Inspection on 01/06/05 for Limetree Care Centre

This inspection was carried out on 1st June 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Limetree Care Centre 26/11/07

Limetree Care Centre 05/12/06

Limetree Care Centre 08/08/06

Limetree Care Centre 09/05/06

Limetree Care Centre 16/11/05

Limetree Care Centre 25/01/05

Limetree Care Centre 03/06/04

Limetree Care Centre 01/03/04

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

CARE HOMES FOR OLDER PEOPLE Limetree Care Centre 8 Limetree Close London Address 3 SW2 3EN Lead Inspector Lynne Field and Mary Magee Announced 01/06/05 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Limetree Care Centre G52-G02 S43119 Limetree Care Centre V225365 010605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Limetree Care Centre Address 8 Limetree Close, London, SW2 3EN Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0208 674 3437 0208 674 3949 Excelcare Holdings IN Private 92 Category(ies) of N Care Home with nursing registration, with number of places Limetree Care Centre G52-G02 S43119 Limetree Care Centre V225365 010605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd January 2005 Brief Description of the Service: Lime Tree Care Centre is a purpose built care home, opened in 2003. It is located close to the South Circular road between Tulse Hill and Streatham Hill in South London. Lime Tree Care Centre offer’s residential care provision to 64 frail and elderly service users, some with dementia care support needs and nursing needs, and residential care and support for 28 service users with dementia care needs. This service is part of Excel Care holdings. The unit itself holds 92 bedrooms with full en suite facilities. Additionally there are assisted bathrooms, toilets, a hairdressing salon, large laundry room and kitchen. In addition to the above there is also a treatment room for visiting professionals. Limetree Care Centre G52-G02 S43119 Limetree Care Centre V225365 010605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors undertook this announced inspection. It lasted over seven hours. The inspectors met with twelve relatives who were attending a barbeque to which family and friends of the service users of the home had been invited. The inspectors spoke to sixteen service users. Service users records were seen. This included pre-assessments, care plans, risk assessments and some nursing notes. Throughout the course of the day the inspectors interviewed a cross section of care staff and ancillary staff. Seven staff files were viewed including the files of two new members of staff who had recently joined the home. What the service does well: What has improved since the last inspection? The home has continued to make steady progress in improving the way care is delivered. The team leaders are being empowered and learning through supervision they are accountable for their staff team as well as for making every day decisions about how their unit is being run. This ensures the service users receive a more robust service. The staff team have stabilised with a more consistent approach in operation, with service users individual needs and preferences being known to all staff. There has not been such a turnover of staff. Service users at the home receive more stimulation. Service users with dementia are feeling more valued and in particular they have been enabled to Limetree Care Centre G52-G02 S43119 Limetree Care Centre V225365 010605 Stage 4.doc Version 1.30 Page 6 participate and contribute in a number of areas which in the past it may have been considered they could not do. Such as decorate the home for the BBQ. Service users at the home are enabled and supported to lead more fulfilling lifestyles since the introduction of a new activities coordinator. This is using a person centred approach in the way activities are being delivered and promoting activities of daily living. This has given back to those who live at Limetree the right to make their own decisions and have a sense of independence. Care staff are working and supporting the activities coordinator to ensure service users receive a full activities program that reflects the service users individual needs. This includes Activities of Daily Living, such as being able to brush you own hair no matter how long it take. Which is looking beyond the limitations and seeing the abilities. What they could do better: 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. Limetree Care Centre G52-G02 S43119 Limetree Care Centre V225365 010605 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Limetree Care Centre G52-G02 S43119 Limetree Care Centre V225365 010605 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2 & 3 There is a good pre-admission process which obtains a full service user’s needs assessment. This leads to care plans which contain relevant information about each service user’s assessed needs and how the needs are to be met. EVIDENCE: The pre assessment form is completed by one of the senior staff going to visit the service user before coming into the home. The inspectors saw the statement of purpose and the service users’ guide which had been recently up dated. Service users are given copies of these to keep in their rooms. There are pre admission assessment records and care plans, which contain information. This ensures all the service user’s personal, health care and social needs are met. Files