CARE HOMES FOR OLDER PEOPLE
The Lemon Tree 133 Hornby Road Blackpool Lancashire FY1 4JG Lead Inspector
Mr Wesley Cornwell Unannounced Inspection 4th January 2006 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 The Lemon Tree DS0000062940.V260004.R01.S.doc Version 5.1 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. The Lemon Tree DS0000062940.V260004.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service The Lemon Tree Address 133 Hornby Road Blackpool Lancashire FY1 4JG 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) 01253 021643 Mrs Nivedita Devi Kurtis Care Home 12 Category(ies) of Old age, not falling within any other category registration, with number (12) of places The Lemon Tree DS0000062940.V260004.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered provider should, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection The home is registered for a maximum of 12 service users over the age of 65. 12th September 2005 2. Date of last inspection Brief Description of the Service: The Lemon Tree is registered for 12 male and female residents over the age of 65 years. The home is situated close to Blackpool town centre and comprises of the following accommodation: One lounge and one dining room/sitting area both of which are designated as non-smoking areas. Resident bedrooms are situated on the ground and first floor. Three bedrooms have en-suite facilities. The home has a chairlift that facilitates access between the ground and first floor. The Lemon Tree DS0000062940.V260004.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and started at 9.30am and took place over 3 hours. The Inspector spoke to two staff members, five residents and the owner. Staff and care records were also examined. A full tour of the premises was undertaken with the owner What the service does well: What has improved since the last inspection?
The owner of the home has introduced meetings to consult residents about the running of the home and seek their views about the care being provided. One resident said they looked forward to the meetings. The Lemon Tree DS0000062940.V260004.R01.S.doc Version 5.1 Page 6 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 Lemon Tree DS0000062940.V260004.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Lemon Tree DS0000062940.V260004.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed during this inspection. EVIDENCE: The Lemon Tree DS0000062940.V260004.R01.S.doc Version 5.1 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): 8,9 and10 Promotion of health is taken seriously. Residents welfare is closely monitored and health needs were met. Residents feel respected by the staff team and their right to privacy is upheld. EVIDENCE: Discussion with staff members confirmed they were fully aware of the healthcare needs of residents and these are monitored and kept under review. Entries made on care plans showed good communication between the home and healthcare professionals. The records of one resident confirmed a health problem had been identified and appropriate action had been taken by the home to ensure the resident was receiving medical assistance. Medication practices observed were safe and good records had been maintained. The Lemon Tree DS0000062940.V260004.R01.S.doc Version 5.1 Page 10 Residents spoken to said they liked living at the home and were well treated by staff members. One resident said, “ I moved here when my previous care home closed. I am very happy and more than satisfied with my care”. Two residents said the staff team respected their privacy and they could spend time on their own if that was their wish. Staff members spoken to had a good understanding of the needs of residents and felt they were able to respect the rights of residents at all times. Training records confirmed staff are instructed during their induction on how to treat residents with respect whilst completing their duties. The Lemon Tree DS0000062940.V260004.R01.S.doc Version 5.1 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 The homes procedures enable residents to exercise choice and control over their lives. EVIDENCE: Residents spoken to said routines within the home were flexible and they were able to make their own decisions about how to live their lives. One resident said, “ This place is home from home. The staff are very caring and give me all the support I need. They are very respectful and allow me to make my own decisions”. Another resident said they went out daily for a walk into town, which helped to keep them active. The resident said, “ The staff are really good. I don’t have to worry about being back for lunch at a particular time as they always have a hot meal ready for me no matter what time I return”. Most residents at the home handle their own financial affairs or these are handled by their relatives/representatives. Records being kept by the home in respect of residents unable to manage their own finances were being well maintained. A tour of the premises confirmed residents had been allowed to bring their own personal possessions with them on admission to the home. The Lemon Tree DS0000062940.V260004.R01.S.doc Version 5.1 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): These standards were not assessed during this inspection. EVIDENCE: The Lemon Tree DS0000062940.V260004.R01.S.doc Version 5.1 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): 20, 21, 22, 23, 24, 25 and 26 The home has a planned maintenance and renewal programme for the redecoration and refurbishment of the home to ensure residents live in a comfortable, homely and safe environment. EVIDENCE: Lounge and dining areas have been decorated and furnished for the comfort of residents. The grounds were tidy, attractive and accessible to residents. All residents spoken to said they were happy with their rooms and were provided with the choice of spending time on their own or in the lounge area’s. One resident said they liked to spend time on their own in their room and the staff respected their privacy.
The Lemon Tree DS0000062940.V260004.R01.S.doc Version 5.1 Page 14 Toilet and bathing facilities are located on all floors and are easily accessible for residents. The home has a chairlift to provide access between the ground and first floor. The Inspector observed residents using the chairlift independently during the inspection. Radiators throughout the home are guarded or have guaranteed low temperature surfaces to protect residents from the risk of burning. Hot water temperatures throughout the home were checked and found to deliver water at a safe temperature in line with health and safety guidelines. It was observed during the visit the home was clean and hygienic. The Lemon Tree DS0000062940.V260004.R01.S.doc Version 5.1 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): 27 and 28 Staff are well trained to ensure they have the competencies to meet residents needs. The deployment of staff throughout the day is sufficient to meet the needs of residents EVIDENCE: Staffing levels were sufficient for the number of residents living at the home. Residents said they were happy with the care they receive from the home and were well treated by the staff. One resident said, “ I have lived here for a number of years and I am very happy with my care. There is always plenty of staff on duty and they are always there when you need them”. Staff spoken to said they were clear about their role and work well as a team to ensure the individual and collective needs of residents are met. Observation of care practices throughout the day confirmed residents are treated with respect and dignity. Records show one staff member has gained a National Care Qualification and another three members of staff are working towards these. One staff member said they had enjoyed undertaking their training and intended to pursue further training opportunities. The Lemon Tree DS0000062940.V260004.R01.S.doc Version 5.1 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): 31,33,35 and 36 The home is well managed and run in the best interests of residents. EVIDENCE: The owner of the home is a Registered General Nurse and has achieved a relevant management qualification. Records seen confirmed the owner has access to training to ensure her knowledge and skills are updated. Systems in place for gathering the views of residents, their relative’s and staff as part of the monitoring of quality are informal and the owner is aware this is an area that needs to be addressed. Inspection of records for resident’s finances were well maintained and up to date.
The Lemon Tree DS0000062940.V260004.R01.S.doc Version 5.1 Page 17 Staff at the home are not receiving formal supervision and the owner is aware this is an area that needs to be addressed. The Lemon Tree DS0000062940.V260004.R01.S.doc Version 5.1 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 X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X X The Lemon Tree DS0000062940.V260004.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 OP28 OP33 OP36 Good Practice Recommendations 50 of the care staff team should achieve NVQ qualifications Staff meetings should be held with minutes documented and retained for inspection. Staff members at the home should receive formal supervision at least six times a year. The Lemon Tree DS0000062940.V260004.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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