Care Home: Lime Trees, The

Similar services:

• Henry Nihill House
• Birchwood
• The Infirmary
• Orchard House Nursing Home
• St Josephs Rest Home
• Red Court Nursing Home
• Spinney (The)
• Queen Elizabeth House

What the care home does well The home provides good, personalised care and support to the one resident living there at present. What has improved since the last inspection? At the last inspection on 28 February 2008, three requirements were made. All have been met. The Safeguarding Adults Policy has been updated. The rota accurately reflected the staffing on the day of the inspection and the current staffing level in the home. Staff received photographs on their staff files. What the care home could do better: The property needs to be better secured at the rear and side to prevent unauthorised access. All bedrooms must have functional window restrictors to protect the people living there. The first floor bathroom needs a functional lock. The lighting in each bedroom must be improved as each new resident comes into the home, in consultation with the residents. All communal bathrooms should have paper towels to ensure good infection control and minimize the risk of cross infection. The COSHH cupboard in the hallway needs a lock fitted. The five yearly electrical installation certificate needs renewing. Six recommendations were made at this inspection. The Service Users Guide should explicitly state that the home would only accept people with mild to moderate dementia, which will be fully assessed on an individual basis to ensure that the home can meet each person`s needs. Expanded equality and diversity information should be included in the statement of purpose. As the home`s occupancy levels increase, the staffing levels should be correspondingly reviewed and increased. To ensure that all training is kept up to date for all staff, the home should undertake a training review and book refresher training as needed. Senior staff would benefit from taking a course in dementia care mapping to build their capacity to deliver dementia care in line with current best practice. Once the home`s occupancy increases, at least one fire drill should be held when night staff are on duty at night. CARE HOMES FOR OLDER PEOPLE Lime Trees, The 2 The Limes Avenue London N11 1RG Lead Inspector Margaret Flaws Unannounced Inspection 10:00 27 August 2008 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lime Trees, The DS0000010636.V367814.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lime Trees, The DS0000010636.V367814.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lime Trees, The Address 2 The Limes Avenue London N11 1RG 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) 020 8361 5840 020 8361 8020 aloi@btinternet.com Aloysius Augustine Onyerindu Provider in Day to Day Charge Care Home 15 Category(ies) of Dementia - over 65 years of age (15), Old age, registration, with number not falling within any other category (15) of places Lime Trees, The DS0000010636.V367814.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP 2. Dementia - code DE(E) The maximum number of service users who can be accommodated is: 15 28th February 2008 Date of last inspection Brief Description of the Service: The Lime Trees is a privately run care home for up to 15 older people. It is situated in a residential road in New Southgate close to local amenities, shops and public transport. Residents bedrooms are on the ground and first floors. The laundry, office and staff accommodation are on the second floor. A lift serves all floors of the home. There are twelve single bedrooms, some with en-suite facilities, and two double rooms. Communal space consists of a ground floor lounge/dining area with two smaller rooms on the first floor, with a garden at the rear of the building. There are enough bathrooms and toilets in the home for the number of residents. There are some aids and adaptations in the home to help people with physical disabilities get around more easily. However the narrow corridors and sloping floor surfaces means that there are limitations for wheelchair users who wish to be as independent as possible. Fees for the home start at £450. Lime Trees, The DS0000010636.V367814.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day. Inspector David Hastings assisted the lead inspector, Margaret Flaws. During the inspection, we spoke at length to the Registered Provider, his voluntary, temporary Management Consultant, the one senior care staff member on duty and the one current resident. The inspection also comprised a review of policies and procedures, care, staff and general home records, and a tour of the building and grounds. The Registered Person provided CSCI with an Annual Quality Assurance (AQAA) document, which contributed information to this inspection. A survey was received from the one person living in the home at the time of the inspection. The nature of the inspection was unusual, in that the home only has one resident living there at present. The new category of dementia has recently been added to the home’s registration but this report reflects the outcomes for the one current service user in the pre-existing OP category. The quality rating for this service is 2 stars. This means that the person who using this service experiences good quality outcomes. What the service does well: What has improved since the last inspection? At the last inspection on 28 February 2008, three requirements were made. All have been met. The Safeguarding Adults Policy has been updated. The rota accurately reflected the staffing on the day of the inspection and the current staffing level in the home. Staff received photographs on their staff files. Lime Trees, The DS0000010636.V367814.R01.S.doc Version 5.2 Page 6 What they could do better: The property needs to be better secured at the rear and side to prevent unauthorised access. All bedrooms must have functional window restrictors to protect the people living there. The first floor bathroom needs a functional lock. The lighting in each bedroom must be improved as each new resident comes into the home, in consultation with the residents. All communal bathrooms should have paper towels to ensure good infection control and minimize the risk of cross infection. The COSHH cupboard in the