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Care Home: Lime Trees

  • Harwich Road Sparrows Corner Little Oakley Essex CO12 5AD
  • Tel: 01255880281
  • Fax: 01255886374

Lime Trees is a large detached bungalow situated in the small village of Little Oakley on the outskirts of Harwich. There are parking facilities to the front of the bungalow and extensive gardens to the rear. The property has been adapted to accommodate six adults with learning disabilities, who may also have physical disabilities. Individual bedrooms are spacious and all have en-suite bathrooms. The communal lounge and the dining room are spacious, homely and well furnished. The service supports people to live in an ordinary home environment that reflects their individual needs. Lime Trees has its own mini bus that is accessible to people who require the use of a wheelchair. The home charges approximately £1,000.00 a week for the service they provide. There are additional charges for chiropody and leisure activities such as the `music man` who visits the home. This information was given to us in April 2008. Information about the home can be obtained by contacting the manager. Inspection reports are available from the home and from the CSCI website www.csci.org.uk

  • Latitude: 51.904998779297
    Longitude: 1.1920000314713
  • Manager: James Barry Moor
  • UK
  • Total Capacity: 6
  • Type: Care home only
  • Provider: James Barry Moor
  • Ownership: Private
  • Care Home ID: 9712
Residents Needs:
Dementia, Physical disability, Learning disability

Latest Inspection

This is the latest available inspection report for this service, carried out on 14th April 2009. CQC found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

For extracts, read the latest CQC inspection for Lime Trees.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Lime Trees Harwich Road Sparrows Corner Little Oakley Essex CO12 5AD 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: Ray Finney Date: 1 4 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. They reflect the things that people have said are important to them: 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 Adults (18-65 years) 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. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 35 Care Homes for Adults (18-65 years) Audience Further copies from Copyright 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 Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: Lime Trees Harwich Road Sparrows Corner Little Oakley Essex CO12 5AD 01255880281 01255886374 lindadurrant1963@aol.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) : James Barry Moor care home 6 Number of places (if applicable): Under 65 Over 65 6 6 6 0 6 6 dementia learning disability physical disability Additional conditions: The home accommodates six people with learning disabilities who may also have physical disabilities Date of last inspection 1 8 0 4 2 0 0 8 Care Homes for Adults (18-65 years) Page 4 of 35 A bit about the care home Lime Trees is in Dovercourt. It is a home for six people with Learning Disabilities. The home is a large purpose built bungalow. This means that people who need to use wheelchairs can get around easily. The home has a car that people can use. This means that people who live there can get out and about easily. Care Homes for Adults (18-65 years) Page 5 of 35 Everyone has their own bedroom. Everyone has their own bathroom. There is a large garden at the back of the bungalow that people can use. There is a Service Users Guide that the home can let you have. It costs about £1,000.00 a week to live there. Care Homes for Adults (18-65 years) Page 6 of 35 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 7 of 35 How we did our inspection: This is what the inspector did when they were at the care home We looked at lots of different evidence for this report. We looked at paperwork like care plans, staff files and menus. The manager sent us information called an Annual Quality Assurance Assessment or AQAA. This gave us information about how they run the home. We visited the home on 14th April 2009. We looked around the home. Care Homes for Adults (18-65 years) Page 8 of 35 We talked to people living in the home and staff. We looked to see if people were happy with what goes on in the home. What the care home does well Care Homes for Adults (18-65 years) Page 9 of 35 Listens to people and helps them to do the things they want to do. Looks after peoples health and cares for them well. Helps people keep in touch with their families and friends. Helps people get out do lots of activities that they enjoy. Care Homes for Adults (18-65 years) Page 10 of 35 The home has very comfortable rooms to live in. People have comfortable bedrooms with their own things in them. What has got better from the last inspection Care Homes for Adults (18-65 years) Page 11 of 35 There has been some redecorating. There has been some new furniture. Some of the paperwork is better. Peoples money is looked after safely. Care Homes for Adults (18-65 years) Page 12 of 35 Staff know how to keep people safe and who to tell if something goes wrong. What the care home could do better Carry on making the paperwork better. Care Homes for Adults (18-65 years) Page 13 of 35 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Ray Finney CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 Adults (18-65 years) Page 14 of 35 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 15 of 35 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People choosing to live at Lime Trees can expect to have their needs assessed before