Inspection on 16/11/05 for Limetree Care Centre

This inspection was carried out on 16th November 2005.

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

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

Other inspections for this house

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 01/06/05

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 SW2 3EN Lead Inspector Pam Cohen Unannounced Inspection 16/11/05 9:00 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 Limetree Care Centre DS0000043119.V252451.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Limetree Care Centre DS0000043119.V252451.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Limetree Care Centre Address 8 Limetree Close London SW2 3EN 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) 0208 674 3437 0208 674 3949 Excelcare Holdings Care Home 92 Category(ies) of Dementia - over 65 years of age (28), Mental registration, with number disorder, excluding learning disability or of places dementia (6), Old age, not falling within any other category (64) Limetree Care Centre DS0000043119.V252451.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st June 2005 Brief Description of the Service: Limetree Care Centre is a modern, purpose built home. It is located just off the South Circular Road between Tulse Hill and Streatham Hill. It is owned and managed by Excelcare Holdings. Limetree offers residential and nursing care for older people suffering from dementia; there is one residential floor and two nursing floors. There are 92 service users all with their own bedroom with full en suite facilities. On the day of inspection there were 6 vacancies. Limetree Care Centre DS0000043119.V252451.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place during the day of 16th November 2005. The manager and care manager were in the home and facilitated the inspection. The administrator and maintenance manager were also of great help. The inspector was able to speak to staff, three relatives, service users and an OT from the Community Mental Health Team. What the service does well: What has improved since the last inspection? 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 DS0000043119.V252451.R01.S.doc Version 5.0 Page 6 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 Limetree Care Centre DS0000043119.V252451.R01.S.doc Version 5.0 Page 7 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 4,5. The home does not provide intermediate care. Service users suffering from dementia have special needs in terms of orientation, stimulation and understanding. These are not being met by the home. Friends and relatives are encouraged to visit the home to assess its suitability. EVIDENCE: At the moment the home is not able to demonstrate that it meets the needs of its service users. It looks after older people suffering from dementia but this is not evident from visiting the home. The environment does not offer any adaptations for reality orientation or stimulation of this group. The staff group also have not had the training to equip them with the knowledge to look after service users suffering from cognitive impairment. This was commented upon by a professional from the community mental health team who was visiting the home. She felt that staff did not have insight into cognitive impairment and they believed that a service user was able to care for himself, when he could not. A start has been made on giving such training, but it is at an early stage. The manager said that most service users are admitted from hospital and are too frail to visit the home. Also in view of the fact that this home is for people Limetree Care Centre DS0000043119.V252451.R01.S.doc Version 5.0 Page 8 who suffer from dementia, it is not clear how useful such a visit would be. However, relatives and friends are encouraged to visit and most do. All admissions are on a trial basis with a review at six weeks. The home does not offer intermediate care. Limetree Care Centre DS0000043119.V252451.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,9 Service users’ care needs are generally well detailed in their care plans. Medication is not administered and recorded accurately which means that service users may not be getting the medication they need. EVIDENCE: Six care plans were seen and were generally of a good standard. They included detailed actions needed for all aspects of service users’ care and were reviewed regularly. When applicable they looked at how to deal with challenging behaviour and they included individualised assessments of areas of risk. There were separate sections for social activities and there were also night time care plans. Areas which still need improving are: Life reviews-these were usually not filled in and those that had been completed were sparse. Evidence that care plans are drawn up with the service user and/or their relative or advocate. The use of risk assessments for all service users who have bed rails. It is also of concern that an OT had drawn up instructions for helping a service user with their self care, but she reported that when she came to see how the Limetree Care Centre DS0000043119.V252451.R01.S.doc Version 5.0 Page 10 plan was going nothing had happened. Her instructions could not be found, they had not been incorporated into the care plan and the OT felt that carers were not aware of their existence. Another service user had challenging behaviour around dressing and a good care plan was written on how to try and help him dress appropriately. However when checked he had no clothes in his room and so it is unclear how the care plan could be implemented. Most service users in the home would not be able to look after their own medication needs. However the home has respite places and it is essential that people who are going back to their own homes be assessed on admission to see if they take any part in their medication administration so the skills are not lost. Medication administration records were checked, and on all floors there were several instances where medication had not been administered as recorded. This meant that either service users had not received medication when they should, or that their stock would run out early. Limetree Care Centre DS0000043119.V252451.