hallway needs a lock fitted. The five yearly electrical installation certificate needs renewing. Six recommendations were made at this inspection. The Service Users Guide should explicitly state that the home would only accept people with mild to moderate dementia, which will be fully assessed on an individual basis to ensure that the home can meet each person’s needs. Expanded equality and diversity information should be included in the statement of purpose. As the home’s occupancy levels increase, the staffing levels should be correspondingly reviewed and increased. To ensure that all training is kept up to date for all staff, the home should undertake a training review and book refresher training as needed. Senior staff would benefit from taking a course in dementia care mapping to build their capacity to deliver dementia care in line with current best practice. Once the home’s occupancy increases, at least one fire drill should be held when night staff are on duty at night. Lime Trees, The DS0000010636.V367814.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Lime Trees, The DS0000010636.V367814.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lime Trees, The DS0000010636.V367814.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. There is a range of assessment information about people using the service, which is used to plan their care and meet their needs. Prospective residents and referrers have reasonable general information about what the home offers to meet their needs. However, clearer information about the degree of dementia that the home can support would be helpful to prospective referrers and residents. EVIDENCE: Throughout the inspection, we were assisted by the Registered Person, Mr. Oneyindu and by the home’s unpaid, temporary Management Consultant. The Senior Care Worker on duty also assisted us. The home has an updated Statement of Purpose. This states that care is now offered to people with dementia, the new category of registration approved in July 2008. It also makes clear that the home does not offer nursing care or Lime Trees, The DS0000010636.V367814.R01.S.doc Version 5.2 Page 10 intermediate care. The details of the Registered Person in the Statement of Purpose were accurate. We were shown the Service User Guide, which also contained information from the Statement of Purpose. This Guide covered the aims and objectives of the service and the newly registered dementia category. It included a clear complaints procedure with timescales and an equal opportunities statement. We had a lengthy discussion about the new registration category with the Registered Person and the Management Consultant. We discussed the wording of the information about dementia care offered and expressed our concern that, because of the statement was very general (“suffering from dementia”), this might imply to referrers that the home could care for people with severe dementia. This might be challenging as the home builds up its initial expertise in this area of care. We suggested changing the wording in the Service Users Guide, to state that the home can accept people with mild to moderate dementia, which will be fully assessed on an individual basis to ensure that the home can meet each person’s needs. A recommendation is made. We also discussed how people’s dementia care needs might be met by the home through extending the training programme for staff. Staff have received introductory dementia care training and the Registered Person described some of his learning on dementia and showed us materials from his course of study. We recommended that senior staff undertake a course in dementia care mapping to build their capacity to deliver this care in line with current best practice. The recommendation is given under Standard Thirty. The Registered Person said that, along with the Management Consultant, he would undertake new assessments. The Management Consultant said that she would continue to assist in a full time capacity in the medium term, to support the home gaining and establishing new placements, including placements for people with dementia. We also discussed the equality and diversity statements made in the Annual Quality Assurance Assessment (AQAA) provided to CSCI and recommended that they be included in the statement of purpose. We inspected the care records for two people, one for the current resident who has been living at the home for some years and the other for a person who came for respite care in May 2008. On the current resident’s file, there was written evidence of regular reviews and reassessments by the home and by the local authority, including recent reassessments, on his care file. Lime Trees, The DS0000010636.V367814.R01.S.doc Version 5.2 Page 11 The assessment information obtained for the respite placement was good. For example, full assessments by the placing local authority social work team and from associated healthcare teams were completed prior to admission and the information was put into the care plans. Lime Trees, The DS0000010636.V367814.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 10 People who use the 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 care for the one current service user is planned and documented with his involvement. Risks are assessed and actions taken to ensure that these risks are minimised for the one current service user’s benefit. The resident’s privacy rights and dignity are protected. It was not possible to properly assess the medication standard at this inspection. EVIDENCE: We reviewed the care planning documentation for the current resident and for a person on respite placement earlier this year. There was a range of paperwork including handwritten care plans, review notes, risk assessments, health records, medication profile, weight and bathing charts and details of daily activities. We also saw the daily notes. Lime Trees, The DS0000010636.V367814.R01.S.doc Version 5.2 Page 13 We spoke to The Registered Person, the Management Consultant and the Senior Carer about the care provision. We also spoke to the person currently living in the home about his views on the care he receives. The current resident has personal care in the form of assistance with getting up and having a wash every day and a bath every two days. He said that his