admission and information about the service will be made available in a format appropriate to their needs. Evidence: Since the last inspection there is a new manager in Lime Trees. There have been no new admissions to the home since the last inspection and there are currently no vacancies. The information in the Statement of Purpose and Service User Guide has been updated so that it is available should a vacancy arise. The manager explained that they are also in the process of updating the photographs in the Service User Guide so that it better reflects the home. The manager gave a comprehensive account of the homes assessment process in the AQAA. It stated, Adults with a learning disability would receive an extensive, detailed and holistic pre-admission assessment which would be carried out, usually by the proprietor and homes manager. The assessment would normally be carried out in the prospective residents current home and will involve carers who know the person well. The assessment will serve to identify the individuals specific needs and in turn will Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: enable clarification as to whether Lime Trees would be able to meet those needs and to briefly outline how those needs would be met. The manager further explained, Arrangements will be made for staff from Lime Trees to visit the individual in their current home to get to know the prospective resident and the way in which their needs are currently being addressed. Arrangements will also be made for the individual to spend pre-admission periods at Lime Trees, thus giving him or her the time and opportunity to get to know the staff and adjust to new people and unfamiliar surroundings. An initial care plan will be drawn up from the identified needs in the assessment. The assessment process remains thorough. Through discussions the manager was able to demonstrate a solid knowledge of the importance of having a robust assessment process in place because of the complex needs of people using the service. Records examined contained comprehensive assessments covering Emotional Wellbeing, Productive Wellbeing, Health Related Needs, Being Safe and Risks, and Service Needs. Emotional Wellbeing covers behaviour, self-esteem, mood and spirituality. Productive Wellbeing covers areas such as eating and drinking, mobility, personal hygiene, communication, choice and decision making, activities and social interaction. Areas addressed in Health Related Needs include physical needs, vision and hearing, medication and mental health needs. Being Safe and Risks includes sexuality and safety. Service Needs looks at what the service needs to do to meet the assessed needs of the individual including staff training needs and care plans. The manager also demonstrated an understanding of the importance of ongoing assessment to meet peoples changing needs. National Minimum Standard 6 does not apply, as Lime Trees does not offer intermediate care. Care Homes for Adults (18-65 years) Page 17 of 35 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living in Lime Trees receive good quality care based on their assessed and identified needs. Evidence: Records examined on the day of the inspection contained a range of care plans that have been developed from peoples assessed needs. The care plans contain good detailed information setting out what staff need to do to ensure all aspects of peoples health, personal care and social needs are met. In the sample of care plans examined, there was a section at the beginning on How I am Cared For, which is written from the individuals point of view. This section had good details to guide staff about what the person needs and prefers. Care plans identify the need requiring action, the short term goal for the person and detailed actions needed to achieve the short term goal. There is a planned evaluation of the care plan and a record of the outcome. The care plans clearly state what the person wants and enjoys as well as what they do Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: not want. One stated, I prefer to use just a spoon when eating. I find it easier if my food is cut up for me, as I am at risk of choking. I can manage a normal cup or glass and I dont need any special eating aids. Another stated, I like someone to put make-up on me and then I like to put my jewellery on myself and another, When I get up in the morning I like a cup of tea before I go and have my bath. This level of detail ensures that staff have sufficient information to ensure people are receiving the care and support they needs in a consistent manner and in ways that they would wish to be supported. This is particularly important for the people living in Lime Trees who have complex needs and communication difficulties related to their learning disability. As at the last inspection, staff spoken with were able to demonstrate a good awareness of peoples needs and wishes. Although peoples complex needs and difficulties with communication meant they were unable to express opinions about the care they receive, we saw on the day of the inspection that people were being given opportunities to make decisions and choices. There are a range of risk assessments and management plans in place covering individual identified risks. The nature of the hazard or risk is identified, the likelihood of the risk occurring, the level of the risk and how the risk is managed. The management of the risk details what steps are to be taken to minimise the risk or harm. Risk assessments in the sample of records examined covered areas including epilepsy, abuse or exploitation from others, household