Inspection on 26/11/07 for Limetree Care Centre

This inspection was carried out on 26th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

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 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 Maria Kinson Key Unannounced Inspection 26th November 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Limetree Care Centre DS0000043119.V351050.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. Limetree Care Centre DS0000043119.V351050.R01.S.doc Version 5.2 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 mohamed.madarbux@excelcareholdings.com Limetree Healthcare Ltd Mohamed Iqbal Madarbux 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.V351050.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th February 2007 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. The home is some distance from tube or train stations but local shops and other facilities are within walking distance. The home is owned by Excelcare Land Management Ltd and is managed by Limetree Healthcare Limited, a company associated with Excelcare Holdings Plc. Limetree provides residential and nursing care for older people with dementia; there is one residential floor and two nursing floors. There are 92 bedrooms in the home, all of which have en-suite facilities. The fees range from £419.89 to £564.57 per week. Additional charges are made for services such as hairdressing and newspapers. This information was supplied to the commission on 03/02/08. Limetree Care Centre DS0000043119.V351050.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by two inspectors and was unannounced. On 26/11/07 two inspectors carried out a short observational focused inspection (SOFI) in the first floor lounge. This helps inspectors to understand the experiences of people that cannot communicate. Following the observation period the inspectors looked at care plans and medication charts for two of the people they observed. On 28/11/07 two inspectors spent the day on the ground and second floor units. The inspectors spoke with some of the people that lived in the home, and some of the staff that were on duty. Care and medication records were examined. All of the communal areas and a small number of bedrooms were viewed on the ground and second floor units. Written comments about the service were obtained from nine people that lived in the home, two relatives and four health care professionals. What the service does well: Staff assessed people’s needs before moving into the home. This information helped staff to provide appropriate care for people that had difficulty communicating. An individual care plan was developed for each person. Plans were reviewed regularly to ensure that information was up to date. People received their medicines regularly. Staff had developed good working relationships with other health care professionals and sought advice and support to meet peoples changing needs. There was a varied programme of activities and information about people’s personal interests and hobbies was recorded. The menu was varied and most people said they liked the food provided in the home. Relatives were able to visit the home when they wanted. Staff received safeguarding training and took prompt action to protect people. The home was well maintained and all areas were clean and tidy. Equipment was checked and serviced at regular intervals and fire safety arrangements were good. Limetree Care Centre DS0000043119.V351050.R01.S.doc Version 5.2 Page 6 The manager obtained feedback from residents and relatives during meetings and in surveys. This information was used to improve the service. There were systems in place to check that staff were following procedures and to identify concerns. The management and staffing arrangements were stable. This provides good continuity of care for residents. What has improved since the last inspection? What they could do better: Some staff carried out tasks without telling residents what they were doing and did not take time to listen to what people were saying. The menu was displayed but was positioned too high for some people to see and was difficult to follow. Staff did not always sign and date the records when medicines were changed or stopped. Limetree Care Centre DS0000043119.V351050.R01.S.doc Version 5.2 Page 7 Staff had access to suitable training but some staff had not received wound care training. Staff on the Overseas Nursing Programme received clinical supervision but did not have an opportunity to sit down and discuss their training needs or concerns on a ‘one to one’ basis. Three people had portable heaters in their rooms, as their radiators were not working. Although staff had completed a risk assessment the heaters were not secured to the wall and felt hot when touched. The risk assessment should be reviewed to see if any additional action could be taken to maintain peoples safety. One bath was not emptying properly. A record was kept about items handed to staff for safekeeping. There was no evidence that any checks were carried out to ensure that all of the items listed were still present. The home had provided an area at the bottom of the staircase for residents to smoke. This area was close to the fire exit and could cause an obstruction in the event of a fire. This issue must be discussed with the Fire Authority and Local Authority. 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. Limetree Care Centre DS0000043119.V351050.