Inspection on 28/06/07 for Lime Trees, The

This inspection was carried out on 28th June 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Lime Trees, The 09/11/07

Lime Trees, The 07/11/06

Lime Trees, The 25/04/06

Lime Trees, The 15/11/05

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 Key Unannounced Inspection 09:45 28th June 2007 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.V333336.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, The DS0000010636.V333336.R01.S.doc Version 5.2 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 Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Lime Trees, The DS0000010636.V333336.R01.S.doc Version 5.2 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. 7th November 2006 4. 5. 6. Date 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. Fees charged by The Lime Trees are in the region of £400/week. The brochure detailing the service provided by The Lime Trees and inspection reports on the home are made available to residents, families and prospective residents. Lime Trees, The DS0000010636.V333336.R01.S.doc Version 5.2 Page 5 Lime Trees, The DS0000010636.V333336.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 1 day and lasted 7.5 hours. Brian Bowie and Jane Ray from the Harrow office of CSCI carried out the inspection. The owner of The Lime Trees, Mr Onyerindu, assisted with the inspection. The inspectors looked round the home and spoke to all 5 people resident in the home at the time of the inspection. Written comments about the home from families and relatives of 3 of the residents were seen. Staff on duty were also interviewed. A variety of records, including care plans, staff files and health & safety documents were looked at. The overall impression is that The Lime Trees is now providing a reasonable standard of day to day care to residents and has a relaxed family-like atmosphere. Residents and relatives are positive and appreciative about the care provided. Enforcement action was taken by CSCI after the inspection in November 2006. Many important areas relating to the running of the home have now improved. Staff have attended a range of courses so that they now support residents more effectively and residents’ safety and wellbeing has improved. An acting manager from an agency has made an application to be registered by the CSCI Regional Registration Team as the manager of the Lime Trees. CSCI is encouraged by the positive response made by Mr Onyerindu to its serious concerns. However there are significant new requirements in relation to safeguarding to be met. The quality of care provided by the home will continue to be monitored closely to ensure long term, stable and effective management arrangements are put in place and recent improvements are sustained. What the service does well: What has improved since the last inspection? Lime Trees, The DS0000010636.V333336.R01.S.doc Version 5.2 Page 7 Following the last inspection in November 2006 CSCI took enforcement action against the home in response to the persistent failure over time by the management team at The Lime Trees to make essential improvements so that residents had a better quality of life at the home. Mr Onyerindu has responded to and dealt with all the areas identified for improvement, in particular in relation to staff training and supervision and the general running of the home. As a result residents are now more effectively supported by staff and their general wellbeing has improved. Mr Onyerindu had also put forward an experienced manager to the RRT for registration. What they could do better: Following the random inspection made on 3/4/07 there had been 10 areas the home had to improve, in addition to those areas identified in the enforcement notices served on the home. All these areas have now been dealt with. At this inspection 11 new areas to be improved are identified. These concerns included: Failing to keep residents safe by not having sufficiently comprehensive risk assessments, not keeping proper records where the home is supporting residents to manage their monies and not having consistent records regarding residents’ medication. Not having a permanent manager in place A poor living environment that is in need of redecoration and refurbishment • • • • • All key areas of risk to the safety of residents are assessed and a plan devised to minimise these risks Medication records are accurate to minimise the risk of mistakes being made A record is kept of all food provided to residents so that it can be checked if they are having a satisfactory diet There is an ongoing programme of redecoration and refurbishment so that residents can enjoy an attractive living environment. New chairs to be provided in the lounge so that residents benefit from attractive and comfortable seating DS0000010636.V333336.R01.S.doc Version 5.2 Page 8 Lime Trees, The • • • • • • The garden to be well maintained and accessible so that residents can benefit from having a garden. Residents’ bedrooms to be at all times hygienic and kept free from unpleasant odours. Staff identified as needing refresher training get this before their existing certificate expires The home to employ a full time manager who has been registered by the RRT. Proper procedures and records are in place when the home is supporting residents to manage their monies The fire notices displayed in the home to be consistent with the home’s fire safety risk assessment and action plan 3 recommendations are made to improve practice further at the home: • • The staff to be more actively involved in drawing up and implementing care plans The residents to have more regular opportunities to go out from the home to use local community resources as well as going on some group outings Presentation of tables at mealtimes to be improved with suitably attractive tablecloths, condiments, jugs of water and so on • All the areas for improving the service were discussed and agreed with Mr Onyerindu. 