safety, choking. There is also a comprehensive manual handling assessment in place for each person. The assessments examined had all been recently reviewed and updated where necessary. Care Homes for Adults (18-65 years) Page 19 of 35 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 in Lime Trees can expect to enjoy a lifestyle that meets their wishes and needs. Evidence: The manager stated in the AQAA, Everyone who lives at Lime Trees is encouraged to lead as fulfilling a life as possible with regular in-house entertainment and activities, and person-centred access to the wider community. The people living in Lime Trees all now have elderly needs and do not attend college courses. It was reported at the last inspection that the ethos of the home is for daily routines to be flexible so that people are able to choose what they want to do. This includes a good range of activities both in-house and in the wider community to ensure that people enjoy a fulfilling lifestyle that meets their needs and takes into account their advancing age and complex needs. The manager stated in the AQAA, At home the residents enjoy weekly music therapy, Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: one to one nail and hair care, picture books, art and crafts, catchball, jigsaws, dominos, film afternoons and singalongs and Some residents have attended church services, also church carol services, in-house carols from the village schoolchildren and pantos during the Christmas season. Records examined on the day included an activities planner, which contains individual in-house activity monitoring sheets. These record what the person has done on a daily basis and whether they enjoyed the activity. Some of the recent recorded activities for one person included cooking, watching television, dominoes and music therapy. It was observed on the day of the inspection that when people were watching a comedy film on television, staff interacted with them and it was a social event. Peoples individual records also document when people prefer not to do activities. One person said they dont want to do jigsaw puzzles any more but like colouring and want to watch DVDs. On the day of the inspection these were the activities that this person was doing. The manager stated in the AQAA, We are going to explore new avenues for increased indoor and community activities for next winter to enable greater choice as age and infirmity make the winter months more difficult to fill. We discussed this on the day of the inspection and the manager explained that as the residents are becoming increasingly elderly, trips out when the weather is very cold or wet can be both difficult or pose a health risk and people living in the home do not want to go out so much in the winter. Records examined also contained Community Access Activity Monitoring sheets for each individual in the home. Examples of the community activities recorded in the sample of records examined included trips to the Harwich boats, out for tea, shopping and taking a bus ride. The manager gave details in the AQAA of some of the community activities that people living in the home have accessed in the past year. The manager stated, During the last year residents have visited the local harbour to watch the world go by with a cup of tea or an ice cream, the local port to see the large cruise ships and containers, and the local estuary to see the boats and wildlife. local garden centres also appear popular and have their own cafe facilities. There was also a day trip to the Norfolk broads. There have been meals out at cafes and restaurants, shopping trips, picnics, parties, barbecues and the celebration of all major calendar events. The manager further stated, Two people who have shown an interest have been to watch planes at the airfield and to do some train spotting. One person went to visit family and went out for lunch with them and a repeat trip is being planned. There was evidence of input from family and friends, although the manager explained that as the people living in the home get older, they have fewer relatives who are able to take an active interest. The manager stated in the AQAA, Visitors are welcome, with an open door policy. Unfortunately, many of our residents do not have anyone to come and visit and for some who do, their families are elderly, not in the best of health and not very local. When visitors are here, the visit can be in either a private or communal area to suit the residents wishes. Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: The manager explained that they try to encourage people living in the home to get involved with the daily routines of the home where possible but this is increasingly difficult because of elderly needs. As people are becoming less active they appear to prefer short visits to shops rather than large shopping trips. As a consequence the main shopping for the home is now ordered online and delivered so that people can make shorter unhurried trips to the shops for fresh items such as bread or milk. One person likes to go to the supermarket to have a drink and a doughnut and then come home again. When asked how the service had improved in the last twelve months, the manager stated in the AQAA, A better diet with greater emphasis on the quality and variety of food on offer, especially fresh fruit, salad and vegetables. The manager went on to say, Residents appear to enjoy making their own lunch on a weekly basis and generally enjoy a good, wholesome and varied diet and Mealtimes are unhurried and any assistance needed is given in as discreet a way as possible. Our residents all have