Inspection on 05/12/06 for Limetree Care Centre

This inspection was carried out on 5th December 2006.

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

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

Other inspections for this house

Limetree Care Centre 26/11/07

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 Lisa Wilde Unannounced Inspection 11:00 5 December 2006 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Limetree Care Centre DS0000043119.V323001.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.V323001.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.V323001.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th August 2006 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 not very close to any tube or train stations and the local shops and other facilities are a fifteen-minute walk away. It is owned and managed by Excelcare Holdings. Limetree offers residential and nursing care for older people with dementia; there is one residential floor and two nursing floors. There are 92 rooms all with full en-suite facilities. The current fees are charged from £350 per week. Additional charges are made for things such as hairdressing and newspapers. The home makes copies of the Commission’s reports following the inspections, available in the reception area of the home. Limetree Care Centre DS0000043119.V323001.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day in December 2006. This was the first full inspection on the home since August 2006 although there had been one inspection in October 2006 focussing on specific issues of concern. The focus of this inspection was the large number of requirements made at the August inspection and in previous inspections and to assess the standards of health, safety and care at the home to decide if the embargo that had been placed on the home preventing them accepting new service users on the first and second floors, could be lifted. Given the particular focus of the inspection and the number of service users and relatives that had been consulted at the August inspection, the inspector did not speak with many service users or relatives during this inspection. The inspector met with the Registered Manager, the Regional Operations Manager and staff. She further examined records and medication stocks and toured the building. The inspector found that most of the previous requirements had been met at this inspection and progress had been made on some of the remaining requirements. Although additional issues were identified during this inspection the home evidenced that significant improvements have been made in many areas of the service. The inspector was satisfied that at this point standards of health, safety and care have improved to the point where the embargo preventing the home from accepting new service users can be removed. The inspector will be visiting the home again in the next few months to assess the standards that were not assessed during this or the last inspection and to make sure that the standards of care and health and safety continue to improve as new service users move to the first and second floors. The management and staff at the home must be highly commended for the recent efforts they have made to ensure that standards are raised at this home that has for a number of years struggled to offer an acceptable service. Limetree Care Centre DS0000043119.V323001.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? There has been significant improvement in many areas since the last full inspection in August 2006. • • • • • • • • • Senior staff assess prospective service users’ needs before they move to the home. Care plans are in place that state what staff will do to support service users in all aspects of their life. Details of health care monitoring are recorded in the service user files and accurate notes kept of any day-to-day issues. Staff understand the needs of service users more and understand how they should work to meet those needs. Medication systems and procedures are followed effectively. Service users are listened to and their concerns are taken seriously and acted upon. Complaints are investigated appropriately. Service users are protected from abuse. There are enough staff on duty to meet the needs of service users. (This issue will be assessed again at the next inspection when more usual numbers of service users are living at the home) DS0000043119.V323001.R01.S.doc Version 5.2 Page 7 Limetree Care Centre • • • • Staff receive adequate training in order for them to be able to meet the needs of service users The financial systems in operation in the home make sure that service users’ money is held safely and they are protected from abuse. Recording throughout the home has improved significantly. Weekly fire system tests and monthly fire drills now take place as planned. 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. The summary of this inspection report can be made available in other formats on request. Limetree Care Centre DS0000043119.V323001.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.V323001.