Inspection on 09/11/07 for Lime Trees, The

This inspection was carried out on 9th November 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 28/06/07

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 Duncan Paterson Key Unannounced Inspection 10:10 9 & 18th November 2007 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.V354320.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.V354320.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 Aloysius Augustine 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.V354320.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. 21st August 2007 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 per 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.V354320.R01.S.doc Version 5.2 Page 5 Lime Trees, The DS0000010636.V354320.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection involved a full day on 9 November 2007 and was carried out by two inspectors. A second shorter visit, also involving two inspectors, was made to the home starting at 9.30pm on 18 November in order to check a staffing matter arising from the 9 November visit. Currently, there is only one person living at the home. The inspection involved speaking with the person living at the home, the staff on duty and the owner, Mr Onyerindu. A telephone conversation took place with a care manager, who is visiting the home each week. This was taken into consideration. The inspection also involved looking at the care planning documentation, staff files and a sample of the home’s records, procedures and forms. Observation and a tour of the premises also took place. What the service does well: What has improved since the last inspection? What they could do better: The main areas requiring improvements are the management arrangements and staff recruitment. Currently, there is no registered manager and the management systems and procedures have become disorganised and undisciplined. The registered person is currently managing the service. He has made some decisions which have meant that The Care Homes Regulations 2001 have not been complied with and other decisions have not followed good practice. Enforcement action is being considered by CSCI about this matter. Staff recruitment practices are poor resulting in staff having been employed without their full work histories having been obtained and in one case without a CRB check having been obtained. Again, CSCI is considering enforcement action about this. Lime Trees, The DS0000010636.V354320.R01.S.doc Version 5.2 Page 7 The policies are in need of review and organisation. There was confusion about the statement of purpose. The record of complaint investigation was brief and did not detail how complaints had been investigated. The Safeguarding Adults policy needs amendment. The care plan was detailed but needed to involve the people using the service more so that it better reflected their choices and enabled care provision that is based on an accurate view of people’s needs and wishes. Enforcement action is also being considered by CSCI about this. 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.V354320.R01.S.doc Version 5.2 Page 8 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.V354320.R01.S.doc Version 5.2 Page 9 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): 12&4 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. There is a range of assessment information about people using the service which is used to plan care aimed at meeting people’s needs. The service needs to be able to respond to issues as they arise so that people’s needs and dignity are not compromised. Having clear written information will benefit people using the service and others. EVIDENCE: We were shown two copies of the home’s statement of purpose. Neither was dated and there was some confusion as to which was the one in use. At the end of the inspection the registered person showed us the one he said was in use. There is a need to amend the statement of purpose to make sure that the names of registered people are correct. For example, the name of the manager on the statement of purpose was of a person who had left the home. The statement of purpose will also need amendment should there be a change to the categories of registration. There is a current application from the provider to CSCI for a change to the categories of registration. Lime Trees, The DS0000010636.V354320.R01.S.doc Version 5.2 Page 10 We were shown two statements of terms and conditions relating to the person currently using the service. One had been issued by the home and the second from the local council which fund the placement. We inspected the care planning documentation relating to the person using the service. This person has been resident for a number of years so it was not possible to assess the standard relating to needs assessment. However, we could see that there had been input from the local authority such as regular reviews having been carried out. We saw written evidence of these reviews. The telephone conversation with the care manager before the inspection confirmed that the needs of the person using the service were being met and that there had been some improvements over the course of the placement such as enabling the person to use the toilet independently. Having said that we found a problem relating to the clothes and belongings of the person using the service. The registered person advised us that the person’s clothes and a TV set had been removed from the home by the funding local authority when other people using the service moved out. The person using the service confirmed to us that his belongings had been taken. The precise events were not clear but the registered person confirmed that this had happened two months before and that he had not, to date, attempted to have the clothes and TV set returned. He told us that he had provided the person using the service with clothes that had been left behind at the home when other people using the service had died. A replacement TV was also provided. The registered person said that relatives had given permission for the clothes to be donated. During the inspection the registered person telephoned the local authority to request the return of the clothes and TV. Following the inspection