Inspection on 18/04/08 for Lime Trees

This inspection was carried out on 18th April 2008.

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 Trees 19/04/07

Lime Trees 01/03/06

Lime Trees 18/11/05

Lime Trees 16/03/05

Lime Trees 03/09/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOMES FOR OLDER PEOPLE Lime Trees Harwich Road Sparrows Corner Little Oakley Essex CO12 5AD Lead Inspector Ray Finney Unannounced Inspection 18th April 2008 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 Trees DS0000035818.V362721.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 Trees DS0000035818.V362721.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lime Trees Address Harwich Road Sparrows Corner Little Oakley Essex CO12 5AD 01255 880281 01255 886374 lindadurrant1963@aol.com 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) James Barry Moor James Barry Moor Care Home 6 Category(ies) of Dementia (6), Learning disability (6), Learning registration, with number disability over 65 years of age (6), Physical of places disability (6), Physical disability over 65 years of age (6) Lime Trees DS0000035818.V362721.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home accommodates six people with learning disabilities who may also have physical disabilities 19th April 2007 Date of last inspection Brief Description of the Service: Lime Trees is a large detached bungalow situated in the small village of Little Oakley on the outskirts of Harwich. There are parking facilities to the front of the bungalow and extensive gardens to the rear. The property has been adapted to accommodate six adults with learning disabilities, who may also have physical disabilities. Individual bedrooms are spacious and all have en-suite bathrooms. The communal lounge and the dining room are spacious, homely and well furnished. The service supports people to live in an ordinary home environment that reflects their individual needs. Lime Trees has its own mini bus that is accessible to people who require the use of a wheelchair. The home charges approximately £1,000.00 a week for the service they provide. There are additional charges for chiropody and leisure activities such as the ‘music man’ who visits the home. This information was given to us in April 2008. Information about the home can be obtained by contacting the manager. Inspection reports are available from the home and from the CSCI website www.csci.org.uk Lime Trees DS0000035818.V362721.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. A range of evidence was looked at when compiling this report. Documentary evidence was examined, such as menus, staff rotas, care plans and staff files. An Annual Quality Assurance Assessment (AQAA) with information about the home was completed by the manager. Throughout the report this document will be referred to as the AQAA. A visit to the home took place on 18th April 2008 and included a tour of the premises, discussions with the manager, deputy manager and members of staff. Further information was supplied by the manager by telephone on 2nd May 2008. We spoke with some of the people living in the home. However, people at Lime Tress have complex needs and some are unable to communicate verbally, although we were able to have some communication based around facial expressions and gestures. Observations of how members of staff interact and communicate with people living there have also been taken into account. On the day of the inspection the atmosphere in the home was relaxed and the inspector was given every assistance from the manager and the staff team. What the service does well: Lime Trees provides a service that recognises the individuality of people who live there. Staff are able to provide support for people in a way that meets their complex needs. The personal and healthcare needs of people living in the home are met and relevant healthcare professionals are consulted where appropriate. Lime Trees provides a comfortable, homely environment for people. Throughout the home the furnishings are of a high standard and bedrooms that are decorated to reflect individual tastes. Each individual bedroom has it’s own en-suite bathroom and the rooms are bright, spacious and clean. Visitors are made welcome and people are encouraged to maintain contact with families and friends. The registered manager, Mr James Moor, demonstrates a commitment to delivering a high quality service. Lime Trees DS0000035818.V362721.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Lime Trees DS0000035818.V362721.R01.S.doc Version 5.2 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 Trees DS0000035818.V362721.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People choosing to live at Lime Trees can expect to have their needs assessed before admission and information about the service will be made available in a format appropriate to their needs. EVIDENCE: The deputy manager said that the Statement of Purpose had been updated and she was looking at updating the Service User Guide, although she couldn’t put her hand to the documents. At the time of the inspection the deputy manager said the Statement of Purpose and Service User Guide were not available in alternative formats such as large print, pictorial or recorded, which would be appropriate for people with learning disabilities or elderly needs. However, a subsequent discussion with the manager confirmed that there is an electronic version of the Service User Guide on the computer that can be made available if required. The AQAA states, “Lime Trees provides a well informed & Lime Trees DS0000035818.V362721.R01.S.doc Version 5.2 Page 9 responsible pre-admission process” and “ensures it is suitable to meet the needs of all individual Clients”. All the people living in Lime Trees have been there since the home opened, there have been no new admissions. The deputy manager was able to demonstrate an awareness of the transition process when people moved in. As previously reported, the people living at Lime Trees moved in under the reprovision programme from NHS long stay hospitals, as part of the ‘Better Lives’ programme. The transition process was well planned and appropriate preadmission assessments were carried out that identified people’s physical, social and emotional needs. National Minimum Standard 6 does not apply, as Lime Trees does not offer intermediate care. Lime Trees DS0000035818.V362721.