CARE HOMES FOR OLDER PEOPLE
THE LIME TREES 2 The Limes Avenue London N11 1RG
Lead Inspector Brian Bowie Announced 12 & 14 April 2005 @ 08.30 am 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. THE LIME TREES Version 1.10 Page 3 SERVICE INFORMATION
Name of service The Lime Trees Address 2 The Limes Avenue, London, N11 1RG 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) 020 8361 5840 Mr Aloysius Onyerindu Ms Nnenna Ekeoma PC Care Home 16 Category(ies) of OP registration, with number of places THE LIME TREES Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Room 11 must not be used for a service user needing a wheel chair. 2. Room 12 must not be used for a service user needing two people to transfer as the bed is against the wall. 3. Room 17 to be used as a shared room for a couple of either sex who were previously living together prior to admission. The small quiet room adjacent to be used for the sole use of the couple in that room. 4. The top floor rooms, ie staff sleeping in room; owners bedroom; staff room and bath and toilet facilities must be used only by staff. These are not registered for the use of service users. The owner confirmed this address as his permanent address. 5. The home must not admit a service user with a diagnoses of dementia, learning or physical disability or suffering from a mental health illness. 6. Staffing levels must at all times comply with the regulations and that there must be a minimum of two waking staff in the night. Date of last inspection 2 November 2004 Brief Description of the Service: The Lime Trees is a privately run care home for 16 older people. It is situated in a residential road in New Southgate close to local amenities, shops and public transport. Residents bedrooms are on the ground and first floors. The laundry, office and staff accommodation are on the second floor. A lift serves all floors of the home. There are twelve single bedrooms, some with en-suite facilities, and two double rooms. Communal space consists of a ground floor lounge/dining area with two smaller rooms on the first floor, with a garden at t the rear of the building. There are enough bathrooms and toilets in the home for the number of services users. There are some aids and adaptations in the home to help people with physical disabilities get around more easily. However the narrow corridors and sloping floor surfaces means that there are limitations for wheelchair users who wish to be as independent as possible. THE LIME TREES Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection took place over two days and lasted 14 hours. Additional time was spent checking if the home had responded adequately to a significant number of areas identified at the previous inspection as needing improvement. The owner and manager were present throughout and assisted with the inspection. A tour of the premises was made and all of the twelve people resident in the home at the time of the inspection were spoken to. Relatives and friends of five of the residents were interviewed to get their views and comments on the home. All four staff on duty were also spoken to. A variety of records, including careplans, staff files and health & safety documents, were looked at. What the service does well: What has improved since the last inspection?
At the previous inspection there had been 19 areas which the home had to improve. These particularly involved the various records that the home needs to maintain. The home had taken action on all these areas. As a result the majority of these areas are now better than before so that none of these areas needed to be repeated again in this report. This represents a much more satisfactory response than previously by the owner to ensuring that areas identified at previous inspections as needing improvement have been attended to. Improvements have also been made in the decoration and furnishing of the home so that it is becoming more welcoming and homely. Five new areas in which the home needs to improve are detailed in this report. The management team at the home emphasised that they were keen to work
THE LIME TREES Version 1.10 Page 6 closely with CSCI in order to raise standards at the home in order to be able to provide the best possible quality of life for residents at The Lime Trees. What they could do better: 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. THE LIME TREES 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 THE LIME TREES 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) 1,3 People moving into the home have their needs assessed so that the home can be sure that it can meet these needs. However people wanting to move into the home do not have all the information they need to make a fully informed decision that this is the place where they want to live. The home has to provide this information. EVIDENCE: All twelve of the residents were spoken to. They said that they enjoyed living at the home and thought that their needs were being met. One resident said: ‘Its quite good really, they do what they can to make me cheerful.’ Relatives or friends of five of the residents were interviewed. Most of these people visited the home regularly and thought that their relative was happy in the home and well cared for, with one person saying: ‘The home’s fine, and the staff are fine.’ The files kept on each resident were looked at and showed that before someone moved in a full assessment had been carried out which stated that the needs of the person concerned could be met at the home. The home has detailed information about what it aims to do and about the services and care available. This information does not include the comments and views of residents themselves about what it is like to live in the home