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 & 6 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Service users are issued with terms and conditions that tell them about their rights and responsibilities so they know what is expected of them and what they can expect from the home but they do not include all the required details so the are not being given all the information they need. Senior staff assess prospective service users’ needs before they move to the home so that no one is offered a place without the staff team believing they can support someone. Standard 6 is not applicable, as the home dos not provide intermediate care. EVIDENCE: There is new legislation in place now that came into force on 01/09/06 and other changes come into force on 01/10/06 which will require services to state Limetree Care Centre DS0000043119.V323001.R01.S.doc Version 5.2 Page 10 exactly what fees each service user is paying and how it breaks down into different areas, in the service user guide. (See Requirement 1) There was a previous requirement that the Registered Individuals must ensure that all service users have comprehensive, signed terms and conditions (or a contract if they are paying privately) in place and that new service users receive these documents at the point of moving to the home. All service users are now being given terms and conditions and all efforts are made to get relatives to sign them. The new terms and conditions being used do not include the fees that service users are paying, whether they are privately funded or paid for by the local authority and they do not have the sections completed which state whether they have medium, high or very high needs. (See Requirement 2) There was a previous requirement that the registered person must ensure that service users have a comprehensive needs assessment completed in consultation with them and /or their representative, having regard to the service user’s needs in respect of health and welfare. This assessment must be kept under review. This is now being done. Currently the Care Manager of the home is undertaking all assessments whereas senior staff used to do them and the Registered Manager said that the plan is for them to begin undertaking them again. This would be more effective as then better ways could be thought about of trying to match the assessor to the potential service user to assist with making the service user more comfortable and more able to talk about their issues i.e. to be sure that the home gathers more information and can conduct a more useful assessment. (See Recommendation 1) Limetree Care Centre DS0000043119.V323001.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, 10 & 11 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Care plans are in place that state what staff will do to support service users in all aspects of their life. Staff follow these care plans and the plans are reviewed every month with service users and their family so that service users know that their changing needs are met. Details of health care monitoring are recorded in the service user files and accurate notes kept of any day-to-day issues. Service users do not get enough exercise (or the exercise is not being recorded properly) so the home is not showing that it is meeting service user needs in this area. Generally medication systems and procedures are followed effectively which means that service users are given their medication as required. Limetree Care Centre DS0000043119.V323001.R01.S.doc Version 5.2 Page 12 Service users are cared for when they are dying but as care is not being offered according to current best practice the home may not be doing all it can to effectively offer the most effective end of life care. EVIDENCE: Three service user files on each floor were examined. There was a previous requirement that the Registered Manager must ensure that all staff read and understand the care plans that are in place. Team leaders now meet with keyworkers to talk through care plans and staff sign that they have done so. Staff reported that this had led to greater understanding and also better care plans because more staff are involved in providing information about service users’ needs. There was a previous requirement that the Registered Manager must ensure that all service users have on file details of their dentist, optician and chiropodist (plus district nurse if they are on the residential floor) and who has power of attorney for them. This is now being done. There was a previous requirement that the Registered Manager must ensure that all service users have on file an up-to-date inventory of their possessions that is altered when new possessions are bought or replaced. This is now being done. There was a previous requirement that the Registered Manager must ensure that service users’ possessions are not taken, misplaced or lost by staff or other service users. There are now lost property books on each floor. There was a previous requirement that the Registered Manager must ensure that all service users have an annual review of their care involving service users and their representatives should they choose. Annual reviews have now occurred and relatives are invited. Care plans are reviewed once a month and relatives are invited to take part in this review as well. Not all the new service users have had their six-weekly review of their placement as required by the organisation’s policy, in order to assess if the placement is working out. (See Requirement 3) There was a previous requirement that the Registered Manager must ensure that additional support is given to staff on the first floor to ensure that all fluid, nutrition, weight, wound and other health care records relating to all relevant service users, are kept contemporaneously, in sufficient detail and are accurate. This is now being done. There was a previous requirement that the Registered Manager must ensure care is delivered in accordance with agreed care plans and guidance and that Limetree Care Centre DS0000043119.V323001.R01.S.doc Version 5.2 Page 13 external professionals advice is followed at all times. As far as could be assessed this is now being done. There was a previous requirement that the Registered Manager must ensure that advice is sought on an individual basis from a diabetes specialist as to whether accurate records of food eaten need to be maintained for all the service users with diabetes. Advice has been gathered about which service users need to have detailed records. There are several care plans in place stating that service users should receive regular exercise but records of this exercise are not kept to