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 Limetree Care Centre DS0000043119.V351050.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): 2, 3 and 4. Standard 6 does not apply to this home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission process ensured that people’s needs were assessed prior to care being offered. Information about people’s rights and responsibilities was provided. Some staff did not maintain adequate communication with residents. This may make people feel anxious. EVIDENCE: Signed contracts with terms and conditions were kept in the office. Contracts included an additional sheet detailing the breakdown of fees and outlining the organisation or person that was responsible for payment. Although a contract could not be located for one person that had recently moved into the home, there was evidence that work was in progress to address this issue. Relatives were asked to agree and sign contracts for people that lacked capacity. Limetree Care Centre DS0000043119.V351050.R01.S.doc Version 5.2 Page 10 Most staff bent down to speak to people, addressed people by their preferred name and listened to their comments. However it was noted during the observation period that some staff did not communicate effectively. For instance one staff member was seen mopping under a persons chair and placed items on their table without telling the person what they were doing. Other staff asked people questions as they passed by but did not wait for a response. Some staff spent time in the lounge with residents but did not use this time to engage with people. See recommendation 1. The files for five people that were recently admitted to the home were examined. All of the files included an assessment of the person’s needs and information about medical problems and medication. Assessments were completed before the person moved into the home. The information obtained during the assessment enabled staff to decide if the home could meet the person’s needs and to prepare for the persons admission. The funding authority provided additional information. Limetree Care Centre DS0000043119.V351050.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, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff worked in partnership with other professionals to identify and meet people’s healthcare needs. EVIDENCE: Two sets of care records were examined on each floor. All of the files included assessments; risk assessments, care plans and daily care records. Care plans provided clear guidance for staff about the action they should take to take meet peoples needs and there were risk assessments in place for people that liked to go to the shops or smoke. The records seen were person centred in parts and there was evidence that relatives were consulted. Care plans were reviewed regularly. Records showed that people were referred and seen by a variety of different health care professionals such as the GP, Optician and Community Psychiatric Nurse. Limetree Care Centre DS0000043119.V351050.R01.S.doc Version 5.2 Page 12 The commission obtained written feedback about the service from four health care professionals that were in regular contact with the home. People said that staff requested support about health care issues and were “very willing to learn and take advice”. Comments indicated that staff were usually able to meet people’s needs, although it was acknowledged that a number of people had “challenging and had complex needs”. Residents said they usually received appropriate care and support. People were encouraged to maintain their independence by doing tasks for themselves, where possible. On the ground floor unit some people liked to clean their her own room, lay the tables at mealtimes, make their own hot drinks and snacks and go out to the shops. Medication was assessed on the ground and second floor units. The temperature in the ground floor medicine room was above the recommended level. Staff said a fan had been fitted in recent months to address this issue. Staff should monitor the effectiveness of the fan and take further action if necessary. The medication refrigerator was clean. Good records were maintained about medicines that were received in the home, given to people and sent for disposal. Some medicines that had changed or were discontinued were not signed and dated. See recommendation 2. The list of ‘over the counter’ or homely remedy medicines was agreed and signed by the GP in 2007. Good records were maintained about these medicines. Staff knocked on people’s doors and sought permission before entering. Some of the people on the ground floor unit had their own room key and liked to lock their door if they went out. Limetree Care Centre DS0000043119.V351050.R01.S.doc Version 5.2 Page 13 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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a regular programme of events and activities to stimulate people’s interests. The food provided in the home met peoples cultural and nutritional needs. EVIDENCE: The home employed a dedicated activity coordinator. The activities coordinator was enthusiastic about her role and had worked with older people in the past. The activity coordinator organised a varied programme of individual and group activities such as baking, gardening, relaxation, reminiscence groups, quizzes and ‘one to one’ sessions for people that did not like or were not able to take part in the group sessions. The Christmas entertainment programme