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14,15 The home strives to give service users as much choice and control over their lives as possible. Food provision and service was seen to be good. EVIDENCE: There was evidence that the home works to ensure that service users are able to be independent where possible. They can bring in personal possessions and some rooms very much reflected the personalities of those who lived there. Records also showed that service users were helped to have access to their own money at all times, if at all possible. Information still has to be made available about advocacy services. It is also recommended with this service user group that where there are no relatives or friends an advocate or befriender should be found. The breakfast arrangements were individualised; there was a good variety of foods and service users could eat breakfast where they wished. The meal was leisurely and good natured and provided a positive start to the day. Service users said that they enjoyed the food at the home. Blue plastic aprons should not be used for service users to protect their clothes. It is also recommended that the home think about the timings of meals as breakfast, lunch and supper are all taken between 10 and 5. Limetree Care Centre DS0000043119.V252451.R01.S.doc Version 5.0 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Complaints are taken seriously and investigated properly. Good procedures are in place to protect service users. A full programme of training will ensure that all staff are aware of the issues involved in protecting vulnerable adults. EVIDENCE: The manager described how he deals with informal complaints, trying to clear up any problems immediately. The complaints book was seen and one complaint had been logged since the last inspection and was still being investigated. An allegation concerning possible adult abuse had been correctly dealt with, in terms of liaison with the proper agencies and supervision of staff. The care manager has been undertaking training on protecting people from abuse and must ensure that this training is delivered to all staff. Limetree Care Centre DS0000043119.V252451.R01.S.doc Version 5.0 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,23,24,26. The home is comfortable, accessible and suitable for its purpose. It was seen to be clean and well maintained. EVIDENCE: The home is a modern one and is comfortable, accessible for all service users and is well maintained. All service users have comfortable single bedrooms, which are well furnished and meet the needs of service users. There is a variety of communal space on each floor which caters well for the needs of service users. However on the first floor, because one communal room had been made into a hair dressing room, the remaining lounge only had space for 18 out of the 30 service users. This has implications for service user activities and leisure time. The home provides smoking areas on each floor but these are in the small kitchenette off the dining area. This is not a suitable place for smoking. All bedrooms have an en-suite shower and there are other assisted bathing facilities. This provision is more than adequate but more shower chairs need to be provided for the showers. The home was clean throughout and one relative commented that recently she was happier with the standard of cleanliness. Another relative commented that the home sometimes smelt Limetree Care Centre DS0000043119.V252451.R01.S.doc Version 5.0 Page 14 but this was not apparent on the day of the inspection other than in the lift. The maintenance man explained that this was due to water in the lift shaft which was a structural fault and was being dealt with. Limetree Care Centre DS0000043119.V252451.R01.S.doc Version 5.0 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28,29,30 The home is working well to train carers to NVQ level 2 standard. Other areas of training are not yet at the level needed to ensure that carers are given the skills needed for their jobs. Recruitment practices are thorough and contribute towards safeguarding a vulnerable service user group. EVIDENCE: The home is on target to have 50 of staff trained to NVQ level 2. Other training issues are being dealt with by the manager and his deputy but are not yet of a proper standard. There is not an up-to-date training and development programme to ensure that all staff are trained to meet the needs of the service users. Training for basic areas such as fire safety, infection control and food hygiene have not been completed. Induction and foundation training is not being completed to National Training Organisation standards. A start has been made on training staff on the needs of service users with dementia, and although there are plans for more such training, this has still not been delivered to all staff