show that this is being carried out and there is no evidence that the people who are offering the exercise have been trained in how to do so safely. (See Requirement 4) There was a previous requirement that the Registered Manager must ensure that risk assessments are reviewed to reflect any changes in the risk management of the service user. This is now being done. There was a previous requirement that the Registered Manager must ensure that copies of accidents and incidents relating to the service user are kept in their files. This is now being done, although in addition the notifications sent through to the Commission should be held on individual files as well. There was a previous requirement that the Registered Manager must ensure that staff use the hoist as directed by the community physiotherapist when moving and transferring the identified service user. An investigation of the previous incident that triggered this requirement has highlighted areas for improvement and staff have received instruction and additional training in how to operate hoists effectively at all times. There were several requirements made about medication at the last inspection. No problems were noted with medication records and stocks during this inspection expect that on one floor certain medications had run out of stock on a few occasions. (See Requirement 5) There was a previous recommendation from the Commission’s pharmacist inspector that the Registered Manager should ensure that the frequency of all blood monitoring is indicated on the blood-monitoring sheet, including the action to be taken for high/low readings, or refusals to have monitoring carried out. The blood monitoring sheets are in place but do not indicate procedures for high/low readings or refusals. This information is currently kept on a separate sheet. (See Recommendation 2) There was a previous requirement that the Registered Manager must ensure that staff sensitively gather the views of service users and their relatives with regard to end of life issues. In the interim, if relatives do not wish to discuss the matter, this should be recorded on the care plan. This is now being done. Limetree Care Centre DS0000043119.V323001.R01.S.doc Version 5.2 Page 14 Service users are asked what they want in the event of death in terms of practical arrangements. The home does not yet work within the Gold Standard Framework or the Liverpool Care Pathway systems, which would assist with ensuring that all needs in the event of serious illness and death are met. The home is starting to access training and is working with the local St Christopher’s nurses to develop in this area. (See Requirement 6) There was a previous recommendation that the Registered Manager should consult with other managers in the organisation to establish a clear set of guidelines and procedures so that staff can be confident of how to draw up palliative care plans to prevent service users having to be unnecessarily sent to hospital when they wish to die in the home. This is now reworded and made into a policy requirement. (See Requirement 7) Limetree Care Centre DS0000043119.V323001.R01.S.doc Version 5.2 Page 15 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 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home is not yet doing enough to make sure that service users’ individual needs regarding stimulation and fulfilment are being met. Family and friends can visit as they choose. EVIDENCE: There was a previous requirement that the Registered Manager must ensure that service users or their representatives are consulted about their interests and favoured lifestyles, these must be recorded and appropriate opportunities are given to service users in relation to meeting these needs. Two new parttime activities co-ordinators have been employed but only started at the home three weeks before the inspection and have not yet had time to make much of an impact. They discussed their plans with the inspector and appeared well qualified to offer an effective activities programme. This requirement is not yet met but would be more usefully assessed at the next inspection. (See Requirements 8 & 9) Limetree Care Centre DS0000043119.V323001.R01.S.doc Version 5.2 Page 16 There was a previous requirement that the Registered Manager must ensure that service users and their relatives are consulted about their satisfaction with the food on offer and that action is taken to improve satisfaction for individual service users. A survey was done in September and the Registered Manager has now to draw up an action plan showing how the home will aim to address the issues raised and improve satisfaction before the next survey is sent out. There are now food comment books on each floor where service users can record if they are happy or unhappy with the food. The chef looks at this book but the Registered Manager must also audit these comments and any action taken in order to further improve action planning in this area. Food will be further assessed at the next inspection. There was a previous requirement that the Registered Manager must ensure that advice is sought from the dietician for all service users as to the effects of the home’s snacking policy and what appropriate snacks should be available. This has now been done and the sugary snacks are now more closely monitored for some service users. There was a previous recommendation that the Registered Manager should ensure that service users who are on pureed food have as varied and nutritious a diet as possible. The chef says that now pureed food is the same meal as all other service users receive. Limetree Care Centre DS0000043119.V323001.