Inspection on 07/11/06 for Lime Trees, The

This inspection was carried out on 7th November 2006.

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 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 7th November 2006 09:30 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.V318786.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.V318786.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 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.V318786.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. 25th April 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. In April 2006 Mr Onyerindu, the owner of The Lime Trees, said that the fees charged by the home ranged from £377/week up to £ 400/week. The brochure detailing the service provided by The Lime Tress and inspection reports on the home are made available to residents, families and prospective residents. Lime Trees, The DS0000010636.V318786.R01.S.doc Version 5.2 Page 5 In October 2006 Mr Onyerindu applied to CSCI for the Lime Trees to be registered to admit people with mental and physical disabilities, dementia, diabetes, Parkinson’s disease, rheumatoid arthritis and recovering alcoholics. Lime Trees, The DS0000010636.V318786.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 2 days and lasted 12 hours. Brian Bowie, the allocated inspector for The Lime Trees, carried out the inspection. The registered manager, Nnenna Ekeoma, assisted with the inspection. The inspector looked round all areas of the home and spoke to all of the 7 people resident in the home at the time of the inspection. 3 of the residents said what they thought about the home in the privacy of their own bedroom. Relatives and friends of 3 of the residents were spoken to in confidence to get their views and comments on the home. 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 continuing to provide a reasonable standard of day to day care to residents and has a relaxed familylike atmosphere. Relatives spoken to were very positive and appreciative about the care provided to their family member. However a number of important areas relating to the running of the home have still not being dealt with. As a result the general assessment of the service is now considered to be poor, rather than adequate. This situation must be tackled as a matter of urgency so that residents can be assured of a living in a home that is fully effective in meeting all their needs all of the time. What the service does well: What has improved since the last inspection? Lime Trees, The DS0000010636.V318786.R01.S.doc Version 5.2 Page 7 Some areas that needed sorted out from the previous inspection have been dealt with. As a result care plans detail more clearly the needs of each resident. Occupational therapists have carried out an assessment of the premises in relation to accessibility for people with disabilities. What they could do better: At the previous inspection there had been 15 areas the home had to improve. 4 of these areas have been sorted out. Of the other 11 areas in some cases there had been improvements but overall had not yet reached the national minimum standard. As a result action is once more needed on these areas with new timescales set to get things done. Further information about unmet requirements can be found in the relevant section. Unmet requirements impact upon the welfare and safety of service users. Failure to comply by the revised timescale will lead to the Commission for Social Care Inspection considering enforcement action to secure compliance. In addition 7 new areas to be improved are identified. 2 areas needed sorting out urgently. New staff had been taken on without first obtaining a CRB disclosure, and a resident had been admitted with dementia which the home is not permitted to do. In order that the needs of residents are properly met at all times the home needs to achieve the following: • • • • • • • • No person to be admitted into the home who falls outside of the home’s conditions of registration Risk assessments to indicate clearly the level of risk and how this has been worked out Staff to have the skills and training needed to meet the health needs of residents An imaginative and varied programme of activities to be available with take up of activities offered recorded Complaints to be dealt with promptly and effectively Staff to have training in adult protection A minimum of 2 staff to be on duty at all times in order to ensure residents are kept safe Over half of the care staff to achieve an NVQ Level 2 in caring for older people, or equivalent qualification DS0000010636.V318786.R01.S.doc Version 5.2 Page 8 Lime Trees, The • New and satisfactory CRB disclosures to be obtained for the 2 staff specified and in the meantime these staff must work under the supervision of a senior member of staff An ongoing programme of training that responds to the developing needs of both residents and staff All staff to have training in working with people with dementia in order to improve practice at the home The manager to keep up to date with good care practice by attending training in dementia, person-centred planning and adult protection The home to be managed effectively at all times Staff to have regular, recorded supervision meetings at least 6 times each year Records to be up to date, accurate and available for inspection so that the home is run effectively and residents safeguarded CSCI to be notified of any serious event in the home, including the death of a resident The home to have an up to date fire safety risk assessment of the premises which has been seen by the LFEPA (London Fire & Emergency Planning Authority) • • • • • • • • One recommendation is made: • The home to provide more and clearer signing to assist residents to get around the home more confidently All the areas for improving the service were discussed and agreed with the manager, as were the 2 items that needed sorting out urgently. Without these improvements the good care practice that is in place at the The Lime Trees will be further weakened and residents will end up with a poorer and less reliable service. 