THE LIME TREES Version 1.10 Page 9 which would help people thinking about moving in, and their families, to decide whether The Lime Trees is the right place. THE LIME TREES Version 1.10 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 standard(s) 7,8,10 The home is good at meeting the health needs of residents together with evidence of satisfactory care planning systems in place. Staff support residents in a way that shows respect to the residents and enables the residents to have privacy. EVIDENCE: The records for three residents were looked at and indicated that for each one there was a current plan of care which set out the needs of the resident and how they were to be met by the home, with evidence that these were being reviewed regularly. In addition each file contained an assessment of any areas where there was considered to be any risk to the resident and how these risks were to be dealt with and minimised as far as possible. The records also showed that residents were being weighed regularly and were being seen by dentists, opticians, chiropodists and doctors. Relatives of one resident confirmed that district nurses were coming in and treating the individual as required. One relative commented: ‘They check her weight and organised the chiropodist.’ Residents themselves said they felt well looked after, and one of the doctors used by the home had written that he was satisfied with the care provided in the home. Throughout the two days of the inspection staff were observed treating the residents with respect. Staff were seen to provide support discretely at
THE LIME TREES Version 1.10 Page 11 mealtimes if a resident needed some help. One relative commented: ‘Staff respect his dignity and don’t embarrass him about his incontinence.’ Residents themselves said they considered they had privacy when they needed it, one of them saying: ‘They always knock before they come in.’ THE LIME TREES Version 1.10 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 standard(s) 12,13,14 Residents are getting what they expect from the home in terms of the friendly and caring atmosphere, with close relationships built up between residents and between residents and staff, so that residents feel relaxed and settled at The Lime Trees. Residents make their own decisions wherever possible about what they do when. The home is not so good at having a wide range of activities available to meet the diverse needs of the current group of residents. EVIDENCE: One resident said that he goes out when he wants to, sometimes with a friend, sometimes to the local church or for a walk. Another resident went out weekly with a member of staff for a pub lunch which he really appreciated. Relatives commented on the friendly and relaxed atmosphere in the home and thought that residents were settled in the home and felt cared for. However there was little evidence of a comprehensive and varied programme of activities within the home. One resident said: ‘I’d like to see more adult games, like cards and draughts.’ A relative commented: ‘I think there could be more outings-there doesn’t seem to be a lot going on.’ The home needs to review its provision in this area so that a more imaginative and varied programme of activities is available, which takes account of the different needs and interests of the current group of residents. THE LIME TREES Version 1.10 Page 13 During the inspection residents were observed making choices about how they spent their time, with one resident saying: ‘I go to bed when I want to and get up when I want to.’ Another resident said he was able to do what he wanted when he wanted and that he also looked after his money himself. During the inspection several relatives and friends visited residents and were seen to be relaxed in the home with good relationships with staff and the owner. One relative said: ‘The home is very welcoming of visitors and families- you’re always offered a cup of tea.’ THE LIME TREES Version 1.10 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 standard(s) 16,18 The home has a satisfactory complaints system so that residents and relatives feel confident their complaints and concerns will be listened to and acted on. The home has satisfactory adult protection systems in place which make sure that residents are safe and secure whilst at The Lime Trees. EVIDENCE: The home has policies and procedures in place in relation to reporting and investigating complaints. The complaint record showed that no complaint had been made since the previous inspection. Residents said they felt able to make complaints and raise issues if they needed to. Some said: ‘We’ve got no complaints.’ Relatives interviewed also confirmed that when they had raised issues these had been responded to by the home. The owner had provided training for care staff at the home in adult protection. The home also had copies of the relevant local authority guidelines on dealing with abuse and had copies of the appropriate form available to be used when reporting an incident, or alleged incident. There had been no incidents in relation to adult protection in the home in the last year. THE LIME TREES Version 1.10 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 standard(s) 19,22,26 The living environment, both indoors and outdoors, at the home has improved since the previous inspection but still does not provide a completely safe setting for all residents at all times. Residents who are wheelchair users have restricted access around the home. A good standard of cleanliness and hygiene is maintained by the home. EVIDENCE: The Lime Trees was observed to provide a homely and comfortable environment for residents, with improvements made since the last inspection in terms of the decoration and furnishings. Both residents and relatives commented that it was a nice environment to live in. However a section of the fencing had fallen down in the rear garden without any indication that any risks arising had been identified in order that residents’ safety was not compromised. In one of the bedrooms a wardrobe was unstable and needed to be secured to ensure the safety of the resident. The Lime Trees is a converted building with some restrictions for wheelchair users, including narrow corridors and some sloping floors. One relative
