Inspection on 15/11/05 for Lime Trees, The

This inspection was carried out on 15th November 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Lime Trees, The 09/11/07

Lime Trees, The 28/06/07

Lime Trees, The 07/11/06

Lime Trees, The 25/04/06

Lime Trees, The 12/04/05

Lime Trees, The 02/11/04

Lime Trees, The 19/05/04

Lime Trees, The 23/03/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Lime Trees, The 2 The Limes Avenue London N11 1RG Lead Inspector Brian Bowie Unannounced Inspection 11:00 15 November 2005 th 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, The DS0000010636.V251063.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, The DS0000010636.V251063.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Lime Trees, The Address 2 The Limes Avenue London N11 1RG 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) 020 8361 5840 020 8361 8020 Mr Aloysius Onyerindu Ms Nnenna Ekeoma Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Lime Trees, The DS0000010636.V251063.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Room 11 must not be used for a service user needing a wheel chair Room 12 must not be used for a service user needing two people to transfer as the bed is against the wall. 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. 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. The home must not admit a service user with a diagnoses of dementia, learning or physical disability or suffering from a mental health illness. Staffing levels must at all times comply with the regulations and that there must be a minimum of two waking staff in the night. 12th April 2005 4. 5. 6. iDate of last inspection Brief Description of the Service: The Lime Trees is a privately run care home for up to 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 the rear of the building. There are enough bathrooms and toilets in the home for the number of residents. 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. Lime Trees, The DS0000010636.V251063.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 over one day and lasted 6.5 hours. It was carried out by Brian Bowie and Angela Hunt. The owner was present throughout and assisted with the inspection. A tour of the premises was made and most of the 10 people resident in the home at the time of the inspection were spoken to. A friend of one of the residents was interviewed to get their views and comments on the home. Staff on duty were also spoken to. A variety of records, including care plans, staff files and health & safety documents were looked at. The overall impression was that The Lime Trees is continuing to provide a reasonable standard of care and has a relaxed family-like atmosphere. It needs to improve further the range and quality of daytime activities available to the residents. Areas for improving the service were discussed and agreed with Mr Onyerindu. What the service does well: What has improved since the last inspection? At the previous inspection there had been 5 areas which the home had to improve. These included revising the home’s statement of purpose, reviewing their activities programme, dealing with health and safety issues, getting an O.T.(Occupational Therapist) assessment of the premises and extending the quality assurance scheme used in the home. The home had taken action on all these areas. As a result the majority of these areas are now better than before. Improvements have also been made in the furnishing of the home so Lime Trees, The DS0000010636.V251063.R01.S.doc Version 5.0 Page 6 that it is becoming more welcoming and homely. A start has been made on providing a planned programme of daytime activities for residents. What they could do better: 12 new areas in which the home needs to improve are detailed in this report: • • • • • • • • • Keeping care plans and risk assessments updated Having a medication policy specific to the situation at The Lime Trees Improving the quality and range of the activity programme Ensuring all complaints are recorded Making sure the rear garden is well maintained Having an accurate & clear staff rota Ensuring there is an ongoing process for reviewing and improving the quality of care provided Making sure that staff supervision meetings are recorded consistently Ensuring fire safety arrangements are revised and approved by the London Fire Emergency Planning Authority The owner of the home emphasised that he is keen to work closely with CSCI 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. 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, The DS0000010636.V251063.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, The DS0000010636.V251063.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): 3 People moving into the home have their needs assessed so that the home can be sure that it can meet these needs. EVIDENCE: The majority of the residents were spoken to and said that they enjoyed living at the home and thought that their needs were being met. The file on the resident who had most recently moved into the home was looked at and showed that before they moved in a full assessment had been received from Social Services. The home had then carried out its own assessment in order to determine if the home could meet the individual’s needs. A care plan had then been drawn up by the home indicating how these needs were to be met. As previously required the home has revised its information about the home. It now includes the comments and views of residents themselves about what it is like to live in the home in order to help people thinking about moving in, and their families, to decide whether The Lime Trees is the right place. Lime Trees, The DS0000010636.V251063.