Care Home: Lime Tree House

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What the care home does well The service meets the Christian Science nursing care needs of people who have chosen to rely on the Bible based system of spiritual healing known as Christian Science. All people who are admitted to Lime Tree House are assessed fully by a Journal listed Christian Science nurse. The manager makes sure the service can meet the person`s needs before they move in. Care plans and risk assessments were reviewed regularly and included the likes and dislikes of the people supported. People are treated with dignity and respect. People were complimentary about the standard of care they received in the home including the opportunity for support in their religious beliefs. One person wrote, "From the beginning to the end all my needs were met. I cannot think of anywhere where I would get better care." The four people who filled in the surveys said the staff always listened and acted on what they said. People are served nutritious, appealing and wholesome food with choices available in a family friendly environment. The people said they liked the food and one person said, "The food is excellent and there is always a choice for me." People were able to raise any concerns by using informal methods or by using the complaints procedure. People spoken to said they knew who to talk to if they were unhappy about anything and records showed how some concerns had been addressed in a positive way. The environment is well kept, homely and well maintained to meet the needs of the people accommodated. Staff recruitment and staff training needs are well recorded. Staff spoken to said they enjoyed working in this environment. One person said, "We give a very high standard of care and we have time to spend with people here which is satisfying." People who use Lime Tree House benefited from a committed and caring manager with a clear sense of direction who provides leadership for a caring staff team. Health and safety checks were regularly maintained so the welfare and safety of the people living at the home was protected. What has improved since the last inspection? Since the last inspection the manager has reviewd and improved some of the documentation. The manager constantly reviews and updates where possible the systems, policies and procedures in place. At the time of this visit the manager was updating the service user guide to a larger format for easier reading. Some new equipment has been purchased to assist in the moving and handling of people who use the service to make transfers more comfortable. What the care home could do better: The outcomes for people who use this service were excellent and the manager recognised that by continuing to listen to people who use the service, relatives and staff they will find ways to keep improving and updating the service. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Lime Tree House 264 Washway Road Sale Cheshire M33 4RZ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Elizabeth Holt     Date: 0 9 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Lime Tree House 264 Washway Road Sale Cheshire M33 4RZ 01619737956 01619735777 limetreehouse@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mountlands Trust Ltd care home 4 Number of places (if applicable): Under 65 Over 65 4 old age, not falling within any other category Additional conditions: 0 All service users must be willing to rely on bible based healing known as Christian Science. Care provided to service users who are aged 18 years and over on admission. There is a maximum of four (4) service users requiring Christian Science nursing care and/or Christian Science care and/or rest and study. Date of last inspection Brief description of the care home Lime Tree House provides short term residential accommodation with Christian Science Nursing care for up to four (4) people (who prefer to be referred to as patients) within the category of old age (OP). They may also admit adults aged 18 years and over. The aim of the service is for people to return to their own homes. Lime Tree House is a private Christian Science respite care home that is owned by Mountlands Trust Limited. Mrs Julie Brearley is the registered manager. It provides religious non medical Christian Science nursing care. Care is given by fully qualified Journal listed Christian Science nurses. The premises is a large bungalow, with pleasant grounds, which are enclosed to afford the patients privacy. The home is Care Homes for Older People Page 4 of 27 Brief description of the care home situated on the main road in Sale. The home is in easy reach of all amenities of Altrincham and Sale. The home has access to the local transport network and is near to the main motorway links in the area. Lime Tree Houses fees range from £50.00 to £250.00 per day however as a Registered Charity people pay within their means. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection included a site visit that took place on the 9th April 2009. The manager and staff at the home did not know that the visit was going to take place. All the key National Minimum Standards (NMS) were reviewed during this inspection. Information was gathered as part of the inspection process which included the manager filling in an annual quality assurance assessment (AQAA), this is a self assessment form that gave the manager the opportunity to tell us what they feel they do well, what they needed to do better and what had changed since the last key inspection. This form was well completed and the manager told us what plans there were to develop the service. Care Homes for Older People Page 6 of 27 Prior to this inspection, we sent surveys out to people who use the service and staff so they could tell us what they thought about the service. Four of the staff and four of the people who use the service returned completed surveys. Comments from these surveys are included in the report. Information was taken from various sources during this assessment which included observing care practices, talking with people who use the service, their relatives, the manager and other members of the staff team. Care plans for two people were looked at in detail and where possible these two people were spoken to. A selection of records were looked at including staff training records, accident, incident records and maintenance records. What the care home does well: What has improved since the last inspection? What they could do better: The outcomes for people who use this service were excellent and the manager recognised that by continuing to listen to people who use the service, relatives and staff they will find ways to keep improving and updating the service. Care Homes for Older People Page 8 of 27 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given information and have their needs fully assessed before moving into the home so they are confident their needs can be met in full. Evidence: People who use the service receive information about the home and as much information is gathered from the prospective person, their family, and any healthcare professionals to make sure the home are able to meet the care needs of the person. The four people who returned surveys said they had received enough information about the home before they moved in so they could decide it was the right place for them. In the AQAA the manager stated that as well as the statement of purpose and the service users guide, brochures of the home are available, a power point presentation and a DVD on Christian Science nursing in order to share the understanding of this service with other people. The completed admissions assessments for three people were looked at which showed Care Homes for Older People Page 11 of 27 Evidence: in detail that the persons assessed needs could be met at Lime Tree House. The admission process included a specific assessment in relation to meeting the criteria for Chrisitian Science nursing care as well as a physical needs assessment. The information gathered was used to start the persons care plan. The four staff members who returned surveys said they are given up to date information about the needs of the people they support or care for. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs were met in the way they preferred and with respect for their privacy and dignity. Evidence: A care plan was in place for each person accommodated at Lime Tree House. which covered their practical and spiritual needs. Each persons care plan identified the persons needs and contained the information to provide guidance for the staff to provide the necessary guidance and support. Care plans were seen to be person centered and included the likes and dislikes of the individual. Detailed daily records of the persons progress was in place and evidence of regular reviews of the care provided. Care plans were signed by the person supported to show they had been involved in their care plan. Risk assessments covering health and safety and environmental risk assessments were in place for each person. In relation to medication, the care home does not provide medicines or medical treatment in keeping with the Christian Science philosophy of care. The service has a policy in place to guide staff on the action to take if a person brings medication into the home with Care Homes for Older People Page 13 of 27 Evidence: them or is discharged from hospital with medication. People are supported if at any point they choose to access medical care. One of the nurses wrote in the survey that she felt she was given support to meet the individual needs of the people using the service and went on to say that, We have a holistic approach where we give support to the patients religious belief and faith and all the practical care that is within the belief and faith of the patient. We can suggest solutions to the problems the patient presents and together meet the needs relating to the disability, faith, race, age, ethnicity and sexual orientation of each individual patient. In the AQAA the manager gave examples of how people accommodated are treated with respect and dignity. Examples included knocking on a persons bedroom door before entering, privacy to use toilet facilities and addressing people by their preferred name. From observations made during the visit and discussions with people who use the service, they felt their needs for privacy and dignity were respected. Responses from four people who returned surveys showed that the staff listened and acted on what they said. Some comments from cards that had been sent to the staff were, Thank you for the outstanding care you and all the staff gave to our parents and the loving support you gave us, another person wrote, We all agreed that Mum was given the highest and utmost care anyone could receive. One person wrote in the survey that ,There is just the odd time when immediate help is not available, however a nurse always warns if a delay is going to be. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from choices in their daily lives to allow them to exercise control over their lives and enjoyed a choice of food. Evidence: The people living at Lime Tree House at the time of this visit were happy that the service met their expectations and preferences. Of the four people who filled in a survey, they all said there were always activities arranged by the home they could take part in. A schedule of activities was available which supported the healing process based on Christian Science for the people living at the home. The home supports people who rely on spiritual healing and provides the choice for people to have quiet time and study and opportunities to increase their spiritual understanding. Information about peoples daily lives and preferred social activities was held on file and this gave the staff information about the persons individual preferences. Comments from people who use the service included, I enjoyed the flexibility of the staff supporting me when I felt like it, I dont go for strict timetables and they were very understanding. Another person wrote, It is not easy to find words to express my heartfelt gratitude for the loving care I received during my stay at Lime Tree House. I Care Homes for Older People Page 15 of 27 Evidence: just want you to know that I remain enveloped in the warmth , thoughtfulness and tenderness in which you wrapped me. From the beginning to the end of my stay all my needs were met. Other activities people had enjoyed were flower arranging, film watching, dancing, gardening and cooking lessons. The manager said that routines, activities and plans are person centred and individual. In the Homes self assessment the manager wrote, We have a chef who enjoys making food which is wholesome, appealing and suitable to the individual, and she tailors the menus to the current service users needs, often making different meals for different people. Mealtimes are always unhurried and flexible to suit the person. People living at the home confirmed that the food was great and that the cook was great at offering them what they liked to eat. One person wrote, The chef is very helpful and will always offer an alternative if I dont want the meal on the menu or the vegetarian dish. The manager carried out an internal satisfaction questionnaire, comments from the repsonses included, It was like having a personal chef and The food is excellent, made just as I need it. The kitchen/dining room is homely in its design and people are encouraged to participate in mealtimes together to make this a social experience. A staff member wrote in the survey that, We have meals with the service users which contributes to the family atmosphere in the home. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were confident that any concerns they raised would be managed appropriately and the staff had been trained in the protection of vulnerable adults which promoted the safety and welfare of the people living at the home. Evidence: The homes complaints procedure was seen in the service users guide, a copy of which was held in each persons bedroom. A copy was dispalyed in the office and in each staff members handbook. The four people who filled in surveys said they knew how to make a complaint and people spoken to said they always knew who to speak to. Two people spoken to during the visit confirmed they could speak to the manager who was Easy to talk to or in fact any of the staff and they felt their concerns would be addressed. A complaints record was available however none had been received during the last twelve months and none had been sent directly to the Commission. The Responsible Individual visits the home on a monthly basis to broaden the quality assurance process in place and this contributes to staff, people living at the home and relatives feeling confident to address any issues. The policy on the Protection of Vulnerable adults (POVA) was available for the staff to access. Two staff spoken to had a clear understanding of what they would do in the event of an allegation of abuse. The manager confirmed that all staff had received Care Homes for Older People Page 17 of 27 Evidence: training in the protection of vulnerable adults and she had attended a specific course for managers. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefited from a clean, homely, safe and well maintained environment to meet the needs of the people living there. Evidence: Lime Tree House is a large converted bungalow so all the Christian Science nursing care is provided on the ground floor. Each bedroom has its own en suite which have aids and adaptations to meet the needs of people using the service. A partial tour of the premises was carried out and the home was clean, tidy and homely. There is a patio area in the garden where people can sit out and enjoy the garden. Parking is available at the front of the bungalow. People spoken to during the visit were positive about the environment, comments included, It is very homely here, look at my bedroom what more could I ask for? The four people who filled in surveys wrote that the home is always fresh and clean, one person added, I wish everyone was as comfortably placed as I am. In the AQAA the manager stated that, Many visitors, service users, family members and professionals comment on the sense of peace and love they feel when at the home, and very much appreciate the efforts made to make it homely. During the visit it was seen there is an ongoing programme of refurbishment. Two bedrooms and the communal corridors had been redecorated in the last few months and all carpets were cleaned regualrly. The home uses the services of a cleaning Care Homes for Older People Page 19 of 27 Evidence: company to keep the environment plesant for the people living at Lime Tree House. Since the last inspection the manager stated they had updated the homes policy on infection control to minimise the risk of cross infection for people living at the home. The service have seen a need to increase the number of nursing rooms and have plans to extend Lime Tree House in the near future. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home benefited from being cared for by well supported staff, who were trained and competent to do their work. Evidence: On the day of the site visit there were three staff including the manager for the four people accommodated. The people living at Lime Tree House spoke highly of the staff and said they felt well cared for. In the surveys, the four people who responded showed they always received the care and support they needed, the staff always listened and acted on what they said and the staff are always available when they were needed. The way in which the staff are recruited to work at Lime Tree House was assessed by looking at the records held for two staff members. The staff files looked at were found to be well organised. Each file contained a copy of the application form, confirmation of Criminal Reord Bureau checks, two written references and items confirming proof of identification. In the AQAA the manager wrote, As the home only employs Christian Science Nurses for care they do not use agency staff. It has its own temporary staff, ensuring that induction is completed and this supports patient centred care. There is very little staff sickness. Two people living at the home knew the staff members well and said there was continuity of care. It was clear from the comments made by people living at the home about the staff, that they were happy with the service provided by the staff members. One person said, The girls are patient and Care Homes for Older People Page 21 of 27 Evidence: kind and very understanding. A staff member wrote in the survey that, We have an extremely high standard in our home. The high staff to resident numbers enables us to spend plenty of time with each person and to give them our full and individual attention. A detailed training plan was in place and one of the nurses interviewed said she felt she had received alot of training and support over the last twelve months. Examples of training she had attended was fire safety, Mental Capacity Act training, POVA training, moving and handling and attending a Christian Science conference. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has the systems in place to monitor the service based on peoples views. The people accommodated benefited from a commited and caring manager and the home was seen to promote safe working practices. Evidence: The manager has managed the service for over five years and is clearly aware of her responsibilities and is committed to providing a caring and safe environment for people living at the home and the staff. The manager holds the NVQ level 4 in Management and is a fully qualified Christian Science nurse. Staff said that the manager was supportive, that she was actively involved in the day to day running of the service and that she communicated well with the staff team. A staff member wrote in one of the surveys that, The nursing manager is very understanding and encourages rather than criticises staff. She is a good role model and contributes very much to the harmonious running of the service. One person who had stayed at Lime Tree House wrote, in response to the question, What do you think of the standard of care given?the Care Homes for Older People Page 23 of 27 Evidence: response was Embraced by loving care and thoughtfulness of staff. The manager was seen and heard to treat peole who use the service and staff in a respectful and reassuring manner. The home has a policy in place in relation to safeguarding the financial interests of people who use the service, however the manager was clear that the service does not manage peoles money for them. Both formal and informal quality assurance checks were in place. This involved questionnaires and surveys to gather the views of people who use the service and staff satisfaction surveys. Examples were seen of how the manager had improved the service or made changes to meet the needs of individuals following comments made. Examples looked at showed how the views of people who used the service influenced how the service was run. A sample of the maintenance records for the service were looked at. Fire safety checks were up to date and an up to date fire risk assessment was in place to protect people from the risk of fire. Other records looked at which showed checks had been carried out were for the boiler and the central heating system. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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