included religious services, entertainment and social events. Records indicated that people were supported to undertake activities that they enjoyed such as trips to the shops and that staff spent time talking to residents. Limetree Care Centre DS0000043119.V351050.R01.S.doc Version 5.2 Page 14 People said that they were able to visit the hairdressing salon or attend religious services if they wanted. One person on the ground floor unit said he was aware of the activity programme but did not attend the sessions through choice. This person said he preferred to read, watch television and smoke. The records for this person showed that he was invited to take part in activities but often declined. The home had received information about the use of multi sensory stimulation for people that have difficulty communicating. Work was in progress to assess the benefits for residents and to introduce similar activities in the home. Records included information about people’s lifestyle choices and preferences. One person that was recently admitted to the home was not able to communicate but information was obtained from his relative and recorded on the lifestyle agreement. This document provided valuable information for staff about the person and about how they chose to live their life. Residents said their relatives could visit the home when they wanted and were made to feel welcome. Written comments about the service were received from two relatives. Feedback was mostly positive. Relatives said staff usually had adequate skills and knowledge to meet their family members needs. The local authority had agreed to fund a local befriending service for people that did not have regular visitors or relatives. The manager had referred four residents to this service. The home had information about a national advocacy scheme, which can provide support for residents. Staff were seen asking people where they wanted to sit and what they wanted to eat. Records showed that people were consulted about end of life care and some information about preferred routines was recorded. Complex issues were discussed with relatives or advocates if staff felt the person was not able to make an informed decision. A four weekly menu plan was displayed in a glass showcase on the wall. The position of the menus and the amount of information displayed made it difficult for people to know which menu was in use. The menu was varied and included some traditional Caribbean dishes, which a number of people on the ground floor unit said they enjoyed. Lunch was observed on all of the floors, over a two-day period. The tables in the dining room were nicely laid out but there were no condiments and they were not offered. People were able to sit with their friends or alone if they preferred and some people chose to eat in their rooms. The food looked appetising and most people said they enjoyed their meal. The manager said a dietician had recently spent two weeks in home assessing the nutritional content of the menu and providing advice for kitchen staff. See recommendation 3. Limetree Care Centre DS0000043119.V351050.R01.S.doc Version 5.2 Page 15 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 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had procedures in place for staff to follow when investigating complaints or concerns. Staff received safeguarding training and knew they should report allegations or concerns to senior staff. EVIDENCE: Residents and relatives were aware of the homes complaints procedure. The complaints book was examined. Complaints were acknowledged and investigated within set timescales. Action was taken to address concerns and the manager had identified and addressed reoccurring issues. The commission received one anonymous complaint about the home in October 2007. The complaint was investigated by the Operations Manager and was considered during this inspection. No evidence was found to support the allegations made by the complainant. Staff had a good understanding of peoples needs and recognised signs that indicated that people were unhappy or unwell. Staff received safeguarding training and demonstrated a good knowledge about the action they should take if there were suspicions of abuse or neglect. Limetree Care Centre DS0000043119.V351050.R01.S.doc Version 5.2 Page 16 Allegations were reported to social services and the commission was notified about significant events that occurred in the home. Records showed that the manager investigated issues thoroughly took action where necessary to address his findings. Limetree Care Centre DS0000043119.V351050.R01.S.doc Version 5.2 Page 17 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, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This home provides a clean and comfortable environment for people using the service EVIDENCE: All parts of the home were clean, tidy and odour free. No significant maintenance issues were identified. One of the baths on the ground floor unit was not emptying properly. Water was collecting in the pipe and seeping back into the bath at times. The maintenance manager agreed to consider how this issue could be resolved. See recommendation 4. Limetree Care Centre DS0000043119.V351050.R01.S.doc Version 5.2 Page 18 Efforts had been made to make the communal areas homely and to personalise people’s bedrooms. Many of the rooms seen included personal photographs, pictures and small items of furniture from the person’s family home. Some of the signs