Inspection on 06/10/05 for Lime Tree Manor

This inspection was carried out on 6th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 Manor 25/06/07

Lime Tree Manor 10/04/06

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 Bijayraj Ramkhelawon Unannounced Inspection 6th October 2005 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.V254146.R01.S.doc Version 5.0 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.V254146.R01.S.doc Version 5.0 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 (110), 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.V254146.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th April 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 26 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 21 bedrooms and a rear unit of 26 bedrooms. The first floor consists of a front unit with 26 bedrooms and a rear unit of 26 bedrooms. The second floor consists of one unit of 11 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 DS0000019450.V254146.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Feedback received from service users, their relatives and visitors was positive. Standard of care and practices observed were good. However, staff must ensure that the privacy and dignity of service users are maintained at all times and must not enter their private rooms without first knocking on the door and waiting for response. They must also be aware that meals times must not be rushed or task orientated but to make this session as enjoyable as possible. Their approach must be discreet and sensitive when assisting service users at meal times. 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 registered 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? The home and its ground were well maintained. The general cleanliness of the kitchen area has improved and staff commented positively in relation to working as a team in achieving the aims and objectives of the home. There was a good feel about the home and this was also echoed by the service users, their relatives and visitors. Lime Tree Manor DS0000019450.V254146.R01.S.doc Version 5.0 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.V254146.R01.S.doc Version 5.0 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.V254146.R01.S.doc Version 5.0 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): 1-5 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 DS0000019450.V254146.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7-11 Service users health, personal and social needs are identified, planned for and delivered in an appropriate manner. Care plans were detailed and reviewed regularly to ensure that individual needs were met. However, an action plan must be devised to manage service users who exhibit challenging behaviour. The policies and procedures for the administration and management of medicines must be reinforced to ensure that safe practices are maintained. Privacy and dignity of service users must be respected at all times. EVIDENCE: Care plans inspected 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. However, it was noted that there was no strategy or action plan devised to manage service users who exhibit challenging behaviour. 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. Lime Tree Manor DS0000019450.V254146.R01.S.doc Version 5.0 Page 10 All service users are registered with a GP, who refers service users to all other health care agencies as and when required. 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. The records of medicines including the receipt, administration and management had major shortfalls whereby unidentified and labelled medicines were accepted on behalf of the service users. Some of the MAR sheets did not indicate correct dosage and frequency of medicines to be given but simply stated ‘as directed’. There were gaps and sticky labels used on MAR sheets. All service users were appropriately dressed and were correctly addressed by staff. The home has a “knock and wait” policy but it was noted that not all staff were adhering to it. 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 were in place for care of the dying. 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 DS0000019450.V254146.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 The home promotes autonomy and choice. Visitors are welcomed and the home promotes integration with the local community in accordance with service users preferences. However, staff must ensure they assist service users with their meal in a discreet and sensitive manner. They should also ensure they do not dish out service users meals too early (resulting in them being left to get cold). EVIDENCE: The home employs two activity co-ordinators who organise a variety of activities and entertainment. A weekly activity programme was devised and displayed on the notice board. On the day of the inspection coffee morning was held where relatives formed part of this session. Service users also 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. Lime Tree Manor DS0000019450.V254146.R01.S.doc Version 5.0 Page 12 Service users who are able to manage their own financial affairs do so with the help of their relatives. Staff on behalf of the service users managed their personal allowances. Personal belongings were evident in service users bedrooms. Confidential and private information was locked away and care plans were securely stored in an office on each floor. Service users have their relatives or social workers or solicitors as advocates. There were regular service users meeting held and minutes kept. The lunch was unhurried with assistance and encouragement given by staff. However, it was noted that were giving such assistance by standing up next to the service users and not sitting down as they had done previously. It was also noted that meals were dished out too early which had gone cold by the time staff had decided to assist feed. Unfortunately, these service users did not finish their meals. Tables were laid nicely and a choice