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Service users are listened to and their complaints are taken seriously and acted upon. More work can be done to monitor and address less formal complaints and concerns. Service users are protected from abuse by staff being trained in the issues and systems in place for the protection of service users being operated effectively. EVIDENCE: There was a previous requirement that the Registered Manager must ensure that details of complaints investigations, outcomes, action taken, timescales and whether the complainant was satisfied with the outcome are recorded accurately and held in the home. This is now being done for formal written complaints but there is no central system for bringing together and monitoring action taken on all informal complaints or comments/concerns. (See Requirement 10) There was a previous requirement that the Registered Manager must ensure that record of all allegations and adult protection issues is maintained in a confidential manner in the home. This is now being done although the Registered Manager had thought that he only needed to keep records of allegations that were made into formal vulnerable adult issues by the Limetree Care Centre DS0000043119.V323001.R01.S.doc Version 5.2 Page 18 borough’s adult protection team whereas allegations, regardless of the outcome, need to be held on file. There was a previous requirement that the Registered Individuals must ensure that all staff attend adult protection training. This has now been done. A recent investigation into an allegation has identified the need for the organisation to draw up a policy making clear its approach to recognising the religious and faith needs of staff while balancing this with the needs of service users. (See Recommendation 3) Limetree Care Centre DS0000043119.V323001.R01.S.doc Version 5.2 Page 19 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, 25 & 26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home has adequate living and dining areas on each floor. The communal areas on the upper floors of the home are too warm. There is a pleasant landscaped garden to the rear of the home. On the day of the inspection, the home was clean and hygienic throughout. EVIDENCE: There was a previous requirement that the Registered Manager must ensure that the temperature in the home is comfortable at all times and that service user’s relatives are aware of how to turn down the radiators in service users’ rooms. The upper floors of the home were still very warm and some service Limetree Care Centre DS0000043119.V323001.R01.S.doc Version 5.2 Page 20 users were complaining of the heat, while it is important that service users do not get too cold this issue must be addressed. (See Requirement 11) Limetree Care Centre DS0000043119.V323001.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There are enough staff on duty to meet the needs of service users. (This issue will be assessed again at the next inspection when more usual numbers of service users are living at the home) Most staff hold or are undertaking the NVQ Level 2 in Care which means that staff know what they are doing. Staff receive adequate training in order for them to be able to meet the needs of service users although their training needs are not assessed annually which means they may not be receiving the best training to develop their practice. Recruitment procedures have improved significantly but there are still a few issues to address to make sure that effective checks are in place to make sure staff are who they say they are and can do the job they are hired to do. EVIDENCE: There was a previous requirement that the Registered Manager must ensure that an accurate roster is maintained of staff, as they worked at the home. This is now being done. Limetree Care Centre DS0000043119.V323001.R01.S.doc Version 5.2 Page 22 Staffing levels have reduced due to their being less service users in the home. The issue of whether there are enough staff to meet service users’ needs will be assessed at the next inspection when the home will probably be closer to full occupancy. Most staff hold or are undertaking the NVQ Level 2 or 3 in Care. Three new staff recruitment and personnel files were examined. There was a previous requirement that the Registered Manager must ensure that all care staff who do not have current enhanced Criminal Records Bureau check on file are appropriately supervised and do not escort service users from the building. Ongoing efforts must be made to find out when the missing checks will be received. This is being done although the organisation is still using the POVAFirst check as a matter of course when it must only be used in emergencies. (See Requirement 12) There was a previous requirement that the Registered Individuals must ensure that no staff begin work at the home without having received back two adequate references. This is now being done although one reference seen did not have any formal stamp or evidence of the organisation and no calls had been made to verify the identity person who made the reference. (See Requirement 13) The home does not destroy CRB checks after six months (or when the inspector has had the opportunity to see the checks) and then keep a central record of the dates of the CRB checks. (See Requirement 14) There was only one interviewer record on each file when all interviewers need to keep records of interviews and then record their discussion and decisions on the records. (See Requirement 15 and Recommendation 4) Some staff are only putting the last few years of their employment or education on their application forms instead of their entire histories. (See Requirement 16) Equalities Monitoring forms are not anonymous and are held on individual files. (See Recommendation 5) There was a previous requirement that the Registered Manager must ensure that all staff receive induction and foundation training that is in line with Skills For Care national requirements. Appropriate workbooks are now in place and given to new staff and longer-term staff are going through the