on toilet and bathroom doors were not easy to interpret. The manager said plans were in place to replace some of the signs that help people with dementia to find their way around the unit and to locate key areas. Three radiators were not working. Portable heaters were in use and risk assessments were in place. The portable heaters were not guarded or secured to the wall and felt hot when touched. The maintenance manager said the heating system would have to be drained to address this issue. Staff were waiting for the weather to get a little warmer before completing this work. The manager should review the risk assessment. See recommendation 5. The home had received a grant from the Department of Health to develop a sensory garden at the rear of the property. Plans were prepared and discussed with relatives. Limetree Care Centre DS0000043119.V351050.R01.S.doc Version 5.2 Page 19 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living in the home received good continuity of care and were protected by the homes recruitment practices. Staff received support to learn new skills and to gain recognised qualifications. EVIDENCE: The number and skill mix of staff on duty on the day of the inspection enabled staff to meet people’s needs. The duty roster showed that suitable staffing levels were maintained and there was little use of temporary staff. Most staff were familiar with peoples individual needs and preferences and had a good understanding of person centred care. Forty- four care staff had a vocational qualification in care at level two or above. This exceeds the national minimum standard. Six staff were registered to complete this programme of training. The personnel files for six of the most recently recruited staff members were examined. Thorough recruitment checks were carried out before new staff were permitted to commence work in the home. The files seen included an application form and employment history, two written references, an enhanced criminal record bureau disclosure, proof of identity, a recent photograph and Limetree Care Centre DS0000043119.V351050.R01.S.doc Version 5.2 Page 20 confirmation of registration with the Nursing and Midwifery Council for qualified nurses. Records were maintained about ‘face-to-face’ interviews. Some of the applicants that applied to work at the home did not have any previous experience of care work but demonstrated during their interview that they a caring approach and were aware of the needs of older people. One recently employed member of staff that did not have any previous experience of working with older people was reported by residents to be “pleasant and eager to please”. The organisation provides induction training for new staff. Evidence of induction training was available for all newly recruited care staff, and acknowledgment of completion of induction workbooks was seen. Induction programmes were signed off by the care manager to show that the carer had completed the induction programme and was competent. There was no specific induction- training programme for nursing staff. See recommendation 6. The training matrix was examined. This provides information about the training that staff had completed during the past twelve months. The matrix showed that staff could attend both ‘in house’ and external sessions, some of which were facilitated by the Care Homes Support Team. During the past year some staff had attended sessions about diseases and conditions affecting older people, dementia, reminiscence therapy, gentle exercise, the Mental Capacity Act and mandatory training such as moving and handling and first aid. Some of the senior staff had attended palliative care training and had spent time working alongside staff from a local hospice. This training will enable staff to implement the Gold Standard Framework. This model of care aims to improve the organisation and quality of care for people that are approaching the end of their life. Staff were satisfied with the training provided in the home and said sessions helped them to meet people’s needs. Some of the mental health trained nurses had not received wound care training. One health care professional that visits the home said some staff were “uncertain how to treat wounds. See recommendation 7. Limetree Care Centre DS0000043119.V351050.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was well managed and led. There were good systems in place to maintain peoples health and safety but the location of the smoking area may cause an obstruction in the event of a fire. EVIDENCE: Limetree Care Centre DS0000043119.V351050.R01.S.doc Version 5.2 Page 22 The manager has a nursing qualification, a degree in business administration and health promotion and the (RMA) registered managers award. The manager was assessed by the commission (CSCI) to have suitable skills and experience to manage a care home for older people with dementia. Staff said the manager visited the units when he was on duty and sometimes at weekends. Staff said that he spent time talking to staff and residents and often “helps out by taking people to the shops or garden”. Staff said the manager was approachable and kept people informed about irrelevant issues. The home had systems in place to monitor the care and services provided in the home. This included regular audits, satisfaction surveys and meetings to obtain feedback about the service. Staff had completed health and safety, medication, care standards, pressure sore and care plan