of drinks was available and there was individual cutlery. In general, service users spoken to were complementary of the food provided. Lime Tree Manor DS0000019450.V254146.R01.S.doc Version 5.0 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 the following standard(s): 16-18 The home has a complaints procedure which all service users and visitors spoken to were aware. There were other policies and procedures, which ensured that service users were protected from abuse. EVIDENCE: A copy of the complaints procedure was 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. Complaints were dealt with satisfactorily in accordance of the home complaints procedure. Staff confirmed they had received training on adult abuse and were aware of the ‘Whistle Blowing Policy’. Lime Tree Manor DS0000019450.V254146.R01.S.doc Version 5.0 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 the following standard(s): The home and its surroundings offer a pleasant, comfortable and safe environment to its service users. However, a skip must be removed from outside a service user’s window and all equipment must be checked and serviced on a regular basis to ensure that these are in good working order. The home was kept clean and well maintained and bedrooms were 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. Lime Tree Manor DS0000019450.V254146.R01.S.doc Version 5.0 Page 15 However, it was noted that there was a skip placed just outside a service user’s window containing broken furniture. To make matters worse, the service user was told that these belonged to ex-service users who had passed away. It was also noted that the dates on the hoists had expired which indicated that the equipment were not checked and serviced on a regular basis. These checks must be carried out annually to ensure that the equipment were safe to use. 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 DS0000019450.V254146.R01.S.doc Version 5.0 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 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): 27-30 The skills and experience of staff were varied. There was an enthusiastic, dedicated and caring staff team. However, the majority of staff were from overseas and on short-term contracts. All training provided for staff must be certified and meet TOPSS requirements. 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 the majority of staff were from overseas and service users commented that they had difficulties in communicating with them and had to adjust to use simple language so that the staff could understand them. They also commented that by the time the staff had perfected their English language, they had to leave due to their short-term contracts which meant that there were a high turnover. Despite their comments in relation to the overseas staff, service users were complimentary about the staff in general, stating, “the carers are good, they look after us and are very kind”. 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. Lime Tree Manor DS0000019450.V254146.R01.S.doc Version 5.0 Page 17 Staff spoken to confirmed that they have received appropriate training. However, not all training provided was certified. These must meet TOPSS requirements. Lime Tree Manor DS0000019450.V254146.R01.S.doc Version 5.0 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): 31-38 The home has a good management structure and is 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. 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 were kept up to date and in good order. Each service user has a separate container and money is not pooled together. Lime Tree Manor DS0000019450.V254146.R01.S.doc Version 5.0 Page 19 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 were 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. Lime Tree Manor DS0000019450.V254146.R01.S.doc Version 5.0 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 1 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 1 3 3 2 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 Lime Tree Manor DS0000019450.V254146.R01.S.doc Version 5.0 Page 21 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 OP7 Regulation 15(1) Requirement The registered manager must ensure that an action plan is devised to manage service users who exhibit challenging behaviour. The registered manager must ensure that no medicines are accepted on behalf of the service users, which are not identified nor labelled. The registered manager must ensure that MAR sheets must indicate the correct dosage and frequency and not ‘as directed’. The registered manager must ensure that sticky labels are not used on MAR sheets. The registered manager must ensure that medicines are given as prescribed and the reasons for any omissions must be recorded. The registered manager must ensure that staff ‘knock and wait’ before entering service users bedrooms. The registered manager must ensure that staff assist service users with their meal in a DS0000019450.V254146.R01.S.doc Timescale for action 09/12/05 OP9 2 13(2) 25/11/05 OP9 3 OP9 4 OP9 5 13(2) 06/10/05 13(2) 13(2) 25/11/05 06/10/05 OP10 6 OP15 7 12(4)(a) 25/11/05 12(4)(a) 25/11/05 Lime Tree Manor Version 5.0 Page 22 OP19 8 OP22 9 10 OP30 23(2)(o) 23(2)(c) 18(1)(c) (i) discrete and sensitive manner. The registered manager must ensure that the skip placed next to the service user’s window must be removed. The registered manager must ensure that all equipment including hoists must be checked and serviced annually. The registered manager must ensure that all training are certified and meet TOPSS requirements. 18/11/05 25/11/05 09/12/05 Lime Tree Manor DS0000019450.V254146.R01.S.doc Version 5.0 Page 23 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 OP15 Good Practice Recommendations Staff should ensure that meals are not dished out too early. Lime Tree Manor DS0000019450.V254146.R01.S.doc Version 5.0 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.V254146.R01.S.doc Version 5.0 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!