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): 7,8,9 The home is good at meeting the health needs of residents, and ensuring there are effective and safe arrangements in place in relation to the administration of medication. However the home needs to have an up to date medication policy relating to procedures to be followed. The home need to improve its systems for reviewing and updating care plans and risk assessments. EVIDENCE: The records for three residents were looked at and indicated that for each one there was a current plan of care. These set out the needs of the resident and how they were to be met by the home together with relevant risk assessments. However there was insufficient evidence that these care plans and risk assessments were being regularly revised to reflect changes in the resident’s needs. The registered person needs to ensure that both care plans and risk assessments are updated regularly so that they reflect changes over time and are accurate. The records showed that residents are being weighed regularly and are being seen by dentists, opticians, chiropodists and doctors. Interviews with staff and the owner indicated that the staff are responding well to the health needs of Lime Trees, The DS0000010636.V251063.R01.S.doc Version 5.0 Page 10 residents and liaises with other health professionals where appropriate. Residents themselves said they felt well looked after. Medication arrangements were observed and relevant records looked at. Medication is given out appropriately and records relating to the administration of medication were found to be accurate and up-to-date. Staff have had training in the administration of medication. The medication policy produced was a general one and not specific to The Lime Trees. The medication policy for the home must be specific to the situation at The Lime Trees and the procedures to be followed. Lime Trees, The DS0000010636.V251063.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 Residents do not have the benefit of a wide ranging programme of activities to take part in. Mealtimes are enjoyed by the residents who have a choice about what to eat. EVIDENCE: One resident said that they go out when they want, sometimes with a friend, sometimes to the local church or for a walk. Other residents like to read and benefit from having a library visiting service to the home. A programme of activities over a 4 week period had been drawn up, but feedback from residents and staff indicated that this was not yet established. The owner made the point that some residents do not wish to take part in activities provided. However the home must ensure that a more imaginative and varied programme of activities is available to residents which takes account of their different needs and interests and which is recorded so that progress in this area can be reviewed. Residents were positive about the food in the home. The lunchtime arrangements were observed and seen to be relaxed. One resident who is a vegetarian was served an appropriate meal. Discussion with the cook and the Lime Trees, The DS0000010636.V251063.R01.S.doc Version 5.0 Page 12 owner confirmed that individual preferences are catered for and that culturally appropriate food is available to residents who wish this. Lime Trees, The DS0000010636.V251063.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 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. However the home must ensure all complaints are properly recorded. EVIDENCE: The home has policies and procedures in place in relation to reporting and investigating complaints. In general residents said that they felt happy and looked after at the home. The complaint record showed that no complaint had been made since the previous inspection. However one anonymous complaint had been investigated by the home and appropriate action taken, but had not been recorded in the complaints book. The owner needs to make sure that all complaints are recorded so that a proper check can be made on this area. Lime Trees, The DS0000010636.V251063.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): 19,22,26 The living environment has improved since the previous inspection but the garden area at the rear of the home needs to be better maintained. Residents who are wheelchair users have restricted access around the home. A good standard of cleanliness and hygiene is maintained throughout the home. EVIDENCE: The Lime Trees provides a homely and comfortable environment for residents, with improvements made since the last inspection including some new chairs in the dining room. The rear garden was in need of tidying up and did not provide an attractive outlook for residents. The owner agreed that the garden would be tidied up so that it looks better. The hot water temperature is checked regularly by the home. The hot water in one bathroom was tested and was observed to be regulated to prevent the potential for scalding. One door On the ground floor one bedroom door was propped open at the resident’s request. However this arrangement must be checked by the London Fire Emergency Planning Authority to see if this contravenes fire safety regulations, and if so the appropriate arrangements that need to be in place. Lime Trees, The DS0000010636.V251063.R01.S.doc Version 5.0 Page 15 The Lime Trees is a converted building with some restrictions for wheelchair users, including narrow corridors and some sloping floors. 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. The owner said he was awaiting a visit from an O.T. who would carry out this assessment. Throughout the inspection the home was found to be clean and hygienic. Comments from residents and staff indicated that they considered a satisfactory standard was being achieved in this area. Lime Trees, The DS0000010636.V251063.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 Residents benefit from the support of a committed and experienced team of staff at the home and from staff who have been recruited using the procedures and checks designed to safeguard residents. The staff rota needs improvement so that it is accurate at all times and clear to understand. The home is good at ensuring staff get the basic and essential training to do the job but not so good at ensuring staff have ongoing and varied training opportunities so that they keep up with good practice in the care of older people. EVIDENCE: Staff on duty 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. Positive feedback was received from the residents about the care they receive from staff. Staff are positive about the residents with comments such as: ‘They’re a lovely group to work with.’ The staff rota was looked at and had not been corrected to show a change which had taken place on a recent shift. The rota was also difficult to follow in term of which staff were working at what times. The owner must ensure the staff rota is accurate, with changes noted, and is clear so that it can be readily understood as to who is working when. It is recommended that the owner identifies ways in which the ethnic make up of the staff team can more closely reflect the ethnic make up of the residents. Lime Trees, The DS0000010636.V251063.R01.S.doc Version 5.0 Page 17 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. Some staff were undertaking NVQ Level 2 training in the care of older people to improve their caring skills further. Each member of staff had a training profile which listed the training they had done. However there was little evidence of a planned and ongoing training programme in response to the identified needs of staff and residents. The owner needs to ensure that there is an ongoing programme of training which responds to the developing needs of both residents and staff. Staff files were looked at and contained the information needed to make sure that all new staff in the home had been recruited appropriately using the appropriate checks, including CRB disclosures and written references. Lime Trees, The DS0000010636.V251063.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): 31,33,35,36,38 Residents benefit from having the home run by an owner who is experienced and qualified to operate a care home and where there are appropriate procedures in place to look after residents’ monies. 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. Staff benefit from having supervision meetings, but these need to be recorded. The home is good at making sure the residents are kept safe and secure but need to improve further fire safety measures to ensure the home is as safe as possible. EVIDENCE: Mr Onyerindu has run The Lime Trees for a number of years and has recently completed the training course for registered managers. He is also undertaking Lime Trees, The DS0000010636.V251063.R01.S.doc Version 5.0 Page 19 further training in the area of the mental health, including dementia, of older people. He demonstrated that he had a good knowledge of the needs of each resident and is actively involved in the day to day running of the home. The manager of the home although not present at the inspection has been assessed and registered as a suitable person to manage the home. The home has a policy on how it reviews the quality of care provided. As previously required the home has now produced reports which include the views and comments of residents, relatives and professionals involved with the home about the care provided. However an ongoing system of evaluation and improvement is not yet in place. The owner needs to ensure that this is put in place and draws on the views and comments of residents. Arrangements regarding residents’ finances were checked. In most cases relatives look after the resident’s monies and financial affairs. One resident looks after his own monies. Staff explained the arrangements in place to support a resident to get monies out of a savings account so that they had some spending money each week. No concerns were raised or identified in this area. Currently the home is not looking after valuables belonging to any of the residents. The staff files showed that staff are now having one-to-one supervision meetings with the manager and/or owner to ensure staff are fully supported and guided on how to improve their practice. However these meetings are not always recorded. The owner needs to ensure that all supervision meetings are recorded so that the regularity and quality of these meetings can be checked. A range of records was looked at, including health and safety and fire safety. In general these records were detailed, up-to-date and accurate and confirmed that the home is being run responsibly with essential checks being made and acted on. Fire drills are held twice a year. It is recommended that fire drills are held more regularly so that residents and staff become familiar with what to do if the alarm rings and react appropriately and quickly. In line with guidance from the LFEPA the home must have an up to date fire safety risk assessment of the premises and an emergency plan. Lime Trees, The DS0000010636.V251063.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 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 x 2 X X 2 X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 2 Lime Trees, The DS0000010636.V251063.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes 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 (2) (b) Requirement The registered persons must ensure that both care plans and risk assessments are updated regularly. Timescale for action 31/12/05 2 OP9 13 (2) The registered persons must 31/01/06 ensure that the medication policy for the home is specific to the arranngements in place at The Lime Trees. The registered persons must ensure that a more imaginative and varied programme of activities is available. The registered persons must ensure that all complaints are recorded. The registered persons must ensure that the arrangement regarding the identified ground floor bedroom door is checked and approved by the London Fire Emergency Planning Authority. The registered persons must ensure that the rear garden is well maintained. The registered persons must ensure that the staff rota is DS0000010636.V251063.R01.S.doc 3 OP12 16 (2) (m) 22 (3) 23 (4) 31/12/05 4 5 OP16 OP19 31/12/05 31/12/05 6 7 OP19 OP27 23 (2)(o) 17 (2) Sch 4 (7) 31/12/05 31/12/05 Lime Trees, The Version 5.0 Page 22 accurate and clear. 8 OP28 18 (1) (c) The registered persons must ensure that there is an ongoing programme of training which responds to the developing needs of both residents and staff. 31/12/05 9 OP33 24 (1) 24 (3) 10 OP36 18 (2) The registered persons must 31/01/06 ensure that the quality of service is regularly reviewed and evaluated. The registered persons must 31/12/05 ensure that all staff supervision meetings are recorded. The registered persons must 31/12/05 ensure that the home has an up to date fire safety risk assessment of the premises which has been approved by the LFEPA. The registered persons must ensure that the home has an emergency plan which has been approved by the LFEPA. 31/12/05 11 OP38 23 (4) (a) 12 OP38 23 (4) (c) (iii) 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 OP27 Good Practice Recommendations The registered persons should formulate and implement a plan to ensure the ethnic make up of the staff team more closely reflects the ethnic make up of the residents. Lime Trees, The DS0000010636.V251063.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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. 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