the care manager has been alerted and has been able to return some of the clothes. He is to compile a list of the items to assist in an attempt to return all the belongings. The registered person told us that he had not followed the matter up because of poor relations with the local council and an unwillingness to cause further disagreement and stress between the two parties. However, the registered person is expected, in order to meet this standard, to ensure that people using the service have their needs met. Especially basic needs such as being able to wear their own clothes. Where people using the service may have difficulty acting for themselves the expectation in this type of situation would be for the registered person to act promptly to arrange the return of the belongings. Intermediate care is not provided at this care home. Lime Trees, The DS0000010636.V354320.R01.S.doc Version 5.2 Page 11 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 10 & 11 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Involving people using the service more in the drawing up of care plans should ensure that care provision is based on people’s needs and wishes. The care plans in use are a useful base from which to expand. A relaxed and friendly style of care has been let down by a lack of understanding about privacy and dignity. A considered, sensitive procedure is needed to manage the belongings of people who have died. EVIDENCE: We inspected the care planning documentation relating to the person using the service. There was a range of paperwork including a handwritten care plan, review notes, a risk assessment, health records, a medication profile, details of weight and bathing as well as a book detailing the daily activities. Daily notes about the care provided were also being kept and these were shown to us. There was correspondence on file about personal finances which indicated that the local authority had been asked to assist the person in making appropriate Lime Trees, The DS0000010636.V354320.R01.S.doc Version 5.2 Page 12 financial arrangements although we could not tell whether the work to do this had been concluded. We spoke to the registered person and the main carer (who was providing care each weekday) about the arrangements for care provision. We also spoke to the person using the service. Personal care is provided assisting the person to get up, wash, bath and to shave. The main carer said that she took the person out both shopping and to the local park. A wheelchair was used for taking the person out. She said that she played cards with him, sat with him and talked with him. There had been a recent trip to Southend. This was all confirmed by the person using the service. He told us that since the other people had moved out he had been, “treated like a King”. The trip to Southend was confirmed both by the person and the home’s written records. We noted that the care plan, although it had eight aims and action points, had some gaps. These included use of the wheelchair, finance and information about the person’s choices and wishes. There was also no mention of his clothes having been taken. The care plan would be improved by having more input from the person using the service about needs and wishes and how care should be provided. We found that there was a record of health care appointments and that the district nurse had visited a number of times including on the day of the inspection when she came to give a flu jab. It was not possible to assess the medication standard. The person using the service was receiving only one item of medicine. This was being stored and recorded properly. With no other people living at the home more detailed medication arrangements were not in place to assess. A friendly, caring and informal approach was evident with good relations between the registered person, main carer and the person using the service. The person was obviously happy and appreciated the attention he was receiving. Steps had been taken to make sure that personal care was sensitively provided and ensured privacy. However, this positive work was let down by the fact that action had not been taken to retrieve the person’s belongings, that clothes of people who had died were seen as a suitable alternative and that it was not clear that visitors arranged for the person were ones that the person wished. Some of the person’s belongings have now been returned and work is in progress to return them all. Extending the care plan to include more detail and input from people using the service will assist in this area. It will be possible then to include details about people’s wishes relating to a whole range of matters including the visitors they have. Enforcement action is being considered by CSCI about the care planning arrangements. Lime Trees, The DS0000010636.V354320.R01.S.doc Version 5.2 Page 13 Two of the bedrooms we visited had a small number of items, such as photographs and clothes, belonging to people who had died. The registered person said that relatives or representatives had taken most of the belongings and had asked for the remaining ones to be donated. There should be a procedure to follow when people die so that items can be appropriately dealt with such as donating to charity. The photographs should be returned to relatives or, if that is not possible, entered into an album at the home. . Lime Trees, The DS0000010636.V354320.