induction as well. No induction workbooks for new staff were available at the inspection as the new staff keep them until they are completed. While progress has been made in this area it could not be fully assessed and will be at the next inspection. (See Requirement 17) Limetree Care Centre DS0000043119.V323001.R01.S.doc Version 5.2 Page 23 There was a previous requirement that the Registered Individuals must ensure that all staff have an at least annual appraisal, following which they then have drawn up an individual training and development plan. These individual plans must then be brought together into an overall annual training and development plan for the home that identifies what training is required for all staff to ensure the needs of service users and aims of the home are met. Appraisals have been done for a few staff and booked for the rest but this requirement is not yet met. (See Requirement 18) There was a previous requirement that the Registered Individuals must ensure that all staff receive training in dementia care and managing challenging behaviour. This has now been done. Limetree Care Centre DS0000043119.V323001.R01.S.doc Version 5.2 Page 24 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, 35, 36 & 38 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There is a Registered Manager in post who has been interviewed by the Commission and who is fit to be in charge. The financial systems in operation in the home generally make sure that service users’ money is held safely and they are protected from abuse. Staff are not yet supervised regularly and effectively, which means that service users are not supported by people who receive enough support and advice from managers. Health and safety systems are generally operated as they should. Limetree Care Centre DS0000043119.V323001.R01.S.doc Version 5.2 Page 25 EVIDENCE: There was a previous requirement that the Registered Manager must ensure that relatives are aware of when the Commission’s inspections occur and when a new report is available for them to read in the home. As far as could be assessed this has been done. The records and systems for giving money to service users from their accounts is open and robust with two staff checking and signing for the amounts when service users are unable except that service users (or their relatives) whose money is managed by the organisation are not issued with monthly statements of their accounts and the home no longer accepts money or cheques from relatives. (See Requirement 19) There was a previous requirement that the Registered Manager must ensure that all staff receive effective supervision regularly. This has improved considerably but many staff have been receiving group supervision which does not cover all areas that individual supervision can and the Regional Operations Director said that this was supposed to be in addition to the individual supervisions that the organisation’s policy requires. (See Requirement 20) There was a previous requirement that the Registered Individuals must ensure that all staff who offer supervision and undertake appraisals have received training in how to do so and have been judged as competent to do so. This has been done for most staff and the others are due to do it soon. There was a previous requirement that the Registered Manager must ensure that all fire call points are tested on a regular basis. This is now being done. There was a previous requirement that the Registered Manager must ensure that tests of the fire system occur weekly and records are kept of these tests. This is now being done. There was a previous requirement that the Registered Manager must ensure that fire doors are not propped open inappropriately. On the day of the inspection one fire door was found propped open with a zimmer frame (See Requirement 21) There was a previous requirement that the Registered Manager must ensure that staff do not inappropriately prevent door alarms from sounding. There are signs telling staff not to do this and the Registered Manager said that staff have been told they will be dismissed if they continue to do this. There was a previous requirement that the Registered Manager must ensure that cleaning procedures and products do not place service users at risk of Limetree Care Centre DS0000043119.V323001.R01.S.doc Version 5.2 Page 26 harm. The housekeeper now meets with the domestics to discuss health and safety issues. No problems were seen in this area during this inspection. Limetree Care Centre DS0000043119.V323001.R01.S.doc Version 5.2 Page 27 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X 2 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 2 2 X 2 Limetree Care Centre DS0000043119.V323001.R01.S.doc Version 5.2 Page 28 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 OP1 Regulation 4&5 Requirement The Registered Individuals must ensure that the breakdown of each service users’ fees is put these in the service user guide/statement of purpose as required by the new legislation. Previous recommendation The Registered Individuals must ensure that all service users have comprehensive terms and conditions (or a contract if they are paying privately) in place. Part of previous requirement: Unmet timescale 30/11/06 The Registered Manager must ensure that six-weekly reviews of service user’s placements take place as per organisational policy. The Registered Manager must ensure that exercise is offered in accordance with care plans and is recorded and monitored effectively. All exercise must be offered by staff trained in how to do so safely. The Registered Manager must ensure that the home does not run out of stock of service users’ DS0000043119.V323001.R01.S.doc Timescale for action 31/12/06 2. OP2 5 31/01/07 3. OP7 15 31/12/06 4. OP8 15 & 16 (2) (m) & (n) 31/01/07 5. OP9 13 (2) 05/12/06 Limetree Care Centre Version 5.2 Page 29 