privacy was respected and his choices supported. He had been involved in his care plan reviews, sitting down at the table, going through the plan and outlining his wishes with his keyworker. The Senior Carer present confirmed this. The care plan was reviewed and signed off by the resident and was sufficiently detailed to cover twenty two areas of identified need. The assessment information and care planning for the person on respite placement earlier this year was good. Risks assessments were completed for nutritional needs, risk of falls and choking, continence care and for maintaining good pressure care. The district nurse had completed assessments for pressure care equipment. The resident was supported to attend hospital for kidney dialysis three times a week. Risk assessments were also in place for the current resident and these had been recently reviewed. Health appointments were clearly documented. The current resident receives home visits from the chiropodist, dentist, doctor and optician. He had also seen an audiologist. These appointments were regular and follow-up actions were documented and actioned. We were not able to assess the medication standard because of the minimal use of medication in the home at present. The current resident had only one medication prescribed for an as and when basis, an asthma inhaler. We observed a relaxed informal atmosphere in the home between the resident and the staff. The resident said that he felt his needs were met and that he could choose how to spend his time. He said that he liked his room, felt that his privacy was protected and that he was treated with respect by the staff. The provision of his personal care was properly documented in the daily notes Lime Trees, The DS0000010636.V367814.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. There is a reasonable range of activities and engagement provided for the one person living in the home including community involvement, in consultation. Food offered is completely tailored to the wishes of the one person living in the home. EVIDENCE: A small, personalised range of activities is provided for the one current resident. Staff accompany him to the shops, to the park and into the local community. Activity plans have been expanded to include more of his personal interests, including visits to a local members’ club. Over the past three weeks, the resident said he has spent time watching the Olympics because he enjoys watching sport on television. We saw photos of the resident at picnics in the local park over the summer. He said he also spends some time reading. During the inspection, the resident went out to the shops with the staff member. Staff also said that they have been doing rehabilitative writing exercises with the resident, who has a diminished ability to write. They said that his ability to write was improving again and showed us some examples. Lime Trees, The DS0000010636.V367814.R01.S.doc Version 5.2 Page 15 The resident said that he was happy with his routine and how he spent his time. His activities were documented in his care file. He said that he was happy living in the home. He has no relatives or visiting friends but was observed to have positive interactions with the staff present. The resident ate a cooked breakfast and cooked lunch during our visit. The menus outlined a good range of three course meals, which were varied and interesting. Meals eaten were recorded and the current resident said he like the food and could choose what he ate. The kitchen appeared reasonably well stocked to meet the needs of the one person living there and the Senior Carer said that the home buys food on a daily basis. Lime Trees, The DS0000010636.V367814.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. There is a complaints policy and procedure to protect people using the service. Safeguarding policy and procedures have been updated to guide potential safeguarding referrals and staff have been trained to improve outcomes in this area. EVIDENCE: There is a complaints policy and procedure, which is replicated in the Service User Guide. It indicates timescales and actions to be taken when a complaint is received. We were shown the complaints book. There had been no complaints received since the last inspection. We saw the updated Safeguarding Adults Policy. This now includes the correct contact details of the CSCI and information on the role of the local authority in investigating safeguarding matters. This meets the previous requirement to provide this information. Most staff have generally been trained in Safeguarding Adults. The one person living in the home at present said he felt safe there. Lime Trees, The DS0000010636.V367814.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24, 26 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Improving physical standards, including better decoration and flooring, have been provided for the one person currently using the service and additional communal space has been created for the future. Improvements are needed in building security, bedroom lighting and infection control to protect the current and prospective residents and enhance their quality of life. EVIDENCE: We were shown around the building and visited all the rooms. The home was created from a conversion of two former houses into a care home. There is a long rear extension to one house in which the kitchen and largest communal space is located. We saw the new ground floor lounge at the front of the building and were told that this lounge has been created to provide choice for people using the service and to add quieter space for residents. The number of Lime Trees, The DS0000010636.V367814.R01.S.doc Version 5.2 Page 18 bedrooms has been subsequently reduced from sixteen to fifteen. The new lounge also has a small dining table with capacity for five people to eat there, reducing potential overcrowding in the other lounge. This arrangement may have staffing implications, which should be considered in the staffing rota as more people come into the home. There was new decorative work in the corridors and rear lounge area. The rear lounge had been opened out to make more space by removing excess furniture and a table. We saw new chairs and new carpets laid in the corridors and rear lounge. The new carpet in the