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall, people can be confident that their personal and healthcare needs will be met in Lime Trees, although more robust processes around medication are needed if people are to be kept safe. EVIDENCE: On the day of the inspection a sample of three care plans were examined. There were risk assessments and management plans in place around mobility, household safety, choking, abuse or exploitation from others, road safety, selfcare and epilepsy. There was a manual handling assessment in each. One member of staff said that they were consulted when the manager was compiling care plans. Care plans contain sufficient information about people’s needs to guide staff so that people can receive the care they need. Staff spoken with were able to demonstrate a good awareness of people’s needs. People living in the home were unable to express opinions about the care they receive, but our observations confirm that people were relaxed and appeared happy in their interactions with staff providing their care. Lime Trees DS0000035818.V362721.R01.S.doc Version 5.2 Page 11 Health records examined included a record of falls and recording of weight, although this had not been completed for a number of months for one person. There is evidence of input from a range of healthcare professionals including chiropodist, dietician, district nursing services, doctor, continence advisor and hospital appointments. People living in Lime Trees may be confident that they will receive input from relevant healthcare professionals according to their healthcare needs. The deputy manager was able to demonstrate a good knowledge of the health needs of people living in Lime Trees and the support that they require. One member of staff who completed a survey said that what the service does well is, “supporting individual’s health and well-being”. The AQAA states, “Staff are fully trained to provide a high standard of care and support relating to all areas of the Client’s individual needs” and “Training relating to specific needs of individuals i.e. Dementia, Diabetes” is provided. Staff records examined confirm that staff training is in place around health issues. Care plans contain a record of people’s prescribed medication, including medication that is prescribed to be taken on a ‘PRN’ (when necessary) basis. There are details of what the medication has been prescribed for and side effects to look out for. The storage and administration of medication was examined. Storage of medication is in individual cupboards in people’s bedrooms, which are securely locked and attached to wall. Cupboards are small and, although large enough to accommodate the monitored dose packs, there did not appear to be sufficient space for all medications. Bottles of liquid medication were seen in two rooms sitting on top of the cupboards. This is a potential risk to people living in the home. One person was observed to spend most of their time walking around the home and staff spoken with confirmed that this is normal behaviour for that person. It would not be possible or necessary for members of staff follow this person around the home at all times, therefore medication left out of securely locked cupboards poses a risk. We discussed obtaining Royal Pharmaceutical Society of Great Britain (RPSGB) guidelines for dealing with medications in care homes with the manager so that staff have guidelines to refer to around appropriate handling of medication. Medicines Administration Record (MAR) sheets were kept individually in medication cupboards and those examined were appropriately completed. We observed that people were treated with respect. On a tour of the premises the manager knocked on doors before entering individual rooms. The complex needs and communication difficulties of people living in the home meant they were unable to answer questions, but we could see from the way people responded to staff that people were relaxed and comfortable with they way they were being supported. Lime Trees DS0000035818.V362721.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall, people living in Lime Trees have opportunities to maintain a lifestyle that meets their needs and wishes. EVIDENCE: Each person’s Care Plan contains an individual activity plan. A sample of three files examined contained details of what people like to do. Activities recorded in the activity plans include armchair exercises, books, puzzles, having nails done, musical bingo and playing cards. There is a chart to monitor in-house activities on a daily basis and staff write comments about the activity and if the person enjoyed it. There are photographs and evidence about a boat trip on the Norfolk Broads that people enjoyed in the autumn of last year. Community activities such as 10 pin bowling or shopping and coffee are also recorded. The ‘music man’ comes in weekly to play music with people. The AQAA states “Lime Trees offers opportunities and provides Clients with the facilities and means to experience a fulfilled life style, taking into consideration the Client’s abilities & disabilities both in and out of the Home” and “Lime Trees has purchased items which can enhance individual lifestyles, such as Sensory Lime Trees DS0000035818.V362721.R01.S.doc Version 5.2 Page 13 equipment, items beneficial