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 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. There is a good range of activities provided including community involvement. Some development work is needed to ensure that the activities provided reflect people wishes. EVIDENCE: As described above, a range of activities are provided. As there is only one person using the service at the moment an individualised service can be provided. Staff spend time with the person using the service and take him out to the shops and the park. The person told us he was happy at the home. However, he told us that he did not particularly like shopping and would prefer to go to sporting venues such as the dogs and snooker. The registered person also told us that people from a local church visited the person using the service. Communication was a little difficult but we did not get the impression that the person using the service minded these visits even though he was not religious. He has no relatives or visiting friends. We spoke to the registered person and main carer and they confirmed that they did not know about the person’s wishes about sporting interests. They undertook to look into that with the person. Lime Trees, The DS0000010636.V354320.R01.S.doc Version 5.2 Page 15 Also, the person told us that he would prefer to retire to his bedroom earlier but felt he was not allowed to by the main carer. This was raised with the registered person and main carer who advised that the issue was about encouraging the person to not retire to his bedroom so early in the day and to avoid isolation. There are peculiar circumstances at the moment as there is only one person living at the home. However, the discussions we had above can be addressed through the care plan being more detailed about such matters. On a similar theme there is some good work having been completed in keeping the person involved in the local community. Trips to the shops and the park help with this. However, the registered person needs to be sure that visitors are people whom the person chooses to see and confirm in writing that the visitors are the person’s choice. Our inspection covered the lunch time period which is when the main meal of the day is provided. The person using the service ate the meal sitting in his armchair in the lounge. We heard the main carer encouraging the person to sit at the dining table but he chose to stay in his armchair. He had a small table in front of him from which he ate. The main carer cooked the meal which was nicely presented with the food looking basic but appetising. Lime Trees, The DS0000010636.V354320.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 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Although there have been few complaints the learning from complaints, which could lead to service improvements, will be greatly improved by recording the specific details of the actual complaint and how they were investigated. Staff having had Safeguarding Adult training is positive but the overall arrangements need improvement through a revision of the Safeguarding policy. EVIDENCE: The complaints record book was shown to us. This was a hard bound exercise book in which there were brief records of complaints. We found it difficult to tell from the records how complaints had been investigated and what action taken. For example, the most recent entry in the book stated that the, “inspector confirmed that the outcome was satisfactory”. However, details were not given as to how the complaint was investigated and in what way the outcome was satisfactory. We were also shown the home’s Safeguarding Adults policy. This was an undated policy entitled, “Abuse of a Service – Guidance Policy”. The policy is in need of amendment and updating. It refers to the National Care Standards Commission rather than CSCI and does not make reference to the need for allegations or incidents of abuse to be reported to the local authority. Local authorities have the lead role to respond to adult abuse situations. We noted that some staff had received Safeguarding Adults training earlier in 2007. Lime Trees, The DS0000010636.V354320.R01.S.doc Version 5.2 Page 17 The difficulties we encountered with the home’s policies, such as not being dated and the need for review was a symptom of a wider poor quality to the management of the service. More details are provided in the Management section of the report below. Lime Trees, The DS0000010636.V354320.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 20 21 22 23 24 25 & 26 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Basic physical standards are provided for people using the service. There are some adaptations which benefit people who may have mobility difficulties but the environment presents limitations such as the small scale of the communal area. The decorative work taking place will enhance the facilities. Additional internal improvement work would bring benefits to the quality of life of people using the service. EVIDENCE: The home has been created through the conversion of two former houses into the larger care home. There is a long rear extension to one house in which the kitchen and the majority of the home’s communal space is located. The staircase and internal wall of one house has been removed allowing the two houses to be joined. The rest of the home is made up of bedrooms on the ground and first floor with a bathroom on the first floor and shower room on the ground floor. There are two small quiet / meeting rooms. There is a Lime Trees, The DS0000010636.V354320.R01.S.doc Version 5.2 Page 19 second floor (made from the former attic space slightly extended) which has the office, laundry and bedroom. Although the home has the required facilities including communal space and a choice of bathrooms the overall environment is unwelcoming and could be improved. There are some specific limitations. The lounge/dining area is small for 16 residents and would be very cramped if full. There is only sufficient room for eight people to sit comfortably around the dining table and even then that would mean encroaching on the lounge area. The home is not easy to get around for people who may have mobility difficulties. There is a slope down to the rear extension and further along the corridor the floor is uneven. Some of the corridors are narrow and have some right angles which would make it awkward for the use of wheelchairs. On the positive side there is a passenger lift though. The kitchen is small. It is domestic in style with a family home sized oven and hob more suited to household use rather than the demands of a care home for 16 people. There is limited work surfaces and dedicated storage space. The home was clean and free from offensive odours and equipped with the required furniture, fixture and fittings. However, we noticed that some of the bedroom furniture was broken and mismatched. Some of the newer bedrooms have en suite facilities consisting usually of a wash hand basin and toilet. Again, should the service be full with 16 people the existing facilities would be in great demand and