Inspection on 18/11/05 for Lime Trees

This inspection was carried out on 18th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 Trees 18/04/08

Lime Trees 19/04/07

Lime Trees 01/03/06

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 Gaynor Elvin Unannounced Inspection 18th November 2005 11.00 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.V323164.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 Trees DS0000035818.V323164.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Lime Trees Address Harwich Road Sparrows Corner Little Oakley Essex CO12 5AD 01255 880281 01255 886374 jamesmoor4@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 Learning disability (6), Learning disability over registration, with number 65 years of age (6), Physical disability (6), of places Physical disability over 65 years of age (6) Lime Trees DS0000035818.V323164.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home accommodates six people with learning disabilities who may also have physical disabilities 16th March 2005 Date of last inspection Brief Description of the Service: Lime Trees is located in the small village of Little Oakley on the outskirts of Harwich, which is a large town and international port. Lime Trees is a bungalow, renovated and extended to a very high standard meeting all the requirements of the National Minimum Standards in terms of room sizes, en suite bathrooms and communal space. Lime Trees is a registered care home for six people with learning disabilities and aged over 65 years. Lime Trees DS0000035818.V323164.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place one day in November 2005, over five hours. The inspection process included an inspection of the premises, discussion with the Registered Manager, deputy manager and care worker, examination of a sample of staff and residents records and supporting documentation and direct and indirect observation. The current residents residing at Lime Trees have high cognitive and communication needs and discussion with regard to care delivery was difficult. Observation of body language, expression and the rapport between the residents and the staff, demonstrated that the residents were comfortable and contented at Lime Trees. Lime Trees is recognised as meeting the international standard for effective investing in people and achieved The Investor in People Award in March 2005. What the service does well: What has improved since the last inspection? What they could do better: The home needs to ensure that all checks with regard to fire safety are recorded accurately, dated and signed by the person carrying out the checks for reference and confirmation. Lime Trees DS0000035818.V323164.R01.S.doc Version 5.0 Page 6 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 Trees DS0000035818.V323164.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 Trees DS0000035818.V323164.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, 3, & 4. The service operates an informative and responsible pre admission process ensuring the home is able to meet the individual’s needs. The home does not provide intermediate care and therefore standard 6 and corresponding expected outcome is not applicable for this service. EVIDENCE: The Statement of Purpose and Service User Guide provided all the details a prospective new resident would require about the services and facilities offered within the home. These documents are also available in an audiocassette version. The service has not admitted any new residents since the last inspection. Previous inspections commended the service for its thorough, comprehensive pre-admission process, which met the intended outcomes for prospective residents. Lime Trees DS0000035818.V323164.R01.S.doc Version 5.0 Page 9 The current residents have lived at Lime Trees since it opened, three years ago, and were admitted under the re-provision programme from NHS long term care, as part of Better Lives programme. They each were involved during the pre-admission process and the transition period, which was well planned and supported through appropriate assessment identifying physical, social, psychological and emotional needs by the home’s manager and the multidisciplinary team. Lime Trees DS0000035818.V323164.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7&8 A clear and thorough care planning system was in place to adequately provide staff with the information they need to satisfactorily meet all the assessed needs of each resident. Healthcare needs were clearly seen as a fundamental part of the residents care. EVIDENCE: Care plans were service user focused, developed according to assessed needs, including care and maintenance of health. They provided good detail of the action required of staff to provide consistent and structured support, promoting optimal independence and well being. Nutritional screening and weight monitoring was recorded, eating and drinking needs, incorporating preferences, support and any aids required to promote independence such as non slip mats and large handled utensils. A great emphasis was given to healthy eating and a balanced diet promoting well being and preventing complications such as constipation in a positive way. Each care plan held a completed annual ‘OK’ Health Check, a comprehensive checklist to enable the key worker to carry out a detailed health check and gather relevant information for the GP in identifying healthcare needs for Lime Trees DS0000035818.V323164.R01.S.doc Version 5.0 Page 11 people with a learning disability. Identified additional information, occurrences or observations in the individual’s physical and mental health or gradual deterioration in well being, was recorded well and reported accordingly to the appropriate professionals and generated into an effective care plan. Care files provided evidence of guidance and prompt intervention from healthcare professionals such as the Continence Advisor, District Nurse, Community Psychiatric Nurse and Community Physiotherapist/Occupational Therapist to meet specific identified needs. Records were in place of ophthalmic and chiropody appointments. Risk assessments and management strategies were included within the care planning process. Each risk assessment had an activity benefit analysis to assess whether taking a responsible risk with support would actually benefit the quality of the individuals lifestyle, experience, competence or dignity. Lime Trees DS0000035818.V323164.