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, The DS0000010636.V333336.R01.S.doc Version 5.2 Page 9 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.V333336.R01.S.doc Version 5.2 Page 10 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): 3 (Standard 6 does not apply to this home) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. • People moving into the home can be confident that their needs will be assessed and an appropriate plan for meeting these needs will be drawn up. EVIDENCE: At the previous inspection in November 2006 a resident had been admitted with a degree of dementia who had then moved on to another home giving rise to concerns that prospective residents might be admitted for whom the home was not registered and whose needs the home would be unable to meet. At this inspection the files for all 5 residents were looked at and indicated that before they moved in a full assessment had been received from Social Lime Trees, The DS0000010636.V333336.R01.S.doc Version 5.2 Page 11 Services. The Lime Trees had then carried out its own assessment in order to decide if the home could meet the individual’s needs. A care plan had then been drawn up by the home showing how these needs were to be met. A member of staff confirmed that prospective residents have the opportunity to visit the home before they decide to move in. The majority of the residents spoken to said that they enjoyed living at the home and thought that their needs were being met. Observation throughout the inspection showed that none of the existing group of residents is inappropriately placed at The Lime Trees. As a result standards in this area have improved and prospective residents are better protected than previously. In line with national policy within CSCI the present conditions attached to the home’s certificate of registration will be reviewed with a view to removing those no longer seen as necessary. Mr Onyerindu indicated that he would be happy to see all existing conditions removed. Lime Trees, The DS0000010636.V333336.R01.S.doc Version 5.2 Page 12 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): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. • Residents feel supported at the home since the individual plans of care for each resident reflect their needs and wishes. However not all residents have the benefit of comprehensive risk assessments. Residents benefit from the attention paid by staff to meeting their health needs. Residents do not have the protection of accurate record keeping in relation to medication. Residents benefit from being treated with respect by staff at the home and can be sure that staff will respect their privacy. • • • Lime Trees, The DS0000010636.V333336.R01.S.doc Version 5.2 Page 13 EVIDENCE: The records for each resident were looked at and indicated that for each one there is a current plan of care. These plans set out the needs of the resident and how they are to be met by the home. All staff had recently attended training in care planning. Staff interviews indicated staff could be more involved in drawing up and implementing care plans, for example by having regular one to one meetings with residents. It is recommended that the staff are more actively involved in drawing up and implementing care plans. All residents had recently been reviewed by their funding authority, given concerns about the running of the home, to ensure that residents’ needs were being met. As previously required risk assessments for residents have been updated and are more detailed so that residents are properly protected at all times. However key areas of risk in relation to one resident had not been assessed. In order for a resident to be as safe as possible it is essential that all key areas of risk to the safety of residents are assessed and a plan devised to minimise these risks. In the past feedback received about healthcare in the home had been mixed. As a result staff had attended training since the previous inspection in dementia, first aid and infection control. As a result the home is now better at meeting the health needs of residents, with positive feedback from both residents and relatives. The records showed that residents are being weighed regularly and are being seen by dentists, opticians, chiropodists and doctors. Medication arrangements were observed and relevant records looked at. All staff have recently had training in the administration of medication. Medication is given out appropriately and most records relating to the administration of medication were accurate and up-to-date. However medication profiles on residents’ files did not in most cases match up with the medication administration sheets being used. The home must ensure that the various records kept in relation to medication correspond to minimise the risk of mistakes being made. Throughout the inspection staff were observed treating the residents with respect. Staff supported residents discretely at mealtimes if they needed some help. One resident was interviewed in his room so that they could have privacy. As a result residents at The Lime Trees benefit from being treated respectfully and have the opportunity to be private when they wish to be. Lime Trees, The DS0000010636.V333336.R01.S.doc Version 5.2 Page 14 Lime Trees, The DS0000010636.V333336.R01.S.doc Version 5.2 Page 15 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): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. • • • • Residents enjoy the friendly and caring atmosphere in the home. Staff are good at welcoming relatives and friends so that they also feel part of the home. Residents make their own decisions wherever possible about what they do when. Mealtimes are enjoyed by the residents who have a choice about what they eat. EVIDENCE: Lime Trees, The DS0000010636.V333336.R01.S.doc Version 5.2 Page 16 ‘I keep very busy.’ ‘I go out for walks. I like my mystery books. The library brings them.’ These were the comments of 2 of the residents about what they did in the home. Religious needs are well catered for with one resident a regularly attending a local church, and a minister coming into the home regularly to see other residents. Efforts have been made to increase the range of activities offered to residents so that there is now a wider range of stimulating activities for residents at the home. However less independent residents rarely go out of the home, partly because in some cases they do not wish to. It is recommended that residents have more regular opportunities to go out from the home to use local community resources as well as going on some group outings. ‘I speak to my family on the phone every day.’ This was the comment of one resident who kept in close contact with their family. Feedback from relatives indicated that they appreciated the friendly family-like atmosphere in the home. One relative had written: ‘ I feel my relative is truly a family member at the home. I myself feel like a member too instead of just a visitor which makes my relative content.’ Residents make choices about what they do. One resident chooses when they go out to church, another if they go for a walk or stay in their room. Residents can participate in or opt out of activities such as doing puzzles, having their nails painted. As a result residents are enabled to choose how they lead their life at the home. ‘The food’s alright.’ ‘I enjoy my food.’ These were the comments of 2 residents about the food in the home. Feedback from staff & residents and residents confirmed that individual preferences are catered for. The lunchtime arrangements were seen to be relaxed with healthy and nutritious food provided. However nutrition intake in general cannot be determined since a record is not kept of food provided to residents. The home must keep a record of all food provided to residents so that it can be checked if they are having a satisfactory diet. The presentation of the tables at lunchtimes was basic. It is recommended these arrangements are improved with suitably attractive tablecloths, condiments, jugs of water and so on. Lime Trees, The DS0000010636.V333336.R01.S.doc Version 5.2 Page 17 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): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. • • Residents and relatives can be confident their complaints will be listened to and taken seriously. Residents benefit from adult protection procedures that make sure that they are safe and secure whilst at The Lime Trees. EVIDENCE: Relatives had written that they were happy with the care provided to their family member and that staff communicated well with them about any issues that needed sorting out. The complaints book was seen and indicated that complaints made have been investigated and resolved. Compliments received by the home included one from a family whose relative had recently died: ‘Sincere thanks from all the family for the assistance you and the staff gave during the time our relative was with you. It is of comfort to know that their Lime Trees, The DS0000010636.V333336.R01.S.doc Version 5.2 Page 18 last few years were spent in such a place.’ Staff interviews indicated they are aware of how to respond appropriately to a complaint. ‘I get no aggravation from the staff. I’m quite happy here.’ This was the view of one resident. There have been no adult protection incidents in the home in the past year. All staff had had recent training in adult protection. Staff interviews confirmed that members of staff now know how to respond appropriately to any allegations or incidents of abuse. Lime Trees, The DS0000010636.V333336.R01.S.doc Version 5.2 Page 19 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): 19,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. • • Residents do not have the benefit of an attractive and well-maintained living environment. Residents benefit from living in a home that is kept clean. However hygiene standards need improving so that residents are protected from unpleasant odours. EVIDENCE: The home has a homely and comfortable but rather tired appearance. The owner acknowledged that the home needed refurbishment and redecoration. It Lime Trees, The DS0000010636.V333336.R01.S.doc Version 5.2 Page 20 is essential that the home has an ongoing programme of redecoration and refurbishment so that residents can enjoy an attractive living environment. The chairs in the lounge are worn and in need of replacement. New chairs must be provided in the lounge so that residents benefit from attractive and comfortable seating. The grass in the garden area had not been cut making it less attractive for residents to sit out in the garden. Garden furniture is needed so that residents are able to take advantage of the garden in good weather. The home must ensure that the garden is well maintained and accessible so that residents can benefit from having a garden. Throughout the inspection the home was found to be clean. Comments from relatives and staff indicated that they considered a good standard was being achieved in this area. A regular visitor had commented: ‘I’m always made to feel welcome and am impressed with the cleanliness.’ Staff have had training in infection control. However in one bedroom it was noted that there was an unpleasant odour. The home must ensure that bedrooms are at all times hygienic and unpleasant odours dealt with. Lime Trees, The DS0000010636.V333336.R01.S.doc Version 5.2 Page 21 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): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. • • • • Residents benefit from the support of a committed and experienced team of staff at the home. Staff have the knowledge and skills to meet the needs of residents. Residents have the protection of staff that have been recruited using the procedures and checks designed to safeguard residents. Residents benefit from being supported by trained and competent staff. EVIDENCE: ‘I get on ok with the staff.’ ‘ I don’t get aggravation from the staff.’ These were the views of 2 residents. Written feedback from relatives was positive, with comments such as: ‘Sincere thanks for all the assistance the staff gave to our relative during the time they were at The Lime Trees.’ Staff at the home have built up a reasonable knowledge and understanding of the needs of each resident. As a result residents are supported by staff who are experienced and Lime Trees, The DS0000010636.V333336.R01.S.doc Version 5.2 Page 22 caring. Staff rotas indicated that there is sufficient staff on duty at all times to meet the needs of residents. The owner and the acting manager have relevant qualifications in relation to the care of older people. As previously required more than half the care staff have now been enrolled on or have achieved NVQ Level 2 training in the care of older people. As a result the staff team is more able to support residents effectively. Staff files contain all the information needed to confirm that staff have had the appropriate checks made. At the previous inspection in November 2006 2 new staff had started working at the home before a satisfactory CRB (Criminal Records Bureau) disclosure had been obtained. Mr Onyerindu is now aware of the importance of obtaining satisfactory CRB disclosures before new staff begin working at the home. As a result residents are now better protected than previously by the home’s recruitment practices. As a result of enforcement action taken by CSCI against the home after the inspection in November 2006 all staff had attended a wide range of courses. This training included: • Health & Safety • Food Hygiene • Moving & Handling • Dementia • Infection Control • Fire Safety • Medication • Care Planning • Adult Protection • First Aid As a result residents now get better support and care from the staff at the home. As previously required the home now has an ongoing schedule of training so that staff get the training they need to support residents effectively. In some cases staff were due to have refresher training in areas where their previous training was only valid for a specific period of time. The management team in the home must ensure that staff identified as needing refresher training get this before their existing certificate expires. Lime Trees, The DS0000010636.V333336.R01.S.doc Version 5.2 Page 23 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): 31,33,35,38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. • Residents benefit from having the home run by an owner who is experienced and qualified to operate a care home. However residents do not have the security of living in a home that is run by a manager that has been registered and approved by CSCI. The comments and views of residents and relatives are taken into account in the day to day running of the home and when reviewing the quality of the service provided. Residents do not have the protection of robust policies and procedures in relation to the management of their monies by the home. • • Lime Trees, The DS0000010636.V333336.R01.S.doc Version 5.2 Page 24 • In general health and safety records are satisfactory but the home must improve its 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 is actively involved in the daily running of the home. Following the inspection in November 2006 CSCI issued a number of enforcement notices against the home in order that failings identified at previous inspections were dealt with so that residents have a more satisfactory quality of life at the home. These failings mainly concerned not providing adequate training for staff and for not running the home properly. The former manager of the home left at the end of 2006 and an acting manager from an agency took over from January to April 2007. In May 2007 another acting manager from the same agency took over and was put forward for registration as a fit manager to CSCI’s Regional Registration Team. This process is not yet complete. Inspections were made on 2/3/07, 3/4/07 and 28/6/07 to check on the progress being made to comply with all the areas of enforcement. Mr Onyerindu, together with the acting managers at the home, has worked hard to deal with all the areas identified as needing urgent action. As a result all these areas of enforcement have now been dealt with. However for