6. OP11 15 7. OP11 15 & 18 (1) (c) (i) 8. OP12 16 (2) (m) & (n) 9. OP12 16 (2) (m) & (n) 10. OP16 22 11. OP25 13 (4) (a) & (c) medication. The Registered Individuals must ensure that staff are trained in and the home operates such systems as the Gold Standard Framework and the Liverpool Care Pathway to fully support someone according to best practice when dying. The Registered Individuals must ensure that there is an organisational policy drawn up describing the current best practice the home will operate to ensure all service users’ needs are met when they are dieing. The Registered Manager must ensure that service users or their representatives are consulted about their interests and favoured lifestyles, these must be recorded and appropriate opportunities are given to service users in relation to meeting these needs. Previous requirement: Unmet timescales 01/08/06 & 30/11/06 The Registered Manager must ensure that there is a frequent, regular reminiscence group and/or reminiscence sessions are offered by appropriately trained staff who are supplied with sufficient materials to support service users to remember their early lives. This work must also meet the specific needs of service users from different cultures and ethnicity. The Registered Manager must ensure that details of informal complaints or concerns are recorded and audited along with any action taken to address these issues and improve the service. The Registered Manager must ensure that the temperature in DS0000043119.V323001.R01.S.doc 28/02/07 31/01/07 28/02/07 28/02/07 31/12/06 31/12/06 Page 30 Limetree Care Centre Version 5.2 12. OP29 13 (6) 13. OP29 13 (6) & 17 (2) 14. OP29 13 (6) & 17 (2) 15. OP29 17 (2) & 18 (2) 13 (6) & 17 (2) 16. OP29 17. OP30 18 (1) (c) (i) 18. OP30 OP36 18 (1) (c) (i) & (2) the home is comfortable at all times. Part of previous requirement: Unmet timescale 09/10/06 The Registered Individuals must ensure that the POVAFirst check is only used in emergencies and not as a means to start staff at the home as a matter of course. The registered provider must ensure that efforts are made to ensure the validity of references. This must include receiving references on headed notepaper or with organisational stamps and recording any verbal verification of references on the applicant’s file. The Registered Individuals must ensure that CRB checks are destroyed after six months or when the inspectors have had the opportunity to see them and that a central record is then maintained of the CRB date and number. The Registered Individuals must ensure that at least two records of staff interviews are made and kept on file. The Registered Individuals must ensure that potential staff include a full history on their application forms and that any significant gaps are investigated appropriately. The Registered Manager must ensure that all staff receive induction and foundation training that is in line with Skills For Care national requirements. Previous requirement that the inspector was not able to fully assess at this inspection. The Registered Individuals must ensure that following an at least annual appraisal, all staff have in place an individual training and DS0000043119.V323001.R01.S.doc 05/12/06 05/12/06 31/12/06 05/12/06 05/12/06 31/12/06 28/02/07 Limetree Care Centre Version 5.2 Page 31 19. OP35 13 (6) 20. OP36 18 (2) 21. OP38 13 (4) (a) & (c) & 23 (4) (c) development plan. These individual plans must then be brought together into an overall annual training and development plan for the home that identifies what training is required for all staff to ensure the needs of service users and aims of the home are met. Previous requirement: Unmet timescale 30/11/06 The Registered Individual must ensue that service users for whom the organisation manages finances are issued with a monthly statement of their accounts (or these statements are issued to relatives if the service user lacks capacity). The Registered Manager must ensure that all staff receive effective supervision regularly. Previous requirement: Unmet timescale 31/10/06 The Registered Manager must ensure that fire doors are not propped open inappropriately. Previous requirement: Unmet timescale 09/10/06 05/12/06 31/01/07 05/12/06 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. Refer to Standard OP3 Good Practice Recommendations The Registered Manager should consider ways in which the staff member assessing a potential service users’ needs can be better matched to the service user in terms of gender, ethnicity and culture in an attempt to make the service user more comfortable and more able to discuss their needs. The Registered Manager should ensure that the frequency DS0000043119.V323001.R01.S.doc Version 5.2 Page 32 2. OP9 Limetree Care Centre 3. OP18 4. OP29 5. OP29 of all blood monitoring is indicated on the bloodmonitoring sheet, including the action to be taken for high/low readings, or refusals to have monitoring carried out. Previous recommendation. The Registered Individuals should draw up a policy making clear its approach to recognising the religious and faith needs of staff while balancing this with the needs of service users. The Registered Individuals should ensure that when the information (given by prospective staff on the application form for a job) or the references do not give enough evidence of the relevant skills or experience necessary for the job, a record is made on the staff file of how the person’s suitability for the position was established. The Registered Individuals should ensure that all Equalities Monitoring forms are held anonymously. Limetree Care Centre DS0000043119.V323001.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH 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.V323001.R01.S.doc Version 5.2 Page 34 - 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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