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 & 15 Family and friendship links are actively encouraged and promoted. The home supplied sufficient quantity and quality of food and provided a well balanced diet that met individual needs and choices. EVIDENCE: The current residents are elderly and formerly resided in NHS establishment for all or most of their lives. Some no longer have relatives and others had lost contact. Staff had recently traced a family member of one individual. Contact was established, supported and maintained by telephone and letters, which led to a reunion when the resident met their sister for the first time in seventy years. The staff had worked closely with the dietician to produce menus that promote healthy eating and nutritional requirements, using fresh and balanced foods. The residents have profound communication difficulties and the staff identify each individuals likes and dislikes by their behaviour, facial expressions and by the foods they eat. To encourage active participation in menu planning and choice for those who do not use verbal communication, the staff were producing photos of foods and meals. Lime Trees DS0000035818.V323164.R01.S.doc Version 5.0 Page 13 Being a small home the care staff take it in turns to prepare and cook the meals for the residents and the residents also participate in food preparation if they wish to. The arrangement works well and was observed to be stimulating and interactive for the residents. A casserole with fresh vegetables and a flan for desert was being prepared and filled the home with delicious smells. Lime Trees DS0000035818.V323164.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Outcomes 16, 17 & 18 not assessed on this occasion. EVIDENCE: Lime Trees DS0000035818.V323164.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25 & 26. Lime Trees is a purpose built care home, designed with reference to relevant guidance, providing a safe and well maintained environment, furnished and decorated to a very high standard, and meets residents’ individual and collective needs in a comfortable and homely way. EVIDENCE: Lime Trees is a spacious bungalow, with ramped exits and wide doorways, suitable for wheelchair users. Grab rails, hoists and walking aids are provided to assist the residents with limited mobility. Each individual bedroom has en suite facilities, which comprise of a washbasin, an assisted bath with a hoist and a toilet. The bedrooms were personalised, decorated and furnished to a high quality and suitable to meet individual needs. The premises were in good keeping with the local community and presented a clean, comfortable homely environment. A large well-maintained garden, greenhouse and garden furniture provided stimulation and interest for the residents. Lime Trees DS0000035818.V323164.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, 28, 29 & 30 Staff morale was high resulting in an enthusiastic workforce that works positively with residents to improve their whole quality of life. Staffing levels and skills were appropriate to the needs of the residents. The homes robust recruitment and selection practice and thorough induction process provided the appropriate safeguards to support and protect the residents. EVIDENCE: Staff spoken with enjoyed working in the home and demonstrated a good understanding and commitment to the residents within their care. They were aware of their roles and responsibilities and felt they received good support and development opportunities by the management team. Training was provided in a planned way and ensured staff continually developed and updated their training and skills to protect and promote the health, safety and welfare of the residents. The staff personnel files examined contained all the information required to ensure the safety of residents through the recruitment process. Lime Trees DS0000035818.V323164.R01.S.doc Version 5.0 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 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): 31,32,33,36 & 37 The home is efficiently and professionally run, promoting an open and supportive atmosphere for the residents and staff. The home has an effective Quality Assurance and Quality Monitoring system in place to measure the success in achieving the aims and objectives of the home and care outcomes for the residents; to further develop care practice in the best interests of the residents. Supervision clearly contained all the elements necessary to support staff in developing and sustaining their working practice. EVIDENCE: Formal supervision and staff meetings as well as day to day contact provided regular team communication and structured support. Staff confirmed they were happy with the guidance, direction and support they received from management enabling them to develop skills and sustain good working Lime Trees DS0000035818.V323164.R01.S.doc Version 5.0 Page 18 practice. Residents were observed to be comfortable and relaxed around the management and staff. The home had carried out its second annual Quality Assurance and Quality Monitoring. An audit framework was used to look at two elements of quality care and was service user focused. The process audit looked at the services being delivered and the audit of outcome assessed the benefits achieved by the resident. A different service user was used for the focus person for this years audit and as well as examining objective standards of good practice it also looked at the objectives which were not achieved on the previous audit. Recommendations from the outcomes of the audit were being addressed to set objectives for future development or change of practice in the areas indicated within the audit, together with target dates for review and evaluation of achievement. Records and log books relating to fire safety checks and fire drills were inspected and entries were found not to be regular or up to date. The Deputy Manager assured the inspector the checks and fire drills had been regularly carried out. Lime Trees DS0000035818.V323164.R01.S.doc Version 5.0 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. 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 X 4 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 4 4 4 4 4 4 4 4 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 3 3 4 X X 3 2 X Lime Trees DS0000035818.V323164.R01.S.doc Version 5.0 Page 20 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 OP37 Regulation 17 Requirement The Registered Manager must ensure records required by regulation for the protection of service users and effective efficient running of the home are maintained, up to date and accurate. Timescale for action 01/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Lime Trees DS0000035818.V323164.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Trees DS0000035818.V323164.R01.S.doc Version 5.0 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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