for the Blind, Group Activities & a professional ‘Arm-chair Exercise Programme’”. The deputy manager said that they support people to keep in touch with relatives. The AQAA states, “The Home recognises that Family contact & input are important & we encourage them to attend a Client’s Care review and the team make every effort to make them welcome”, which is confirmed in records examined. Individual files contain copies of letters written to relatives, telling them about Christmas celebrations, life in Lime Trees or thank you letters for Easter presents. If they have the ability the person has signed the letters. Records also show that staff help people keep in touch with their relatives by email and phone where relevant. The ethos of the home is for daily routines to be flexible so that people are able to choose what they want to do. People living in Lime Trees have complex needs and some have difficulties with communication, therefore they are unable in the main to discuss their likes, dislikes and wishes. The deputy manager explained that over the years they have developed a good knowledge of what people like and dislike by their reactions and their individual ways of expressing pleasure or dislike, sometimes by trial and error. This information helps staff ensure people’s choices are taken into consideration. As at the last inspection, being a small home meals are prepared and cooked by staff. Lunch on the day of the inspection was a sandwich made from processed chicken and some crisps. The menu listed chicken salad sandwiches as the choice, but there was no fresh salad available. Food stocks were examined at the beginning of the inspection and there were few items in the larder or the fridge. The deputy manager explained that they were going to do a supermarket shop that day. After the shopping was done, food stores were again inspected. It was noted that there was a lot of tinned food and supermarket value tins of fruit, but no evidence of fresh fruit and vegetables. Menus examined recorded that a lot of processed foods were used, including baked beans on four occasions during the course of one week. Meals did not reflect that the Department of Health (DOH) healthy eating guidelines of five portions of fruit and vegetables a day were being followed. This was discussed with the deputy manager and she explained that people living in the home enjoyed the food and they planned the menus around what people like. One member of staff often did a ‘batch’ of cooking for freezing, but this person had been off for some days. Overall, although people appear to enjoy their food, further efforts need to be made to introduce a greater variety of fresh foods in a way that people living in the home enjoy. Improving the quality of the menus by introducing a wider variety of fresh fruit and vegetables would give the people living in Lime Trees a better dining experience. Lime Trees DS0000035818.V362721.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service have access to an effective and understandable complaints procedure that ensures that they are listened to. Staff’s understanding of procedures around safeguarding need to be more robust if the people who live in Lime Trees are to be safe from harm. EVIDENCE: As at last inspection there are suitable policies in place and procedures around complaints. Although no completed surveys were received from relatives at the time of this inspection, relatives of the people currently living in Lime Trees have previously expressed satisfaction with the service and were confident that if they had any concerns they would be dealt with promptly. No formal complaints have been recorded since the last inspection. The AQAA states, “Lime Trees ensures arrangements and guidance is in place to promote protection of all clients from any form of abuse” and they “Provide regular Training sessions relating to ‘Abuse’ (POVA) & strict security measures are in place for protection”. Records examined confirm there is an Adult Protection policy and procedure in place that includes a Whistle Blowing policy. Personnel records examined confirm that staff have received Protection of Vulnerable Adults (POVA) training. On the day of the inspection we discussed safeguarding procedures with three members of staff (two carers and the deputy manager). Although the policies Lime Trees DS0000035818.V362721.R01.S.doc Version 5.2 Page 15 and procedures for safeguarding adults are available and give clear guidance to those using them, none of the staff spoken with were able to demonstrate that they knew when incidents need external input and who to refer the incident to. Staff said they would report to the deputy manager or the proprietor but were unaware who they should contact outside the management structure of the home. This lack of understanding of links with external agencies and how safeguarding procedures work poses a potential risk to vulnerable people. Lime Trees DS0000035818.V362721.R01.S.doc Version 5.2 Page 16 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): 19 and 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People living in Lime Trees benefit from a comfortable environment that is well maintained and clean. EVIDENCE: The AQAA states, “Lime Trees provides a Safe, Secure, Clean & Homely environment. The furnishings, décor & the clients personal belongings are regularly maintained & kept to a high standard”. A tour of the premises confirms that the home continues to provide a safe, well-maintained environment for the people who live there. As previously reported, Lime Trees is a spacious bungalow with ramped exits and wide doorways suitable for wheelchair users. The bungalow is decorated throughout to a high standard with ample space in communal areas. All bedrooms have an en-suite bathroom with an assisted bath. Lime Trees DS0000035818.V362721.R01.S.doc