to a sufficient level. There was evidence that all necessary measures are taken during recruiting to safeguard service users, with CRB and POVA checks being properly undertaken. Limetree Care Centre DS0000043119.V252451.R01.S.doc Version 5.0 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,38 The manager demonstrated his intention to run the home in the best interests of service users. Service users’ monies are properly dealt with. Systems are well audited and feedback sought. Service users’ safety where fire safety and moving and handling are concerned, is not assured. EVIDENCE: There has been a new manager appointed since the last inspection. He demonstrated that he has the necessary experience, qualifications and competencies to run the home. He must apply to be registered within the required 3 months. Staff spoken to were positive about his leadership, saying that he “walks the floor” to make sure that he knows what is going on and that he understands staff needs. In conversation he had clear ideas of how he intended to involve service users and relatives, as well as staff, as much as possible in the running of the home. Limetree Care Centre DS0000043119.V252451.R01.S.doc Version 5.0 Page 17 The home is working to audit and monitor its practise and procedures. The manager also described strategies for gaining feedback on how they are doing. He speaks to service users and relies also on information from key workers. He is hoping to perhaps set up a small group of service users who are more able, to act as representatives for all. There are at the moment relatives questionnaires to get feedback on how the home is doing but this is not done in a structured way. It is intended to relaunch relatives meetings. The home also produces an annual development plan. In order to fully meet this standard, surveys needs to go out annually to all relatives and other interested parties and be compiled into a report. There are good procedures to deal with service users monies’ and records are well maintained. Health and safety issues are taken seriously and the maintenance man showed good records that proved that most systems were well monitored and up to date. However the home needs to take advice from the fire service as it was holding service users doors open with a variety of items. The manager also needs to ensure that he and his staff understand what they would do in case of a fire and that fire drills reflect this. Moving and handling issues were a cause for concern. Not all staff had had training on proper moving and handling and risk assessments were not being carried out for all service users who needed them. Limetree Care Centre DS0000043119.V252451.R01.S.doc Version 5.0 Page 18 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 x 2 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 3 3 x 3 3 x 2 STAFFING Standard No Score 27 x 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 x x 2 Limetree Care Centre DS0000043119.V252451.R01.S.doc Version 5.0 Page 19 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 OP4 Regulation 12(1) 18(1)(a) 15(1)2(c) Timescale for action The registered person must 31/03/06 ensure that the home meets the special needs of service users suffering from dementia. The registered person must 31/01/06 ensure that care plans are drawn up with service users and/or their relatives and include a life history and risk assessment for the use of bed rails where appropriate. The registered person must 31/12/06 ensure that medication is administered and recorded accurately. The registered person must 31/01/06 ensure that protection for service users’ clothes when eating, does not compromise their dignity. The registered person must 31/03/06 ensure that all staff have training on working with Vulnerable Adults. The registered person must 31/01/06 ensure that kitchenette’s are not used as smoking rooms. The registered person must 31/03/06 ensure that all staff receive training in dementia care and DS0000043119.V252451.R01.S.doc Version 5.0 Page 20 Requirement 2 OP7 3 OP9 13(2) 4 OP15 12(4)(a) 5 OP18 13(6) 6 7 OP26 OP30 13(4)(c) 18(1)(c) (i)(ii) Limetree Care Centre 8 OP33 24(1)(a) (b)(2)(3) 13(5) 9 OP38 10 OP38 13(5) 11 OP38 23(4) challenging behaviour Target date of 30th August 2005 not met, although it is noted that training has started. The registered person must ensure that an annual survey of service users’ views is undertaken and published. The registered person must ensure that an audit is done of all staff’s moving and handling training, and all training needed is completed. The registered person must ensure that a moving and handling risk assessment is completed for Mrs S. The registered person must ensure that fire service advice is sought regarding the practise of keeping bedroom doors wedged open and the conduct of fire drills. 30/06/06 05/12/05 12/11/05 31/03/06 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 2 3 Refer to Standard OP14 OP15 OP20 Good Practice Recommendations It is recommended that advocacy services are found for those service users who have no friends or relatives. It is recommended that the home consider the timings of their meals. It is recommended that the provision of communal space on the first floor is reviewed. Limetree Care Centre DS0000043119.V252451.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark 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 DS0000043119.V252451.R01.S.doc Version 5.0 Page 22 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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