sores who receive regular input from the District Nurses. Each service user has a nutritional assessment on admission, which is reviewed, if needed, based upon monthly weight gain or loss. All service users are registered with a GP, who refers service users to all other health care agencies as and when required. Lime Tree Manor Version 1.10 Page 10 A log of visits from GP, District Nurses, Community Psychiatric Nurses and all other health care agents was maintained. Service users confirmed that GPs and District Nurses visit them as soon as there are any problems and when requested. On the in bed. service service day of the inspection one service user was very ill and being cared for Individual care practice observed was commendable. A relative of this user was spoken to and he was very complimentary of the staff and provision. Records of medicines including the receipt, storage, administration and disposal were kept in good order. However, the report required that written instructions made on the Medication Administration Record sheets (MAR) should be signed by the author. All service users were appropriately dressed and were correctly addressed by staff. The home has a “knock and wait” policy on entering service users’ bedrooms, toilets and bathrooms. Staff members on duty were observed to deliver care and to attend to service users’ needs in a manner that is conducive to respect for their privacy, dignity, choice and wishes whilst actively promoting independence where possible. All personal and intimate care practices are carried out behind closed doors. Doctors and District Nurses also see service users in the privacy of their own rooms. A policy and procedures are in place for care of the dying. On the day of the inspection, one service user was unwell and the relative spoken to was very complimentary of the staff and service provision. Staff members spoken to were aware of the needs of this particular service user and the action they should take in similar situation. Involvement of the family and friends were noted to be actively encouraged once a service user has been identified as a terminally ill. It was reported that service users are enabled to stay in the home during their last days and family can stay during this time. Lime Tree Manor Version 1.10 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 The home promotes autonomy and choice. Visitors are welcomed and the home promotes integration with the local community in accordance with service users preferences. EVIDENCE: The home employs two activity co-ordinators who organise a variety of activities and entertainment. On the day of the inspection there were various activities being provided including a religious service carried out by the local vicar. A number of visitors spoken to were very positive about the home, particularly the vicar. The home holds coffee mornings, inviting relatives. Service users attend coffee morning in the village hall and at the local church every week. A Holy Communion service is held in the home every month. Other prayer services are also held in the home on regular basis. The records were quite comprehensive, containing many various activities. An external entertainer visits the dementia unit on a weekly basis and the other units on a monthly basis. The hairdresser attends to service users weekly. The mobile library visits the home regularly. The home has the facility of a monthly budget for activities. Service users manage their own financial affairs with the help of their relatives. Personal belongings were evident in service users bedrooms. Lime Tree Manor Version 1.10 Page 12 Confidential and private information is locked away and care plans are securely stored in an office on each floor. Service users have their relatives or social workers or solicitors as advocates. There are regular service users meeting held and minutes kept. The lunch was unhurried with assistance and encouragement given by staff sitting down next to service users. Tables were laid nicely and a choice of drinks was available and there was individual cutlery. Service users spoken to were complementary of the food provided. Lime Tree Manor Version 1.10 Page 13 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 standard(s) 16, 17, 18 The home has a robust complaints procedure of which all service users and visitors spoken to were aware. The manager and the operations manager have a presence within the home thus safeguarding service users. EVIDENCE: A copy of the complaints procedure is available to prospective and current service users. Those spoken to said that they were aware of the complaints procedure but would prefer to speak to a member of staff or the manager if they had any concerns. Two complaints had been received since the last inspection. One was dealt with satisfactorily in accordance of the home complaints procedure and the other is ongoing until the complainant returned from holidays. Staff confirmed they had received training on adult abuse although one did not appear to be aware of the ‘Whistle Blowing Policy’. However, records showed that staff have been provided with the appropriate training including on POVA for which they have signed for. Lime Tree Manor Version 1.10 Page 14 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 standard(s) 19-26 The home and its surroundings offer a pleasant, comfortable and safe environment to its service users. The home was kept clean and well maintained and bedrooms are personalised offering a homely, lived in feel. EVIDENCE: The home is purpose-built and well planned with the aim of meeting all the National Minimum Standards. It is smart, functional and well maintained both internally and externally. The rooms have been pleasantly designed with fitted furniture offering a high degree of comfort. Rooms have locks fitted and service users can be issued with the keys if they wish. Service users’ bedrooms contained personal items and pictures