sloping area leading to the rear lounge appeared to provide better traction on the floor. The Registered Person said that he hopes to create a conservatory at the back of the building to add more communal space for new residents in the future. Painting and decorative work has made the main communal spaces more welcoming. We visited all the bedrooms, only one of which is unoccupied. The unoccupied rooms had their radiators turned off at the time of inspection. Bedrooms have been repainted and refurbished in the past year. One side of the building which faces the next door house wall is quite dingy and the bedrooms on this side lack light. We discussed this with the Registered Person. He said that “institutional” fluorescent lighting had been replaced with the current lights and shades and agreed that these were quite dim. The Registered Person agreed to improve the lighting in each bedroom as new residents come into the home, in consultation with them. A requirement is made. The current resident’s bedroom at the rear of the house was comfortably furnished and had good natural light. It overlooked the flat roof of the extension but is accessible from there. The main issue identified on this inspection is the insecurity of the rear side of the building. The Registered Person said that young people from next door had climbed over the side wall of the property, onto the flat extension roof behind the current resident’s bedroom and painted graffiti on the back wall of the house. We saw a small section of graffiti when we looked up from the garden. The Registered Person had put up barbed wire down the side of his property but, when we looked, it was clear that intruders had climbed underneath it and gained access to the property. On our tour of the building, we also noted that some rooms lacked functional window restrictors. We discussed building security with the Registered Person and the Management Consultant. The lack of security at the rear and the lack of adequate window restrictors in some rooms places the home at risk. There is a risk of burglary and of unauthorised people coming into the home. There is also an increased risk, if people with dementia are admitted into the home, that they might be able to climb out of the windows and leave the home or injure themselves. The Registered Person agreed that improvements were needed to protect current and future residents and staff. Lime Trees, The DS0000010636.V367814.R01.S.doc Version 5.2 Page 19 The necessary improvements needed are to better secure the side of property leading onto the rear extension and to ensure that all rooms have functional window restrictors. Two requirements are given. The kitchen is small and improvements would need to be made to storage and surface areas as the numbers of residents increase. Fridge and freezer temperatures had been monitored and recorded. There was a record kept of the food eaten. The communal bathroom spaces only had ordinary cotton hand towels available. These present a risk of cross infection and should be replaced with paper towel dispensers to ensure good infection control. A requirement is made. The current resident uses the first floor bathroom next to his room. There is a chair lift, which he uses to get in and out of the bath. However, this bathroom does not have a lock and one should be fitted. A requirement is given. The home has a passenger lift and handrails in sloping parts of the building. The home was clean and free of offensive of odours on this inspection. A COSHH cupboard in the hallway needs a lock fitted and a requirement is given. Lime Trees, The DS0000010636.V367814.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Current staffing levels reflect the current low occupancy and are sufficient to support the one person living in the home. Staffing levels will need to be reviewed and increased once occupancy levels go up, to ensure good outcomes for prospective residents. Recruitment to the home has been limited in this period but one new staff member has been safely recruited. Staff are generally trained in core areas but prospective residents would benefit from additional staff training in dementia care. EVIDENCE: We examined the staff rota. It accurately reflected the staffing on the day of the inspection and the current staffing level in the home, based on the reduced number of staff needed to support the one current resident. This meets the previous requirement, that the rota is accurate. The Senior Carer and the Management Consultant told us about the current staffing arrangements. Work is currently shared between the Registered Person, the Senior Carer and three other staff. Some staff were made redundant last year when occupancy levels were reduced. At the last inspection, a recommendation was made that the staffing levels be reviewed when new people are admitted to home. This recommendation is carried Lime Trees, The DS0000010636.V367814.R01.S.doc Version 5.2 Page 21 forward into this report because the home still only has one person living there. Staffing levels would need to be quickly increased once more people are admitted. The increased dependency needs of people in the new category of dementia would also have to be considered in designing a new staffing structure. This was discussed with the Registered Person and the Management Consultant and they agreed to do this. We inspected the files of the five members of staff who were on the staff rota or had worked at the home recently. Staff had had Criminal Records Bureau (CRB) checks, written reference checks and application forms (with no employment gaps) completed. They also had recent photographs on file and other evidence of identity, meeting a previous requirement to have this information in place. We also checked the staff file of the newest staff member, the temporary, voluntary Management Consultant. All preemployment checks had been completed for her, including a CRB check and her employment history was and checked in detail. Staff training records were checked. A range of training had been completed by current and previously employed staff, mostly in 2007. This included safeguarding adults training, introductory dementia care, infection control, food hygiene, first aid and medication. To ensure that all training is kept up to date for all staff, the home should undertake a training review and book refresher training as needed. A recommendation is given. As the home is now able to accept residents under the new category of dementia, a training recommendation is made that senior staff complete a course in Dementia Care Mapping to enable them to assess and support peoples’ needs in line with current best practice. NVQ progress by current staff is good. Two staff have NVQ2, one has NVQ3 and the Senior Carer said she is halfway through study for the Registered Managers’ Award. Lime Trees, The DS0000010636.V367814.