were seen to be dated as being completed within five days of a service user being admitted following the assessments, which were done on admission. Limetree Care Centre G52-G02 S43119 Limetree Care Centre V225365 010605 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8 & 10 Arrangements for delivering care are good with care plans frequently reviewed. Improvements are needed for some of the risk assessments as well as safeguarding service users when in the lounge. Staff need challenging behaviour training. Standard 9: The pharmacy inspection report will be sent separately. EVIDENCE: Nine care plans were viewed during the inspection. Care plans were case tracked following previous inspections and information given to inspectors during the course of this inspection. Individual care plans have been drawn up with service users. These had been reviewed recently and were up to date. Risk assessments were available on the care files. The risk to people from falls was identified and actions were in place to reduce the likelihood of falls. One relative was concerned that when service users were in the lounge there was not always a member of staff present to monitor and support the service users there. On occasions, accident records show that staff were unable to state when or how people had fallen because frequently a member of staff was not nearby at Limetree Care Centre G52-G02 S43119 Limetree Care Centre V225365 010605 Stage 4.doc Version 1.30 Page 10 the time of the fall. It is important that arrangements are in place for a member of staff to be present to monitor and support the group of vulnerable elderly people there. Although there were a number of care plans where the service users had a history of being unsafe at night time with agreements and risk assessments in place, there were also a number of records that did not have any agreements on the use of cot sides or indicate this had been discussed with relatives of service users who now did not have the capacity to consent. A separate file was held for each service user detailing lifestyles and interests. The written records maintained of the daily progress of service users were good and gave a good indication of how service users progress. The records for one service user who becomes agitated and wanders was poor and unclear as to how she should best be supported. It was stated that the objective was to keep wandering to a minimum or that “report to the doctor if she becomes uncontrollable”. Rather than a strategy in dealing with the behaviour. See Standard 30. This approach indicates that more training for staff was required on how to manage people with dementia and people with challenging behaviour. Daily reports are well written and used to pass important information to the staff team, records also gave instructions such as “make sure that the hospital report is read’’ or any changes to individual’s conditions. Nutritional assessments had been completed and were available on care files. Those that had low body weights were monitored and referred to the doctor for consultation. The GP visits the home every week. Monthly meetings are also held between the manager and the GP. In this meeting all concerns regarding those that live at the home are raised. There were no service users with pressure sores. Two people had leg ulcers, which were dressed in accordance with the care plan. The home has a link nurse that liases directly with the tissue viability nurse. Records of continence assessments were present on the files viewed, there were also continence aids and equipment provided to people assessed as requiring them. Sustained improvement was evident in the records maintained of weight records, blood sugars and individuals’ well being. Service user records indicated that individuals experienced long waiting periods for the provision of foot care and chiropody services from the statutory services. Service users were well cared for and showed signs that staff gave attention to dress presentation and grooming. Service users told the inspector that they were looking forward to that evening’s entertainment. Some good practice was observed in the way staff Limetree Care Centre G52-G02 S43119 Limetree Care Centre V225365 010605 Stage 4.doc Version 1.30 Page 11 interacted with individuals. Communication between staff and service users had greatly improved. The interaction was positive with staff demonstrating that they had developed a good relationship and were familiar with the needs of service users. The sons of one service user, who had come for the afternoons event, spent some time talking about how their fathers health had deteriorated before he had come into the home and how he had been unable to remain in his own home safely. They expressed their gratitude and satisfaction for the way staff at the home cared for their father. One elderly lady spoke of the kindness shown by her key worker, she said that she was, “gentle, never rushed her and seemed to know the pace of someone older”. Other observations made were that staff were competent at managing those with challenging behaviour. One lady who frequently becomes agitated, was constantly reassured by a staff member who talked slowly and softly to her, until she eventually became calm and sat down to enjoy her mid morning drink. The medication was inspected by the pharmacy inspector at a separate time and the report is to