quite health appetites and great care is taken to ensure their diet is varied, wholesome, appealing and nutritious. Emphasis is placed on there being fruit, vegetables and salads offered daily and fresh food, cooked at home rather than reliance on pre-packed, processed convenience foods. Experience has shown us the foods that are especially enjoyed and, although all residents need a soft diet, we have found this does not have to equate to bland or boring but does place some restrictions in choice. We have looked for interesting ways to overcome this and incorporate as much variety as possible. The daily main meal is always a cooked dinner and often there is a cooked breakfast or tea as well. An alternative is always offered if a resident pushes their food away. Significant improvements were noted in meals and mealtimes since the last inspection, particularly in the variety, quality and quantity of food available. Stocks of food were seen to be good, including fresh fruit, salads and vegetables. On the day of the inspection people were having salmon fish fingers, chips and mushy peas for lunch and jacket potatoes with fillings and salad for tea. Observations during the day showed the interactions between staff and people living in the home were friendly and appropriate. When asked what the home does well, a relative who completed a survey stated, everything and it is a very good home. Care Homes for Adults (18-65 years) Page 22 of 35 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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 . People using the service can expect their personal and healthcare needs to be identified and provided with the support to ensure these needs are met as they would wish. Evidence: The manager stated in the AQAA, Personal care procedures are in the residents care plans, denoting how the resident has decided or indicated, depending on their level of ability and needs assessment, how they wish this to be done. All personal care is carried out with diligence to maintaining dignity and privacy at all times. The sample of care plans examined on the day of the inspection contained good detailed information about how people like to be supported with personal care. This includes what the person can do for themselves and what they need or want staff to do for them. One care plan said, In the bath when my hair is being washed I am able to hold the flannel up to my eyes. We observed that staff followed good practices when assisting people with personal care and they ensured that personal care was carried out privately and discretely. The manager stated in the AQAA, All records of health related issues are also Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: contained in the care plans. Care plans are drawn from the initial and subsequent assessments of needs, discussion with the resident and their families and from close personal observation and experience, whichever is the most appropriate. Any presenting health issues are discussed, as far as possible, with the resident and their changing needs are constantly monitored. All residents are registered with the GP in the village and our relationship with the surgery is good. The doctor (or practice nurse) will visit the residents here in the comfort of their own home whenever necessary and is always available for telephone advice and is a good source of support for us all. Through discussion the manager and staff spoken with were able to demonstrate that peoples healthcare needs are well met. During the course of the inspection we observed staff bringing an issue to the attention of the manager promptly. The doctor later visited at the request of the manager. From our observations it is evident that there is a good working relationship between the home and the local surgery. The manager stated in the AQAA, All other relevant healthcare professionals such as the community nursing team, occupational and speech therapists and continence nurse are utilised as and when necessary. A visiting chiropodist attends to the residents on a monthly basis and there are annual visits from a domiciliary optical service. Records examined contained evidence of input from the continence adviser, chiropodist and optician. When asked what the service does well, a healthcare professional who completed a survey stated, From a doctors point of view superb care, appropriate staffing, excellent. They also indicated that the service always responds appropriately about issues raised and always manages medication appropriately. The manager stated in the AQAA, Residents medication received into the home is recorded and administered by trained staff in accordance with all relevant guidelines, and policies and procedures are adhered to. As at the last inspection the home has a monitored dose system (MDS) in place for the storage, administration and recording of medication. Medicines Administration Record (MAR) sheets examined were completed appropriately. As reported at the last inspection storage of medication is in individual cupboards in peoples bedrooms, which are securely locked and attached to wall. It was noted then that the cupboards are small and, although large enough to accommodate the monitored dose packs, there did not appear to be sufficient space for all medications. Bottles of liquid medication were seen in two rooms sitting on top of the cupboards. The new manager has addressed this issue and the order for that particular medication has been amended so that it is provided in smaller bottles that can be accommodated in peoples individual storage cupboards. The manager was able to demonstrate a good