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35, 36, 38 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Management systems are improving in the home, which currently benefit the one resident. Health, safety and welfare of the one resident is generally protected and current staff are supported. It was not possible to fully inspect the standards on quality assurance and residents’ financial interests. EVIDENCE: The home has had a history of serious concerns about its management in general and, in particular, about management proactivity, record keeping and about the failure to recruit, appoint and retain an appropriately skilled person Lime Trees, The DS0000010636.V367814.R01.S.doc Version 5.2 Page 23 to manage the home. The Registered Person continues to act as the Registered Provider and Manager of the home at present, while there is only one person living there. The Registered Person said that, as the numbers of residents start to increase, he would recruit and appoint a Registered Manager. The Management Consultant, an experienced care home Registered Manager, is currently acting as a full time, unpaid consultant to the home. She said that she would continue to support the Registered Person to improve and manage the home and help with new admissions, including dementia admissions and care planning support. She said she will continue to work in her current capacity in the medium term and until a competent person is recruited for the role of registered manager. Some management improvements were noted on this inspection. The office appeared tidy and more orderly than on previous inspections. We were bought the files we requested quickly. Care planning and record keeping in general had improved. The quality assurance procedure remains the same as at the last inspection, an annual survey of residents, relatives and professionals. The Registered Person said that a formal survey had not been carried out this year owing to the low occupancy level, but that, once new residents are admitted, formal consultation will take place. It was not possible to fully assess this standard on this inspection. Financial procedures were also not fully assessed on this inspection. The home only has one person living there at the moment, which has resulted in the scaling back of the home’s operations, income, staffing and other costs. The standard on resident’s money was not fully assessed because the only resident living there has his own account, which he manages himself and staff accompany him to access his account as he requires. Staff supervision notes showed that the staff had been supervised every two months and there were notes of these sessions. Fire procedures were followed. A fire risk assessment was in place; an inspection by the fire department took place in October 2007; fire alarms and fire points are checked weekly and fire drills held quarterly (the last drill was in July 2008). It is recommended that, once the home’s occupancy increases, at least one of these fire drills be held when night staff are on duty at night. Certificates for the servicing of equipment were checked. These were all up to date except for the five yearly electrical installation certificate, which was overdue. A requirement is given. Lime Trees, The DS0000010636.V367814.R01.S.doc Version 5.2 Page 24 Lime Trees, The DS0000010636.V367814.R01.S.doc Version 5.2 Page 25 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X 2 X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X 3 X 2 Lime Trees, The DS0000010636.V367814.R01.S.doc Version 5.2 Page 26 No 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. 1. Standard OP19 Regulation 13(4) Requirement The Registered Person must ensure that the property is made secure at the rear and side to prevent unauthorised access. The Registered Person must ensure that all rooms have functional window restrictors. The Registered Person must ensure that the first floor bathroom has a working lock. The Registered Person must ensure that lighting is improved in each bedroom as new residents come into the home, in consultation with them. The Registered Person must ensure that communal bathroom spaces have paper towels to ensure good infection control. The Registered Person must ensure that the COSHH cupboard in the hallway is fitted with a lock. The Registered Person must ensure that the home has an up to date electrical installation certificate. Timescale for action 30/11/08 2. 3. 4. OP19 OP19 OP19 13(4) 12(4) 23(2)(p) 31/12/08 15/11/08 30/11/08 5. OP26 13(4) 15/11/08 6. OP19 13(4) 15/11/08 7. OP38 13(4) 15/11/08 Lime Trees, The DS0000010636.V367814.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations The home should add information into the Service Users Guide, to make it clear that it can accept people with mild to moderate dementia, which will be fully assessed on an individual basis to ensure that the home can meet each person’s needs. The home should include full information about equality and diversity in the home’s Statement of Purpose. The home should review and increase the staffing levels when new people are admitted to home. The home should undertake a training review and book refresher training as needed. Senior staff should undertake a course in dementia care mapping to build their capacity to deliver this care in line with current best practice. Once the home’s occupancy increases, at least one fire drill should be held when the night staff are duty after dark. 2. 3. 4. 5. 6. OP1 OP27 OP30 OP30 OP38 Lime Trees, The DS0000010636.V367814.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Lime Trees, The DS0000010636.V367814.R01.S.doc Version 5.2 Page 29 - 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!