follow. Limetree Care Centre G52-G02 S43119 Limetree Care Centre V225365 010605 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 15 The activities in the home have improved since the last inspection. The food is enjoyable and tasty but improvements are needed to the serving and presentation to service users. EVIDENCE: A variety of activities available has been more available at the home since the appointment of an experienced activities coordinator at the beginning of this year. This was evident from the time the inspectors came to the home, the atmosphere was lively and upbeat throughout the day. The coordinator has taken into consideration individual capacities and likes and needs. Service users with dementia and who had appeared quite bored at previous inspections were seen enjoying themselves and participating in-group activities, others were chatting with members of staff. Decorations had been made by service users for the home in preparation for the evening event. These were colourful and gave people great pride in seeing their finished product displayed. The evening barbeque was well attended by people at the home and their relatives and friends,. It has also encouraged more people to become involved in events at the home. Limetree Care Centre G52-G02 S43119 Limetree Care Centre V225365 010605 Stage 4.doc Version 1.30 Page 13 Relatives and service users spoke about how hard staff had worked to improve the quality of life and give some meaning to their lives. The food served on the day was good and enjoyed by all. One of the areas that relatives felt needed to be improved was the serving of the meals, as well as creating an environment that was as pleasurable as could be possible for service users. In particular they felt that the provision of serviettes and condiments were important at mealtimes. Limetree Care Centre G52-G02 S43119 Limetree Care Centre V225365 010605 Stage 4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 &18 The home takes complaints seriously and deals with complaints immediately. EVIDENCE: There have been 20 complaints in the last 12 months, of which 8 were substantiated and 12 partially substantiated. Most of the complaints made were within the first six month period. Since the last inspection there have been fewer complaints and these have been dealt with and responded to as soon as they have arisen. At the inspection families who were spoken to, said they are generally happy with the service given and said they felt they were listened to when they did make a complaint. There is one Adult Protection issue being investigated and one POVA instigated. The home holds monthly meetings with the commissioning agency to discuss the progress of any outstanding cases. Limetree Care Centre G52-G02 S43119 Limetree Care Centre V225365 010605 Stage 4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 21, 24, 25 & 26 The home is bright and pleasant. The accommodation both for individual and for shared use is nicely furnished and well maintained. The standard of hygiene was very good with no unpleasant odours. EVIDENCE: Several service users bedrooms were visited during the course of the inspection. Both inspectors found all the bedrooms were very individual. Some service users had brought in items of furniture from their home. Some had decorated their rooms with pictures, photos and ornaments. Each bedroom had ensuite facilities as well the home having other bathrooms and toilets which have specialist bathing facilities to meet individual needs. There are several areas of shared space, such as the dinning room, lounge and a quiet lounge, which the service users are encouraged to use. There are small seating areas in the corridors where the service users can take visitors if they want to meet in private. Limetree Care Centre G52-G02 S43119 Limetree Care Centre V225365 010605 Stage 4.doc Version 1.30 Page 16 The home was free from any unpleasant odours. One service users relative said at times the small kitchen on the unit was dirty and felt some of the care staff could clear up after themselves rather than leave it for someone else to do. Limetree Care Centre G52-G02 S43119 Limetree Care Centre V225365 010605 Stage 4.doc Version 1.30 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 & 30 On the day of the inspection there were sufficient staff on duty. Each of the nursing care floors had two trained nurses, who oversee support staff who have the skill mix to meet the needs of the service users who need palliative care. Recruitment procedures need to be tighter. The home needs to ensure the person supplying a reference is the person who has the authority to do this. CRBs must be in place before any member of staff starts to work at the home. EVIDENCE: Sufficient numbers of skilled staff were on duty and the rotas viewed also indicated that numbers available were adequate. There is an in house training and development plan that has been compiled and many of the courses run are facilitated by the care manager and the general operations manager. This programme not only includes the mandatory induction program from the home but includes the foundation training as part of the National Minimum Standards and in turn lead to a higher standard of care for the service users. This programme includes courses run by outside agencies to which the home has training links with. Such as tissue viability, dementia and nutrition. Limetree