awareness of her responsibilities around supporting people appropriately with their medication. Care Homes for Adults (18-65 years) Page 24 of 35 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People using the service can be confident that their concerns about how they are treated are listened to and acted upon as stated in the complaints and safeguarding procedures. Evidence: The manager states in the AQAA, Our complaints policy is robust and concise. All staff are aware of how to assist anyone to access the complaints process. As at previous inspections, the service continues to have an appropriate complaints procedure in place. There have been no complaints recorded by the home or received by us since the last inspection. Minor concerns are dealt with as and when they arise. Discussions with the manager and proprietor demonstrated that they take minor concerns seriously and act promptly on any issues raised. We discussed with the manager how the recording of minor concerns and how they are resolved would provide additional evidence that demonstrates the home is run in the best interests of the people using the service. A relative who completed a survey stated that they had, no need to complain. The manager states in the AQAA, All staff have regular POVA training and are fully aware of their responsibilities if they suspect any form of abuse. There is a comprehensive whistle blowing policy, understood by all staff and information readily available as to the relevant course of action to take if they have cause to do so. Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: As reported elsewhere in this report, robust recruitment procedures are in place including police checks, known as Criminal Record Bureau (CRB) enhanced disclosures, to ensure people working in the home are suitable to be working with vulnerable people. Additionally, records examined confirm that staff receive safeguarding training (previously referred to as Protection of Vulnerable Adults or POVA) to ensure they are aware of how to recognise potential abuse or poor practice. The manager states in the AQAA, The money held on behalf of the residents in the home is in a locked safe in the managers office. Robust records are kept demonstrating how every penny of the money is spent. A concern raised at the last inspection around recording of peoples finances was dealt with under the local authority safeguarding processes. The proprietor carried out a robust financial audit and dealt with the situation in a prompt, professional and thorough manner. At all times throughout this process the proprietor kept us informed and updated on the situation. As a result of the issue, practices around finances have been improved and are more robust. The proprietor and the new manager are working well together to ensure that people are safeguarded. Care Homes for Adults (18-65 years) Page 26 of 35 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 can enjoy living in an environment that suits their lifestyle and which is well maintained and clean. Evidence: A tour of the premises showed Lime Trees continues to provide the same high standard of accommodation as reported at previous inspections. As previously reported, Lime Trees is a spacious double-fronted bungalow that has been extended and adapted to meet the needs of people with mobility difficulties. These adaptations include ramped exits and wide doorways suitable for wheelchair users. The bungalow is decorated throughout to a high standard with ample space in communal areas; furnishings in both individual rooms and in communal areas are of good quality. All bedrooms have full en-suite facilities including individual bathrooms with assisted baths. The manager states in the AQAA, All rooms, private and communal, are kept well decorated and furnished, with anything showing signs of wear or age being replaced. The whole home is spacious with a light, bright and airy atmosphere. The manager also states that improvements in the last twelve months include, Bedrooms have been personalised further and sort furnishings have been replaced. A new bedroom suite is on order for one room which is awaiting repainting to further freshen and brighten its Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: appearance. Two new lounge chairs have been purchased for the comfort of their owners. It was noted during a tour of the premises that peoples individual rooms contain ample evidence of personal possessions, including photographs and items that reflect their interests and tastes. The manager states in the AQAA, A comprehensive and robust housekeeping routine ensures the home is always kept clean and fresh and A dedicated laundry room, at the opposite end of the bungalow to the kitchen, is equipped with a commercial washer with inbuilt sluice facility and commercial drier. The room also contains a purpose built unit of stainless steel handwashing sink and a sluice facility and adequate covered space for the laundry awaiting attention. The room is easy to keep clean, with a ceramic tiled floor and fully tiled walls. A tour of the premises confirmed that the premises are well maintained throughout and cleaning is carried out to a high standard. Care Homes for Adults (18-65 years) Page 28 of 35 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living in the home can be confident they are cared for by a competent staff team who can meet their needs and who have been employed following thorough recruitment checks to ensure people are safeguarded. Evidence: The manager states in the AQAA, Of six daytime staff, three have NVQ level 2 and two of these are beginning