would have to be carefully managed in order to provide people using the service with dignity. There is a bathroom and toilet on both the ground floor and first floor. The ground floor bathroom provides a level access shower facility and the first floor bathroom has a bath seat which can be raised and lowered and used to assist people with bathing. Both are adequate but are somewhat uninviting. Redecoration and redesign with softer colours and fabrics could improve the bathtime experience for people using the service. We were shown an Occupational Therapy assessment of the home which had been completed in 2006. The report described the physical standards at the home and concluded that standard 22 of the National Minimum Standards was met. There are some adaptations for people with disabilities such as the passenger lift, some grab rails, the level access shower room on the ground floor and an assisted chair for use in the first floor bathroom. Apart from that there are no other adaptations at the home or equipment, such as mobile hoists. Navigating the home with a wheelchair would also be difficult as the corridors have right angles. Many of the bedrooms are currently being used to store furniture and other items. Two bedrooms have had the carpet removed and the registered person said that he plans to provide a new floor covering. He also said that decorative Lime Trees, The DS0000010636.V354320.R01.S.doc Version 5.2 Page 20 work is planned but that the decorator had become ill and the work had stopped temporarily. An alternative decorator was to start work and in fact, some decoration to the front hallway had taken place when we returned for the second visit. We visited the bedroom of the person currently living at the home. The room was pleasant and warm with a lot of natural light. However, it did not look personalised to any great extent. Many of the bedrooms had their radiators turned off as there was no one in the rooms. Lime Trees, The DS0000010636.V354320.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 People who use this service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. The staff recruitment procedure followed does not comply with The Care Homes Regulations 2001 and results in staff being appointed without the full required checks having been carried out. This presents a risk to the safety of people using the service. Current staffing levels are not sustainable and result in staff working long hours alone at the home. On a positive note, the training plan adopted and recent training for staff will have increased staff skills and abilities. EVIDENCE: We were shown the staffing rota. Currently there is a reduced number of staff on duty reflecting the low occupancy level. The rota had one person scheduled to work throughout the day working a 9am to 9pm shift and one person working the night shift between 9pm and 9am. The registered person works the night shift throughout the week and told us that he provided a sleeping in service. The registered person and his wife, who is the main carer, provide staff cover for weekdays with two other members of staff covering the weekends. This staffing arrangement is not suitable as it relies too heavily on staff working alone for long periods of time. The main carer is working a 60 hour week working on her own. Such a level of service is not suitable for anything Lime Trees, The DS0000010636.V354320.R01.S.doc Version 5.2 Page 22 other than a period of short duration. It will not be sustainable over time and presents a risk to the person using the service. We inspected the staff files for five members of staff who were on the staff rotas we saw or who had worked at the home in recent weeks. The registered person said that he had 12 staff, who had previously worked at the home, who he could call upon to work. Some of the required staff recruitment information had been obtained, such as evidence of identification and references. However, there were gaps. The application forms in use did not require the applicant to provide a full work history as is required by The Care Homes Regulations 2001. This meant that although there were references for staff it was not possible to link the references to previous employment the staff member may have had. And it was not possible to tell what experience staff had had. The registered person did not realise that it was a requirement under The Care Homes Regulations 2001 to obtain full work histories for applicants. Enforcement action is being considered by CSCI about this matter. One member of staff did not have a CRB check. We saw from the staff rota that the member of staff had been working alone and unsupervised at the home. The registered person claimed that he did not know the staff member was without a CRB check. He made enquiries with the agency that did CRB checks for the home. Apparently, the CRB check application form had not been fully completed and therefore not applied for. An immediate requirement was given to the registered person to obtain a CRB check for the member of staff and to stop the member of staff working until the check had been obtained. The registered person wrote to CSCI to confirm that he had taken this action. The second visit to the home confirmed that the member of staff had been removed from the staffing rota and was not currently working at the home Our inspection of the staff files revealed that staff had had a range of training including in some cases NVQ qualifications. We were also shown a training plan and details of courses which staff had attended. Lime Trees, The DS0000010636.V354320.