have been hung at their request. It was noted that some broken chess of drawers required to be repaired and a lingering odour around the lounges and corridors. The home has a couple of nursing beds, which seem to suit the needs of the occupiers. All bedrooms bar one are carpeted. The only room with non-slip hard flooring was fitted as a result of one service user presenting persistent behavioural incontinence. However, it was noted that there was a lingering odour in the corridors and lounge especially on the ground floor. Lime Tree Manor Version 1.10 Page 15 The home has adequate number of domestic staff and records showed that all staff have been provided with training in hygiene and infection control. Lime Tree Manor Version 1.10 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27-30 The skills and experience of staff is varied. There was an enthusiastic, dedicated and caring staff team who took great pride in the service provision. EVIDENCE: There was adequate numbers of staff rostered on duty per shift during the day and night. There were also adequate number of domestic and catering staff allocated per day and the home has the services of a fulltime maintenance person and two activity co-ordinators. However, it was noted that staff in the middle floor were struggling to attend to the service users calls and staff spoken to stated that an extra staff during peak times would be helpful. Service users were complimentary about the staff and management of the home, stating “the carers are good, they look after us and are very kind”. Five staff files were inspected and found to have all the required documents including the references, CRB and POVA checks. Although the home in the past recruited many overseas staff, the Operations Director stated that recent adverts have had a positive response from the local applicants. Staff spoken to confirmed that they have received appropriate training. This included NVQ, moving and handling, food hygiene, first aid, dementia, adult abuse and other mandatory training. They also said that they receive regular supervision and an annual appraisal and they have been given a copy of the General Social Care Council Code of Conduct. Lime Tree Manor Version 1.10 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31-38 The home has a good management structure and well supported by the Operation Director and the Board of Director’s who also have their offices in this building. The senior staff who have direct involvement, appear to be dedicated to providing a good quality service. EVIDENCE: The manager and the Operations Director communicate a clear sense of leadership within the home and have an open-door policy where staff could see them at any time with any issues or concerns they may have. Pride and dedication is taken in every aspect. Service users and their relatives have commented positively on the good practices and quality of service provision. Evidence was seen that all financial expenditures for service users’ personal allowances are kept up to date and in good order. Each service user has a separate container and money is not pooled together. Lime Tree Manor Version 1.10 Page 18 A valid insurance certificate is displayed in the reception area and this offers cover of no less than £5 million. The home adopts the organisation’s employment policies and procedures and facilitates the induction and training programmes for staff. The home has developed and implemented a programme of formal supervision. All statutory records were available for inspection and maintained in accordance with legislation. Records inspected were up-to-date and accurate and were held securely. Staff spoken to were aware that service users can access their records and information held about them in accordance with the Data Protection Act 1998. The home has policies and procedures in place to ensure that the health, safety and welfare of service users and staff are promoted and protected. These records are accessible to all staff. All accidents and injuries are recorded in the accident book and RIDDOR forms have been completed where applicable. The CSCI has been kept informed of all accidents and admissions to hospital. Regular checks on hot water temperatures and moving and handling equipment are recorded. However, the report required that the home must keep the freezers defrosted and that regular fire drills must be carried out. It also recommended that risk assessment should be carried out for the service user who keeps a number of DIY tools in his bedroom and that the entrance door to the dementia unit should be repaired. Lime Tree Manor Version 1.10 Page 19 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 4 3 4 2 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 x 3 x 3 3 3 3 1 Lime Tree Manor Version 1.10 Page 20 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. Standard OP 26 OP 38 OP 38 Regulation 16 (2) (k) 23 (2) (c) 23 (4) (e) Requirement Lingering odour in the lounge and corridors must be identified and eliminated Freezers must be defrosted Fire drills must be carried out at a regular intervals. Timescale for action 03/12/04 03/12/04 03/06/05 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. 3. 4. 5. 6. Refer to Standard OP 24 OP 38 OP 9 OP 38 Good Practice Recommendations Broken chess of drawers in service users bedroom should be repaired. Risk assessment should be carried out for service user who keeps DIY tools in his bedroom. a)Hand written instructions on MAR sheets should be signed by the person making the entry. b) Medicines returned for disposal should be signed for each item. Entrance door to the dementia unit should be repaired. Lime Tree Manor Version 1.10 Page 21 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City Herts 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 Version 1.10 Page 22 - 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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