the past few months there has been a period of instability in relation to the management of the home that is as yet unresolved. It is essential if the home is to maintain and build on the recent improvements made that the home employs a full time manager who has been registered. The home has a policy on how it reviews the quality of care provided. Relatives are happy or very happy with the service provided by the home. Residents had been helped by staff to complete feedback forms. Residents participate in residents’ meetings where they are able to make suggestions about the general running of the home, as well as highlighting their own wishes e.g. when they wanted staff to clean their room, food preferences. As a result the home now has an improved range of measures in place to work out what life is like for residents at The Lime Trees and how things can be improved. Arrangements regarding residents’ finances were checked. In most cases relatives look after the resident’s monies and financial affairs. Some residents look after their own monies with support from staff. Records kept by the home Lime Trees, The DS0000010636.V333336.R01.S.doc Version 5.2 Page 25 in relation to one resident were unclear and inaccurate so that there was not a proper audit trail for her personal income and expenditure. The local authority concerned had not been promptly provided with information about the resident’s finances by the home when this had been requested. In another case a private arrangement had been set up by a relative with a member of staff which did not provide proper protection in relation to the resident’s monies. As a result residents who are supported by the home with the management of their monies can not be confident that secure arrangements are in place. It is essential that the home has proper procedures and up to date records in place when the home is supporting residents to manage their monies so that there is no risk of financial abuse. Health and safety and fire safety records were looked at. These records confirmed that essential checks are being made and acted on. Fire drills are held four times a year. In line with guidance from the LFEPA (London Fire & Emergency Planning Authority) the home now has an up to date fire safety risk assessment of the premises and has implemented required actions to keep residents and staff safe. However fire evacuation notices displayed in the home were out of date and carried inaccurate information. It is essential that the fire notices displayed in the home are consistent with the home’s fire safety risk assessment and action plan. Lime Trees, The DS0000010636.V333336.R01.S.doc Version 5.2 Page 26 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 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 1 x x 2 Lime Trees, The DS0000010636.V333336.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 13 (4) Timescale for action All key areas of risk to the safety 31/07/07 of residents to be assessed and a plan devised to minimise these risks so that residents are kept safe. Records of medication to 31/07/07 correspond to minimise the risk of mistakes being made. A record of all food provided to 31/07/07 residents to be kept so that it can be checked if residents are having a satisfactory diet. The home to have an ongoing 31/07/07 programme of redecoration and refurbishment so that residents can enjoy an attractive living environment. The garden to be well 31/07/07 maintained and accessible so that residents can benefit from having a garden. New chairs to be provided in the 31/07/07 lounge so that residents benefit from attractive and comfortable seating. DS0000010636.V333336.R01.S.doc Version 5.2 Page 28 Requirement 2. OP9 13 (2) 3. OP12 17 (2) Sch.4 (13) 23 (20 (d) 4. OP19 5. OP19 23 (2) (o) 6. OP20 23 (2) (b) Lime Trees, The 7. OP26 16 (2) (k) Bedrooms are at all times to be 31/07/07 hygienic and kept free from unpleasant odours. Staff identified as needing 31/07/07 refresher training to get this before their existing certificate expires. The home to employ a full time 31/07/07 manager who has been registered by the CSCI Regional Registration Team. The home to have proper 31/07/07 procedures and records in place when the home is supporting residents to manage their monies so that there is no risk of financial abuse. The fire notices displayed in the 31/07/07 home to be consistent with the home’s fire safety risk assessment and action plan. 8. OP30 18 (1) (c) 9. OP31 9 (1) & (2) 10. OP35 13 (6) 11. OP38 23 (4) (e) 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 YA6 Good Practice Recommendations The registered persons should ensure that the staff are actively involved in drawing up and implementing care plans. 2. OP12 The registered persons should ensure that that residents DS0000010636.V333336.R01.S.doc Version 5.2 Page 29 Lime Trees, The have more regular opportunities to go out from the home to use local community resources as well as going on some group outings. 3. OP15 The registered persons should ensure that that the presentation of tables at mealtimes is improved with suitably attractive tablecloths, condiments, jugs of water and so on. Lime Trees, The DS0000010636.V333336.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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. Extracts may not be used or reproduced without the express permission of CSCI Lime Trees, The DS0000010636.V333336.R01.S.doc Version 5.2 Page 31 - 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. 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