Version 5.2 Page 17 Bedrooms are all decorated to individual tastes. The deputy manager explained that some people were able to indicate their preferences around colours but others were not able to communicate on this level. The management team and staff have got to know people and choose for them using past experience of things they appear to prefer. All bedrooms are decorated to a high standard and, as in the communal areas, furnishings are of good quality. Individual rooms contain ample evidence of personal possessions; each person has their own pin-board in their room and has things like photographs, postcards and birthday cards on them. One member of staff who completed a survey said that they, “Provide a calm, relaxed atmosphere so the service users feel comfortable and at home”. Handrails in the corridor had strings of beads wrapped around at intervals. The deputy manager explained that this was to help one of the people living in the home who has impaired vision to orientate themselves and they are able to know when they are near their bedroom by feeling the beads. This is a simple but effective way of improving this person’s daily life. The laundry is small, but suitable for the size of the home. It is well maintained and clean with appropriate hand washing facilities, a nonpermeable tiled floor, a sluice and a professional standard washer and dryer. The AQAA states “Lime Trees provides regular Training for Staff regarding issues of Health & Safety, COSHH etc. Provide Training to support issues relating to ‘Health & Safety’, COSHH, Infection Control etc. Provide Policies regarding Environmental issues, additionally we provide an individual ‘Health & Safety’ Policy File”. This is confirmed in the sample of personnel records examined, which contains evidence of staff training around food hygiene and infection control. These good practices around infection control benefit people living in Lime Trees by ensuring they are safeguarded from potential infection. Lime Trees DS0000035818.V362721.R01.S.doc Version 5.2 Page 18 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): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall people living in Lime Trees benefit from being cared for by a competent staff team, although the recruitment process in the home needs to be followed more closely ensure people are safeguarded by staff who have been recruited following robust procedures. EVIDENCE: The manager said that they use the Department of Health ‘Residential Forum’ tool to calculate staffing levels to meet the assessed needs of the people living in the home. Rotas examined confirm that there are always two care staff on per shift as well as the manager during the day. Observations on the day of the inspection confirm that staffing levels appear sufficient to meet the needs of people living in the home. The AQAA states that they meet the National Minimum Standard of having 50 with National Vocational Qualification (NVQ) at level 2 or above. The manager said that out of a total of eleven care staff seven have completed a National Vocational Qualification at level 2 or above and a further three are in the process of doing the award. The sample of personnel records examined contains evidence of NVQ awards. A sample of three personnel files was examined. Staff files were well organised and two of the three examined contained all the information Lime Trees DS0000035818.V362721.R01.S.doc Version 5.2 Page 19 required under the Care Homes Regulations. One of the three files only contained one written reference instead of the two required by regulation. The deputy manager explained that the member of staff in question had only had one previous job but after discussion recognised that a further suitable reference should have been sought. The deputy manager is able to demonstrate a good awareness of the importance of vetting prospective carers by carrying out appropriate Criminal Records Bureau (CRB) checks and these were all in order in the sample of personnel records examined. The sample of personnel records examined contained evidence of a range of training that has been provided for staff, including manual Handling, First Aid, Food Hygiene, Infection Control, Protection of Vulnerable Adults and Medication. The deputy manager also said that there is training planned for dementia, diabetes and care planning. One member of staff who completed a survey said, “Training is regularly updated” and a member of staff spoken with on the day of the inspection was also positive about the training. Overall people living in Lime Trees benefit from being cared for by a competent staff team. Lime Trees DS0000035818.V362721.R01.S.doc Version 5.2 Page 20 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): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall Lime Trees is competently managed, although improvements need to be made around developing the Quality Assurance system and complying with regulatory requirements to demonstrate that the home is run in the best interests of the people who live there. EVIDENCE: The deputy manager runs the home on a day-to-day basis with the support of the proprietor/registered manager. The deputy manager has now completed the Registered Managers Award. The proprietor and deputy manager are working together closely, with the proprietor maintaining an active role in the home, and it is evident that their skills complement one-another. Lime Trees DS0000035818.V362721.R01.S.doc Version 5.2 Page 21 Information provided during the inspection confirmed that someone had been admitted to hospital, but no notification was made to us at the Commission. The registered person has a responsibility to notify us at the Commission in writing of death, illness and other events as specified under Regulation 37 of The Care Homes Regulations. A further regulatory