Care Centre G52-G02 S43119 Limetree Care Centre V225365 010605 Stage 4.doc Version 1.30 Page 18 Palliative care study days have been run for care assistants and nurses to give them training in specific nursing interventions as well a basic understanding of end of life issues. As referred to above under standard 8, there are some concerns that staff are not always present in the lounge areas to monitor and support service users. The feedback from relatives and service users indicate that when staff are busy, the lounge is left unattended. Recruitment records of nine staff were examined. On each of the personnel files viewed for two new members of staff there were two professional references available, home office work permits, and overseas disclosures were available. From some of the references retuned and held in staff file it was not always clear that the person giving the reference was the person in authority to do this. There were written records that CRB enhanced disclosures had been applied for but had not been returned. The more recently recruited staff that lacked essential linguistic skills is now conversing freely with service users as a result of attending English classes. which the provider has arranged. Each new member of staff has mandatory training. It was found that staff appear to be generally showing more commitment and there is more stability in the team. More training is required for staff on care of people with dementia and challenging behaviour as well as on recording. See Standard 8. Limetree Care Centre G52-G02 S43119 Limetree Care Centre V225365 010605 Stage 4.doc Version 1.30 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 36 & 38 The change in senior management in the last six months has resulted in a stabilising of the team. The management team work together to give positive feedback to staff. The team are empowering leaders to take control of care staff and the care being given to the service users on each of the units. Service users receive better care as a result. EVIDENCE: In the last six months the home has had a new general operations manager, who has applied to be the registered manager and a new care manager, who has direct responsibility to the operations manager and is responsible for ensuring a high standard of care is delivered. Above them, whom they report Limetree Care Centre G52-G02 S43119 Limetree Care Centre V225365 010605 Stage 4.doc Version 1.30 Page 20 to, is the area operations manager, who has been in post since December of 2004. The operations manager holds regular team meetings with the heads of departments who report directly to her. Information is passed on and disseminated down through the teams. Supervision is cascaded down through the team. Staff said they had supervision on a regular basis every month with their immediate line manager and this was recorded. Staff said they felt supported by the management of the home and things were better for them and the service users. The home has a quality development programme, which is sent out every three months to seek the views of families and social services. Forms are also displayed in reception for those who are not on the regular mailing list. Although health and safety of the building was not fully checked on the day of the inspection, there were no noticeable gaps in the health and safety procedures of the home. Limetree Care Centre G52-G02 S43119 Limetree Care Centre V225365 010605 Stage 4.doc Version 1.30 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 3 x 3 x x 3 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 3 x x 3 x 3 Limetree Care Centre G52-G02 S43119 Limetree Care Centre V225365 010605 Stage 4.doc Version 1.30 Page 22 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 8 Regulation 12 (1) (a) & 13 (1) (b) Requirement The registered person must ensure that the home is conducted to make proper provision for the care and supervision of service users ensuring they are supervised at all times in the lounge area. The registered person must ensure service users health and welfare by ensuring food, which is varied, is properly served. The registered person must ensure each member of staff has an enhanced Criminal Record Bureau certificate before commencing work at the home. The registered person must operate a thorough recruitment procedure ensuring that all the required information under Schedule 2 of The Care Home Reglations 2001 is obtained. The registered person must ensure that all staff receive training in dementia care and challenging behaviour. Timescale for action 13 August 2005 2. 15 3. 29 16 (2) & (g) & (h) & (i) Schedule 4 (13) 19 (1) (a) (i) Schedule 2 19 (1) (a) (i) Schedule 2 18 (1) (c) (i) (ii) 13 August 2005 13 August 2005 4. 29 13 August 2005 5. 30 30 August 2005 Limetree Care Centre G52-G02 S43119 Limetree Care Centre V225365 010605 Stage 4.doc Version 1.30 Page 23 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 Good Practice Recommendations Limetree Care Centre G52-G02 S43119 Limetree Care Centre V225365 010605 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Southwark Area Office 46 Loman Street London SE1 0EH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Limetree Care Centre G52-G02 S43119 Limetree Care Centre V225365 010605 Stage 4.doc Version 1.30 Page 25 - 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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