THE LIME TREES Version 1.10 Page 16 commented: ‘It’s not very good for wheelchairs-he can’t be as independent as he would like to be.’ An up-to-date assessment is needed by an OT so that the home can be confident that it is doing everything possible to overcome the environmental difficulties in order that the home is as accessible as possible. Throughout the inspection the home was found to be clean and hygienic. Written comments from residents and relatives indicated that they considered a satisfactory standard was being achieved in this area. THE LIME TREES Version 1.10 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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 Residents benefit from a committed and experienced team of staff at the home who have the skills and training needed to meet their needs. EVIDENCE: All staff on duty throughout the inspection were observed and spoken to. Most staff at the home have worked there for a number of years and have built up a good knowledge and understanding of the needs of each resident. A good deal of positive feedback was received from the residents and their relatives. Comments included: ‘Staff are very good- they do what they can to make me comfortable.’ ‘Staff are quite nice.’ ‘Staff have been lovely to him, especially the member of staff who takes him out for a drink at the pub.’ Staff files were looked at and showed that staff had done training in essential areas, such as food hygiene, manual handling, health and safety, administering medication, first aid. In addition staff had received training in adult protection, pressure ulcers and dementia awareness. Each member of staff had a training profile which listed the training they had done, and any training needs identified. Some staff were undertaking NVQ Level 2 training to improve their caring skills further. THE LIME TREES Version 1.10 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 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) 33,37 Residents need to have more say in how the home works out the quality of the care provided before the home can be sure the it is run in the best interests of the residents. The Lime Trees needs to develop further its methods of reviewing and improving the quality of care provided to residents, using systems which draw on the residents’ own experiences of living at the home. The home is good at keeping detailed records relating to all aspects of the running of the home, with appropriate policies and procedures in place, which help to ensure the residents are properly looked after and their best interests secured. EVIDENCE: The home has a policy on how it reviews the quality of care provided, but had not yet produced reports which highlighted clearly what the home was doing well and where things needed to be better. These surveys need to draw on the views and comments of residents, relatives and professionals involved with the home in order that a system of ongoing evaluation and improvement takes
THE LIME TREES Version 1.10 Page 19 place. The owner indicated his intention of drawing on the model being promoted by CSCI in terms of being able to identify what was working well in the home and what needed to be better. A wide range of records were looked at, including fire safety, electrical and gas certificates, and an environmental health report. These confirmed that the home was being run responsibly with statutory checks being made and acted on. The owner had systems in place to ensure that record-keeping was done consistently and reliably. Records seen were detailed, up-to-date and accurate. THE LIME TREES Version 1.10 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. 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 x x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 x
COMPLAINTS AND PROTECTION 2 x x 2 x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 2 x x x 3 x THE LIME TREES Version 1.10 Page 21 No 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. Standard 3 12 Regulation 5 16 Requirement The service users guide must contain the views and comments of residents The existing daytime activities programme must be reviewed and an extended programme provided to meet the needs of all residents The collapsed fencing in the rear garden must be made safe as must the unstable wardrobe in the bedroom identified An assessment of the premises must be made by an OT the quality assurance system in the home must involve the views of residents, relatives and professionals and ensure there is a process of ongoing evaluation and improvement Timescale for action 31 May 2005 30 June 2005 3. 19 13 30 April 2005 31 August 2005 31 July 2005 4. 5. 22 33 23 24 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.
THE LIME TREES Version 1.10 Page 22 Refer to Standard Good Practice Recommendations THE LIME TREES Version 1.10 Page 23 Commission for Social Care Inspection North London Area Office Solar House 1st Floor, 282 Chase Road London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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