requirement is that the Annual Quality Assurance Assessment (AQAA) is returned when requested. The AQAA was asked to be returned by 8th January 2008 and a reminder letter was sent when it was not received by us. A further reminder by telephone was made on 25th March 2008, but the completed AQAA was not received until 16th April 2008. Information provided in the AQAA was general and did not contain clear, relevant information that was supported by a wide range of evidence to provide us with an informed picture of the service. In particular details about areas for improvement and how they plan to achieve this were not addressed. On the day of the inspection the Quality Assurance system was discussed with the deputy manager and at a later date with the proprietor. They carry out an annual Quality Assurance audit that concentrates on a ‘focus person’ and a copy of this was submitted to us. However, the system does not actively or formally seek the views of people living in the home and their representatives or the views of other stakeholders in the community such as health and social care professionals, for example by means of questionnaires. There is evidence in care plans that relatives are invited to annual review meetings and the views of staff are recorded in team meeting minutes. However, the process should be developed further so that all this information is pulled together to form a development plan for the home, which demonstrates that people’s views and wishes are taken into account. The proprietor acts as appointee for the people living in the home. Each person has an individual bank savings account. Records examined confirm that people’s weekly allowance is transferred into their bank accounts. There is a process in place for recording personal expenditure. A sample of three finance records examined had receipts for items such as toiletries and payment for the ‘music man’. However, all contained £5 less than the records indicated. The deputy manager explained that £5 was taken from each person’s monies the previous evening because they all had a takeaway fish and chips meal and the receipts had not yet been recorded. We subsequently discussed this with the manager and it was agreed that a meal in the home should not be seen as a personal expense as it was not incurred as part of an activity or an evening out. It is also of concern that monies used from people’s personal allowance had not been recorded in a timely manner. The system needs to be implemented in a more robust manner if people are to be safeguarded from potential financial abuse. As at the last inspection, up to date policies relating to health and safety are in place. Records relating to safe working practices were examined and all were found to be in order. These include the fire risk assessment, fire alarms and Lime Trees DS0000035818.V362721.R01.S.doc Version 5.2 Page 22 emergency lighting are tested every 1-2 weeks, recent servicing of fire equipment and records relating to maintenance of equipment and utility services. People living and working in the home may be confident that they will be protected by the processes that are followed around matters relating to Health & Safety. Lime Trees DS0000035818.V362721.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 3 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X 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 X 18 2 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 3 Lime Trees DS0000035818.V362721.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 OP9 Regulation 13 (4) (a) (c) Requirement Timescale for action 13/05/08 2. OP18 13 (6) 3. OP29 19 (4) (b) (c) Schedule 2 4. OP31 37 The manager must ensure that all medications are stored securely so that all areas to which people have access are free from hazards to their safety. The manager must ensure that 31/05/08 staff are fully trained in safeguarding adults and know how to respond in the event of concerns, including when incidents need external input and who to refer the incident to. The manager must ensure that 30/06/08 all documentation relating to the recruitment of staff, including two relevant written references, is obtained prior to the employee starting work so that people are safeguarded from staff who may be unsuitable to work with vulnerable people. The manager must ensure that 13/05/08 notifications under regulation 37 about significant events affecting the welfare of people in the home are made to us at the Commission promptly. Lime Trees DS0000035818.V362721.R01.S.doc Version 5.2 Page 25 5. OP35 17(2) Schedule 4 The manager must ensure that the systems in place for recording people’s finances are more robust, in particular ensuring that there are receipts obtained for all transactions and these are recorded in a timely manner. This would ensure that people benefit from effective safeguarding and management of their money and valuables. 13/05/08 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 The manager should ensure that people are provided with a varied menu with choices that include healthy options in line with Department of Health healthy eating guidelines that include fresh fruit and vegetables, so that people benefit from healthy, nutritious food that they enjoy. The manager should ensure that information requested by us at the Commission, including the Annual Quality Assurance Assessment (AQAA), is returned within the stipulated timescale. The manager should continue to develop a Quality Assurance system so that they seek the views of people living in the home and other interested parties and the information is used to form a development plan, which demonstrates that people’s views are being acted upon. 2. OP31 3. OP33 Lime Trees DS0000035818.V362721.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. 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