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.V318786.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.V318786.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 poor. This judgement has been made using available evidence including a visit to this service. • People with specialised needs moving into the home cannot be confident that their needs will be met. EVIDENCE: One person moved into the home in July 2006 as a result of an emergency placement. The individual had specialised needs because she was insulin diabetic and had dementia, a sensory impairment and some challenging behaviours. Concerns were raised by the local district nursing team in relation to the management of this individual’s diabetes by the Lime Trees. A review was held and a decision taken that in view of the individual’s high needs an alternative placement was required. As a result the person concerned has moved to another home. Lime Trees, The DS0000010636.V318786.R01.S.doc Version 5.2 Page 11 The records in relation to this individual from both health and social services professionals indicate a diagnosis of dementia. The Lime Trees is not registered to admit people with a diagnosis of dementia. The registered manager acknowledged this. As a result the home has to confirm in writing that it will not admit people with needs that they are not currently registered to meet. Following the inspection the registered manager confirmed in writing that the home would not admit people with dementia. Lime Trees, The DS0000010636.V318786.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. • Care plans have improved and indicate more clearly the needs of residents. However residents do not have the protection of detailed up to date risk assessments. In general the home is good at meeting the health needs of residents. However the home has difficulty meeting the needs of residents with more specialised needs, such as dementia or if they are insulin diabetic. Residents are protected by the effective and safe arrangements in place in relation to the administration of medication. Staff treat residents with respect and residents can be sure that staff will respect their privacy. • • • EVIDENCE: Lime Trees, The DS0000010636.V318786.R01.S.doc Version 5.2 Page 13 The records for 3 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 are to be met by the home. Risk assessments had been updated, but were in a summary form that did not indicate how the assessment had been worked out. The home has a form for comprehensive risk assessments that must be completed so that residents can be confident risks to their safety are being carefully calculated and properly managed. Feedback received about healthcare in the home was mixed. Residents themselves are positive about how their health needs are met, with one resident saying: ‘Last week I had my flu jab and blood pressure checked-I’m keeping well.’ Relatives spoken to were also very positive, with comments such as: ‘Their health’s improved- they’re walking better now. ‘ ‘If my relative has any problems they call the GP- their eye problem got sorted out recently.’ ‘They keep us informed and help out with hospital appointments.’ The records showed that residents are being weighed regularly and are being seen by dentists, opticians, chiropodists and doctors. In contrast feedback from health professionals who have regularly contact with the home indicated that staff do not always understand the care needs of residents and that staff need to ‘improve their knowledge and skills in order to give good & safe care.’ The manager must identify with these health professionals where training is needed and then ensure the appropriate training is provided to staff. Medication arrangements were observed and relevant records looked at. Medication is given out appropriately and records relating to the administration of medication were accurate and up-to-date. Staff have had training in the administration of medication. One resident commented: ‘I find the staff are very reliable about giving me my medication.’ Throughout the 2 days of the inspection staff were observed treating the residents with respect. Staff were seen to provide support discretely at mealtimes if a resident needed some help. Staff were also seen knocking before entering residents’ bedrooms. Interviews with both residents and relatives took place in private areas. One resident prefers to stay in her bedroom and this wish has been respected by staff. 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.V318786.R01.S.doc Version 5.2 Page 14 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. However there is an ongoing weakness in the quality of stimulation for residents with higher levels of need. This judgement has been made using available evidence including a visit to this service. • Residents are getting what they expect from the home in terms of the friendly and caring atmosphere. However residents still do not have the benefit of a sufficiently organised and stimulating range of social activities. 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.V318786.R01.S.doc Version 5.2 Page 15 Feedback from both residents and relatives indicated that both groups particularly appreciated the friendly family-like atmosphere in the home. 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. Efforts have been made to increase the range of activities offered to residents. The owner, and some relatives, 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 properly so that progress in this area can be reviewed. This is particularly important for those residents who are not able to go out on their own and have particular needs because of difficulties in communicating or because since moving into the home have developed dementia. The weekly programme indicates that outings and bus trips takes place one day a week. Interviews with staff and residents indicated this was not the case. A member of staff said: ‘Residents do not get out much- outings would be good- or go to a local café.’ The manager acknowledged staff had not had accredited training in dementia and this is limiting the quality of stimulation for these residents. A specific record of activities taken up by residents has still not been produced. Given this area has previously been highlighted it is now urgent that staff have accredited training in dementia so that residents get the stimulation they need and that a specific record is kept of activities offered to and taken up by residents. 3 Relatives were spoken to. Each one was positive about the contact they had with the home and the good relationships they had built up over time with the staff and proprietor, with comments such as: ’They keep in touch with us. We can visit when we want.’ ‘I can come and go when I want. I go to church regularly on my own and to the shops. This was the comment of one resident who valued the opportunity he had at The Lime Trees to live as independent a lifestyle as possible. Another resident commented: ‘I go out for a walk when I want to, and if I want to stay in my room, rather than the lounge, I can do that.’ As a result residents are enabled to choose how they lead their life at the home. Residents were positive about the food in the home. Comments included: ‘The food is good, and is varied.’ ‘I’m practically vegetarian now and I get the food I want.’ The lunchtime arrangements were observed and seen to be relaxed. Discussion with residents and relatives confirmed that individual preferences are catered for. Lime Trees, The DS0000010636.V318786.R01.S.doc Version 5.2 Page 16 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 poor. This judgement has been made using available evidence including a visit to this service. • In general residents and relatives are able to sort out their concerns and complaints as they arise. However a recent anonymous complaint has highlighted a weakness in responding appropriately and effectively to complaints. Residents are not properly protected since staff have still not had training in the current procedures and policies applying to the protection of vulnerable adults. • EVIDENCE: Relatives spoken to said 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 in the past year 2 anonymous complaints had been made. The first had been looked into and appropriate action taken. The second one was still being dealt with since the initial investigation had not been thorough enough and the response made had been slow and included some comments which had been challenged by the professional involved as inaccurate. The home must ensure that complaints are dealt with promptly and effectively. Lime Trees, The DS0000010636.V318786.R01.S.doc Version 5.2 Page 17 There have been no adult protection incidents in the home in the past year. Staff interviews, including the manager, indicated that they did not know the correct procedures to follow if an incident, or allegation, of abuse took place. All staff must have up to date training in adult protection so that they are fully aware of current policies and procedures in order that residents at The Lime Trees are properly protected. It is urgent that staff have this training given that the home has previously failed to see that this is provided. Lime Trees, The DS0000010636.V318786.R01.S.doc Version 5.2 Page 18 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): 19,22,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. • • The living environment is homely and comfortable. Residents with mobility difficulties benefit from the aids and adaptations in the home. People who use wheelchairs have restricted access around the home. Residents benefit from living in a home that is kept clean and hygienic. • EVIDENCE: Lime Trees, The DS0000010636.V318786.R01.S.doc Version 5.2 Page 19 Throughout the 2 days of the inspection the home had a homely and comfortable appearance. One relative said: ‘The resident’s bedroom is always tidy.’ Residents feel safe and looked after at the home, with one resident saying: ‘I like my room. I’ve got everything I want. I can have my meals in here if I want to.’ The Lime Trees is a converted building with restrictions for wheelchair users, including narrow corridors and some sloping floors. As previously requested an up-to-date assessment of the premises by an occupational therapist has been made. The report recommends that if in future residents with severe dementia are admitted into the home then there needs to be clearer signing in the home with more use of photos and colour-coding to help people find their way around the home. It is recommended that the home provides more and clearer signing to assist residents to get around the home more confidently. One resident commented: ‘They’re always cleaning my room.’ Throughout the inspection the home was found to be clean and hygienic. Comments from relatives and staff indicated that they considered a good standard was being achieved in this area. In one case more suitable flooring had been provided in the bedroom of a resident who was regularly incontinent. Lime Trees, The DS0000010636.V318786.R01.S.doc Version 5.2 Page 20 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 poor. 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. However staffing arrangements do not ensure the needs of residents are fully met at all times. Staff have the knowledge and skills to meet the basic needs of residents. Residents do not have the protection of staff who have been recruited using the procedures and checks designed to safeguard residents. Residents, particularly those with higher needs, do not have the benefit of being supported by staff who have had accredited training in dementia and person-centred planning. • • • EVIDENCE: Staff at the home have built up a reasonable knowledge and understanding of the needs of each resident. Positive feedback was received from the residents about the care they receive from staff. One resident said about the staff: ‘ Any time I’m in trouble I can look to them.’ Staff are positive about the residents Lime Trees, The DS0000010636.V318786.R01.S.doc Version 5.2 Page 21 with comments such as: ‘They’re a lovely group to work with.’ commented: ‘ Staff are nice and helpful.’ ‘Staff are very good.’ Relatives On the first day of the inspection there was a period of time when only one member of staff was on the premises because a member had been delayed getting to the home. Given the needs of the residents it is essential that there is a minimum of 2 staff on duty at any time in order to ensure the residents are kept safe. The owner and the manager have relevant qualifications in relation to the care of older people. Some care staff are now undertaking NVQ Level 2 or 3 training in the care of older people to improve their caring skills further. The majority of care staff have not yet achieved NVQ Level 2 in care. The manager must ensure that at least half of the staff team achieve this qualification, or an equivalent, so that residents can be assured there are suitably qualified staff on at all times in the home. Staff files were looked at and contained most of the relevant information needed. However 2 new staff are working in the home without a satisfactory new CRB disclosure having first been obtained. The manager acknowledged this had not been done. In order that residents are properly safeguarded it is essential that CRB disclosures are obtained on all new staff. The manager must ensure that fresh CRB disclosures are obtained for the 2 staff concerned, and that in the meantime they must work under the supervision of a senior member of staff. Following the inspection the manager confirmed in writing that this would be done. 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. However there was little evidence of a planned ongoing training programme in response to the identified needs of staff and residents that ensures staff’s knowledge and skills are kept up to date with good care practice. The owner needs to ensure that there is an ongoing programme of training which responds to the developing needs of both residents and staff. All staff must have training in working with people with dementia in order to improve practice at the home. This is particularly important since the owner of the home has applied to CSCI for a major variation to The Lime Trees’ current certificate of registration to enable the home to admit people with a range of specialised needs, including a diagnosis of dementia. Lime Trees, The DS0000010636.V318786.R01.S.doc Version 5.2 Page 22 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): 31,32,33,35,36,37,38 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 consistently and effectively run at all times. The Lime Trees needs to be better at reviewing and improving the quality of care provided to residents, using systems which draw on the residents’ own experiences of living at the home. Residents benefit from there being appropriate policies and procedures in place in relation to residents’ monies. • • Lime Trees, The DS0000010636.V318786.R01.S.doc Version 5.2 Page 23 • • • Staff benefit from having supervision meetings, but these need to be more frequent and recorded. Key aspects of the day to day management of the home, in particular in relation to the keeping of a wide variety of records, are inadequate. 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 has achieved the award for registered managers for running a care home. He is also undertaking further training in the area of the mental health, including dementia, of older people. He is actively involved in the daily running of the home. The manager of the home has been assessed and registered as a suitable person to manage the home and is training to be a NVQ assessor. The manager was interviewed and acknowledged she had not had specific training in dementia, was not aware of person-centred planning in relation to work with older people and was not aware of the correct procedure to follow in relation to adult protection. The manager must attend training in these areas so that she maintains her own professional development by keeping up to date with good care practice and in order for her to support and manage staff effectively. The day to day management of the home is weak in a number of areas. Records in specific areas, including in-house training, risk assessments, staff supervision are not being kept reliably and consistently. In addition both residents’ meetings and staff meetings are being held infrequently, thereby reducing the opportunities residents and staff have to contribute to the running of the home. As a result many aspects of the management and administration of the home are poor. The manager acknowledged this area of weakness. The manager must ensure that the home is managed at all times effectively and in a way that encourages good practice and improvement so that residents benefit from a home that works hard and consistently at improving the standard of care provided. The home has a policy on how it reviews the quality of care provided. Relatives spoken to said they were happy or very happy with the service provided by the home. Residents had been helped by staff to complete feedback forms. However the information obtained was very limited and did not indicate what the experience for the resident was of living at The Lime Trees. The owner needs to ensure the home has a range of effective measures Lime Trees, The DS0000010636.V318786.R01.S.doc Version 5.2 Page 24 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. One resident said: ‘I go down the shops when I want, and buy what I want with my own money.’ No concerns were raised or identified in this area. The manager said she supervised staff on a 3 monthly basis. A new member of staff in post for 2 months had not yet had a supervision meeting. Little evidence was found in staff files of recorded supervision meetings. As previously required staff must have regular, recorded supervision meetings at least 6 times each year. As highlighted above record keeping is a weak area within the home. Specific staff files and a file on a service user having respite care at the home were not on the premises or made available during the inspection. The schedule for staff supervision had not been updated to include a new member of staff. The manager must make sure that records are up to date, accurate and available for inspection so that the home is run effectively and residents safeguarded. The manager acknowledged that CSCI had not been notified, as is required, following the recent death of one of the residents. The registered manager must ensure that CSCI is notified of any serious event in the home, including the death of a resident. 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 the home must have an up to date fire safety risk assessment of the premises. The owner had requested information about this area, but an up to date fire safety risk assessment had not been made. It is now urgent that a risk assessment is made so that residents are fully protected. Lime Trees, The DS0000010636.V318786.R01.S.doc Version 5.2 Page 25 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 1 X X x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 1 3 X X 3 X X X 3 STAFFING Standard No Score 27 1 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 2 X 3 1 2 1 Lime Trees, The DS0000010636.V318786.R01.S.doc Version 5.2 Page 26 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 OP3 Regulation 14 (1) (b) Timescale for action The registered persons must 09/11/06 ensure that no person is admitted into the home who falls outside the home’s conditions of registration. An immediate requirement is made to ensure compliance. The registered persons must 31/12/06 ensure that risk assessments indicate clearly the level of risk and how this has been worked out. The registered persons must 31/01/07 ensure that staff have the skills and training needed to meet the health needs of residents. The registered persons must 31/01/07 ensure that a more imaginative and varied programme of activities is available with take up of activities offered recorded. (Timescale of 30/06/06 not met. Requirement restated) The registered persons must 30/11/06 ensure that complaints are dealt with promptly and effectively. Requirement 2. OP7 13 (4) 3. OP8 12 (1) (a) 4. OP12 16 (2) (m) 5. OP16 22 (3) Lime Trees, The DS0000010636.V318786.R01.S.doc Version 5.2 Page 27 6. OP18 18 (1) (c) The registered persons must ensure that staff have training in adult protection. 31/01/07 7. OP27 18 (1) (a) 8. OP28 18 (1) (a) (Timescale of 31/07/06 not met. Requirement restated) The registered persons must 07/11/06 ensure that there is a minimum of 2 staff on duty at any time in order to ensure the residents are kept safe. The registered persons must 31/03/07 ensure that over half of the care staff achieve an NVQ Level 2 in caring for older people, or equivalent qualification. (Timescale of 31/07/06 not met. Requirement restated) The registered persons must 10/11/06 ensure that new CRB disclosures are obtained for the 2 staff specified, and that in the meantime they must work under the supervision of a senior member of staff. An immediate requirement is made to ensure compliance. The registered persons must 31/12/06 ensure that there is an ongoing programme of training which responds to the developing needs of both residents and staff. 9. OP29 19 (4) (b) 10. OP30 18 (1) (c) 11. OP30 12. OP31 (Timescale of 30/06/06 not met. Requirement restated) 18 (1) (c ) The registered persons must 31/01/07 ensure that all staff have accredited training in the care of people with dementia. (Timescale of 31/07/06 not met. Requirement restated) 10 (3) The registered persons must 31/01/07 ensure that the manager has ongoing training to keep up to date with good care practice, DS0000010636.V318786.R01.S.doc Version 5.2 Page 28 Lime Trees, The 13. OP32 9 92) (b) and specifically to do training in areas of adult protection, dementia and person-centred planning. The registered persons must 31/12/06 ensure that the home is managed at all times effectively (Timescale of 30/06/06 not met. Requirement restated) The registered persons must 31/01/07 ensure that the quality of service is regularly reviewed and evaluated. (Timescale of 30/06/06 not met. Requirement restated) The registered persons must 31/12/06 ensure that staff must have regular, recorded supervision meetings at least 6 times each year. (Timescale of 30/06/06 not met. Requirement restated) The registered persons must 31/12/06 ensure that records are up to date, accurate and available for inspection. (Timescale of 30/06/06 not met. Requirement restated) The registered persons must 13/11/06 ensure that CSCI is notified without delay of any serious event in the home, including the death of a resident. (Timescale of 27/04/06 not met. Requirement restated) The registered persons must 30/11/06 ensure that the home has an up to date fire safety risk assessment of the premises that has been checked by the LFEPA. (Timescale of 30/06/06 not met. Requirement restated) 14. OP33 24 (1)24 (3) 15. OP36 18 (2) 16. OP37 17 (3) (a) (b) 17. OP37 37 18. OP38 23 (4) (a) Lime Trees, The DS0000010636.V318786.R01.S.doc Version 5.2 Page 29 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 OP22 Good Practice Recommendations The registered persons should provide more and clearer signing to assist residents to get around the home more confidently. Lime Trees, The DS0000010636.V318786.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.V318786.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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