audits in recent months. Action plans were prepared to address issues identified during audits. Satisfaction surveys were sent out regularly and the results were collated and displayed in the home. A food satisfaction survey was undertaken in January 2007. The findings from this survey showed that most people were satisfied with the food provided in the home. The minutes of relatives and residents meetings were seen. The records showed that relatives were encouraged to provide feedback about the service and to comment about proposed changes such as the planned sensory garden. Relatives were invoiced directly for services that were not included in the fees such as hairdressing or chiropody. The home did not store personal money for people but valuables were kept for some people. Valuable items were listed but the records were not always dated. There was no evidence that any recent checks had been carried out to ensure that all of the items listed were still in the safe. The items stored for two people were checked. Two items could not be located for one person. The inspector was advised after the inspection that the items were located at the back of the safe and returned to their owner. See requirement 1. Supervision was becoming more regular and consistent. Senior staff said they could request additional sessions if they had concerns or required support. There was no evidence that supervision for care staff included direct observation. The manager should consider including some observation of staff practice as this may help to identify and improve staff communication. The home employed some nurses from overseas that were completing the Overseas Nursing Programme in conjunction with Sunderland University. Records of assessments and clinical supervision were viewed for overseas staff. There was no evidence that these staff received formal ‘one to one’ supervision. See recommendation 8. The fire risk assessment was reviewed in October 2007. Fire safety equipment was serviced regularly and ‘in house’ checks were also carried out to ensure Limetree Care Centre DS0000043119.V351050.R01.S.doc Version 5.2 Page 23 that equipment was in working order. The fire alarm was tested once a week but it was not clear from the records which alarm point was activated. This information should be recorded so that staff can be certain that all points are tested. Fire drills were carried out regularly and included times when the night staff were on duty. Records showed that regular checks were undertaken to ensure that call bells were working and water temperatures were safe. Inspection and service reports for the passenger lift, hoists, portable electrical appliances, main electricity installation, water chlorination and gas appliances were examined. All of the records seen were well maintained and up to date. The smoking area was located at the bottom of the ground floor staircase, in front of the fire exit. Chairs and ashtrays were provided. This area felt cold, as the door was open to provide ventilation. The people that were in this area did not have any concerns about the temperature. The manager must discuss the location of the smoking area with the fire authority and local authority. See requirement 2. Limetree Care Centre DS0000043119.V351050.R01.S.doc Version 5.2 Page 24 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 3 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 2 3 X X 3 3 3 STAFFING Standard No Score 27 3 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 2 3 X 2 Limetree Care Centre DS0000043119.V351050.R01.S.doc Version 5.2 Page 25 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 OP35 Regulation 17 Requirement The Registered Person must ensure that there are adequate systems in place to safeguard valuable items handed to staff for safekeeping. The Registered Person must discuss the location of the smoking area with the fire officer and local authority. Timescale for action 07/03/08 2. OP38 13 07/03/08 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. 4. Refer to Standard OP4 OP9 OP15 OP25 Good Practice Recommendations The Registered Person should ensure that staff communicate effectively. The Registered Person should ensure that medication changes are signed and dated. The Registered Person should ensure that menus are easy to read and follow and that sauces and condiments are provided at mealtimes. The Registered Person should ensure that water from the ground floor bath drains away freely. DS0000043119.V351050.R01.S.doc Version 5.2 Page 26 Limetree Care Centre 5. OP38 6. 7. 8. OP30 OP30 OP36 The Registered Person should review the risk assessments for the portable heaters. The risk assessment should consider whether there are any risks to residents from trailing leads or touching hot surface temperatures. Strategies that are put in place to manage these issues should be recorded. The Registered Person should develop an induction programme specifically for qualified nursing staff. The Registered Person should ensure that nursing staff receive regular wound care training updates. The Registered Person should ensure that all care staff including those completing adaptation programmes receive one to one supervision. Limetree Care Centre DS0000043119.V351050.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Limetree Care Centre DS0000043119.V351050.R01.S.doc Version 5.2 Page 28 - 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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