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 32 33 34 35 36 37 & 38 People who use this service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. Management arrangements are disorganised and are suffering from the lack of a competent registered manager. The poor quality management arrangements have had a negative impact on people’s experiences of using the service. Despite this there has been some proactive work including the drawing up of a fire risk assessment and the servicing of the home’s installations and equipment. EVIDENCE: This group of standards has been assessed as poor. The reasons for that are as follows. There is no current registered manager for the service and there is a pressing need to bring competent management to the service. The home’s record keeping system and overall administrative arrangements need to be reviewed, re-organised and streamlined. The management decision making Lime Trees, The DS0000010636.V354320.R01.S.doc Version 5.2 Page 24 process needs to be more professional and considered, with outside expertise available. And the home’s policies, such as the Safeguarding Adults policy, need to be reviewed and coordinated. Currently there is no registered manager. Management responsibility has for the meantime been assumed by the registered person. The registered person said that he had advertised for a manager but without success so far. He showed us a copy of the job details which had been advertised in the local Job Centre. The registered person said that if he was not successful in appointing a registered manager he would apply to CSCI for registration himself as the manager. The management arrangements have become ineffective and undisciplined. . Problems with the home’s documentation has been highlighted earlier in the report, such as the mix up with the statement of purpose and the need to update policies. And the failure to obtain a CRB check for a member of staff. Further evidence of the poor quality management of the service was provided by sight of the home’s office. We visited the office in order to inspect the staff files. Inside there were papers and files arranged over the floor and on the majority of available surfaces. There were filing cabinets which had some order but papers had spilled onto the tops of the cabinets. The registered person, on a number of occasions throughout the inspection, searched for files and paperwork we had requested. The keeping of records was random at best and the registered person was not able to quickly retrieve from the system the papers we had requested. Having said that, a manager or administrator could reorganise and file these papers relatively easily. Examples have already been provided about the decision making of the registered person. There was the decision not to request the return of the belongings of the person using the service and the view that it was acceptable for the person to wear the clothes of residents who had died. Also, the registered person’s lack of understanding about The Care Homes Regulations 2001 in respect of staff recruitment. Another example was the registered provider’s acceptance as appropriate a member of staff entering into a financial arrangement with relatives of a person using the service without the member of staff informing him first. Such decision making has meant that The Care Homes Regulations 2001 have not been complied with, people using the service have not had their rights upheld and inappropriate staff / relative arrangements have been tolerated. All of which have had a negative impact on outcomes for people using the service. Outside expertise may assist with decision making. The registered person told us that the quality assurance process followed was to complete annual surveys and to use the CSCI surveys which are usually sent out at the time of key inspections. Should new people be admitted to the service the quality assurance arrangements will need to widen to ensure that Lime Trees, The DS0000010636.V354320.R01.S.doc Version 5.2 Page 25 people are involved in the process and that the system can test whether the aims of the service are being met. There is a need to coordinate the home’s policies and retain them in a readily accessible place. Dating each policy and setting review dates will assist and avoid the confusion as to whether a policy is current or not. Financial procedures were not assessed at this inspection. However, as there is only one person using the service at the moment income for the service is clearly limited. This may place at risk the continuation of the service. Therefore, in order to start to assess the financial situation of the service a requirement is given for a copy of the audited accounts to be given to CSCI. The standard on service users’ money was not fully assessed either. The registered person said that he did not look after money for the person using the service. He is able to do that without help. As described earlier, plans have been made to assist with financial advice and drawing up a will. The registered person showed us staff supervision records which provided evidence that staff had been receiving supervision regularly. Certificates for the servicing of equipment and installations at the home were available including the fire alarm. There had been a fire risk assessment drawn up and the LFEPA had visited on 5 November 2007. Lime Trees, The DS0000010636.V354320.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 2 3 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 3 9 X 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 2 x x 3 2 3 Lime Trees, The DS0000010636.V354320.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 OP1 Regulation 4 Requirement The registered person must make sure that the statement of purpose contains accurate information in accordance with Regulation 4 Schedule 1 of The Care Homes Regulations 2001. The registered person must make sure that complaints records clearly reflect the investigation process and demonstrate how decisions and outcomes have been reached. The registered person must make sure that the written Safeguarding Adults policy clearly states the actions to be taken by staff in any safeguarding matter including referral to the Local Authority Safeguarding Adults team. The registered person must make sure that a copy of the annual audited accounts is provided to CSCI. Timescale for action 01/01/08 2 OP16 22(3) 01/01/08 3 OP18 13(6) 01/01/08 4 OP34 25 01/01/08 Lime Trees, The DS0000010636.V354320.R01.S.doc Version 5.2 Page 28 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 OP11 Good Practice Recommendations The registered person should ensure that suitable arrangements are made after death to manage people’s possessions. Lime Trees, The DS0000010636.V354320.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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. 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