level 3. Another member of staff is beginning level 3 and the other three staff are registered to begin level 2. Of our night staff, one holds NVQ 2 and the other night staff members are all just beginning their level 2 training. Discussion with the management team demonstrated a commitment to valuing staff by supporting them to obtain National Vocational Qualification (NVQ) awards. All but one member of staff already has an NVQ award at either level 2 or level 3 or are working towards the award. Staff spoken with on the day of the inspection were enthusiastic about achieving NVQ awards and about the support they receive. On the day of the inspection staffing levels in the home were seen to be good and peoples needs were being met promptly but in a relaxed and unhurried manner. Robust recruitment procedures are in place including police checks (referred to as Criminal Record Bureau or CRB enhanced disclosures) to ensure people working in the home are suitable to be working with vulnerable people. All documents required by Care Homes for Adults (18-65 years) Page 29 of 35 Evidence: regulation were in place including proofs of identity, application forms with full employment history, two written references and CRB disclosures. The manager states in the AQAA, Regular training has achieved a well informed and motivated staff team and A robust programme of training takes place annually and new subjects are added as the residents needs change and All staff are encouraged and supported to partake in regular mandatory training in line with Lime Trees policy. There is a training and development programme in place that includes both in-house training and external courses, including Manual Handling, Infection Control, Food Hygiene and medication. Staff have received training around safeguarding (previously referred to as Protection of Vulnerable Adults or POVA). Throughout the inspection staff were observed to interact well with people living in the home and staff spoken with were able to demonstrate a good awareness of their roles and responsibilities. When asked if care staff have the right skills and experience to support peoples social and health care needs, a healthcare professional who completed a survey responded always and said they are an excellent team. Care Homes for Adults (18-65 years) Page 30 of 35 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home is appropriately managed in the best interests of people living there. Evidence: The manager states in the AQAA, The manager employs a participative style of management, enabling support staff to be as fully involved as possible in the care planning, risk assessments and day to day life of the residents within the home. The manager tries to involve the support staff as far as possible in any decisions about the day to day routine of Lime Trees, enabling them to feel empowered and supported to take a responsible lead on behalf of the residents. The proprietor of the home has a significant amount of input into the running of the home. In particular he has put in robust systems to audit finances and ensure people living in the home are safeguarded. Since the last inspection there is a new manager in post who runs the home on a day to day basis. Many of the issues highlighted at the last inspection that were shortfalls in the National Minimum Standards have now been addressed. The proprietor and manager keep us informed at the Commission of any issues relating to the home. The management team sent an Annual Quality Assurance Assessment (AQAA) to us when we requested it. This document was completed to a Care Homes for Adults (18-65 years) Page 31 of 35 Evidence: high standard, giving us ample information about life in Lime Trees. Evidence examined throughout the inspection process found this information to be accurate. It was evident from our observations that the proprietor and manager work closely together as a team. Both the proprietor and the manager demonstrated a comprehensive knowledge of the needs of people living in the home. They also demonstrated that they have robust processes in place to manage the home. The management team are committed to ensuring that the views of people living there and other interested parties are listened to and acted upon. Through discussions the manager and proprietor were able to demonstrate that they actively seek the opinions of people using the service including healthcare professionals, relatives and staff. The manager states in the AQAA, All equipment is regularly maintained and serviced with certification available. A sample of records relating to health and safety were examined and all found to be up to date and in order, including maintenance of moving and handling equipment, fire alarms and fire fighting equipment and Portable Appliance Testing (PAT) certificate. Overall, there have been significant improvements since the last inspection in the management of the home. Care Homes for Adults (18-65 years) Page 32 of 35 Are there any outstanding requirements from the last inspection? Yes  No  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 Adults (18-65 years) Page 33 of 35 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 Description 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 Description 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 Adults (18-65 years) Page 34 of 35 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. 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. Care Homes for Adults (18-65 years) Page 35 of 35 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!

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