Care Home: The Lemon Tree

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What the care home does well The homes assessment procedures were very thorough and care plans had been structured to ensure staff recognise the diverse needs of the people they support. Observation of practice and discussion with the staff member on duty confirmed the staff team had been provided with appropriate training to assist them in understanding and meeting the needs of the people in their care People spoken to said the staff team provided sensitive and flexible personal care support and confirmed they liked living at the home and felt well cared for. They were very positive in their comments about the staff who were described as being caring and conscientious. One person said, " I have no complaints about my care and cannot praise the owner and her staff highly enough". Staff employed by the home are well trained and are competent to do their jobs. Observation of care practices throughout the day confirmed the people they support are treated with respect and dignity. The home has over 90% of staff who have achieved National Vocational Qualifications (NVQ) ensuring people are supported by competent and qualified staff. People spoken to said they enjoyed the quality and variety of food being provided and the activities being organised.The home has been decorated and furnished to a good standard to ensure the comfort of people who live there. People spoken to were very happy with the standard of accommodation provided. What has improved since the last inspection? The homeowner has continued to make improvements to the environment since the last inspection. Five bedrooms have been redecorated and refurbished. The homeowner said the refurbishment of the home was ongoing and there were further plans for refurbishment throughout the home to ensure the present standards are maintained. People spoken to were happy with the improvements being made. What the care home could do better: Induction training records should be signed and dated by the staff member confirming they have participated in the training. The homeowner is reminded that she must inform the Commission in writing about events that take place in the home including the death or serious injury of people who live there. CARE HOMES FOR OLDER PEOPLE The Lemon Tree 133 Hornby Road Blackpool Lancashire FY1 4JG Lead Inspector Mr Wesley Cornwell Unannounced Inspection 9th September 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Lemon Tree DS0000062940.V367101.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. The Lemon Tree DS0000062940.V367101.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Lemon Tree Address 133 Hornby Road Blackpool Lancashire FY1 4JG Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01253 621463 Mrs Nivedita Devi Kurtis Manager post vacant Care Home 12 Category(ies) of Old age, not falling within any other category registration, with number (12) of places The Lemon Tree DS0000062940.V367101.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 The maximum number of service users who can be accommodated is: 12 Date of last inspection 25th September 2006 Brief Description of the Service: The Lemon Tree is registered to accommodate 12 people of either sex. The home is situated close to Blackpool town centre and comprises of the following accommodation: One lounge and one dining room/sitting area both of which are designated as non-smoking areas. Bedrooms are situated on the ground and first floor. Three bedrooms have en-suite facilities. The home has a chairlift that facilitates access between the ground and first floor. The home has a Statement of Purpose and Service User Guide providing information about the care provided, the qualifications and experience of the owners and staff and the services residents can expect if they choose to live at the home. A copy of the Service User Guide and most recent inspection report is issued to all prospective residents and their relatives/representatives to help them make an informed choice whether to move into the home. The range of fees at the home are £300.51 to £360.01 covering all aspects of care, food and accommodation. The owner provided this information on the 9th September 2008. The Lemon Tree DS0000062940.V367101.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This unannounced site visit was undertaken as part of the homes Key Inspection and commenced at 9.00am and took place over 5 hours. Prior to the site visit the manager of the home completed an Annual Quality Assurance Assessment form (AQAA) providing detailed information about the service they are providing. A number of people living at the home and staff members were contacted prior to the site visit and their views about the home have been included in the report. In addition we spoke to four people, one staff member, one visitor and the owners during the visit. Staff, care, maintenance and financial records were examined during the site visit and a full tour of the premises was undertaken with the owner. What the service does well: The homes assessment procedures were very thorough and care plans had been structured to ensure staff recognise the diverse needs of the people they support. Observation of practice and discussion with the staff member on duty confirmed the staff team had been provided with appropriate training to assist them in understanding and meeting the needs of the people in their care People spoken to said the staff team provided sensitive and flexible personal care support and confirmed they liked living at the home and felt well cared for. They were very positive in their comments about the staff who were described as being caring and conscientious. One person said, “ I have no complaints about my care and cannot praise the owner and her staff highly enough”. Staff employed by the home are well trained and are competent to do their jobs. Observation of care practices throughout the day confirmed the people they support are treated with respect and dignity. The home has over 90 of staff who have achieved National Vocational Qualifications (NVQ) ensuring people are supported by competent and qualified staff. People spoken to said they enjoyed the quality and variety of food being provided and the activities being organised. The Lemon Tree DS0000062940.V367101.R01.S.doc Version 5.2 Page 6 The home has been decorated and furnished to a good standard to ensure the comfort of people who live there. People spoken to were very happy with the standard of accommodation provided. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Lemon Tree DS0000062940.V367101.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Lemon Tree DS0000062940.V367101.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission and assessment procedures were clear to ensure the care needs of people are met. EVIDENCE: The care plan records of three people admitted to the home had full assessment information including their religious/cultural and relationship needs. The assessment had identified the nutritional needs of the people and risk assessment information advising staff members of the action to be taken to minimize identified risks and hazards. The staff member on duty confirmed they had access to this information and was fully aware of the care needs of the people living at the home. The relative of one person recently admitted said he had he had been involved in the assessment process and was more than happy with the care being The Lemon Tree DS0000062940.V367101.R01.S.doc Version 5.2 Page 9 provided. The person said, “ I am very satisfied with the care my relative is receiving. She has settled very quickly and speaks highly of the owners and staff”. People spoken to during the visit confirmed they were happy with the care being provided and their needs were being met. This home does not provide intermediate care. The Lemon Tree DS0000062940.V367101.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Promotion of health is taken seriously, people’s welfare is closely monitored and health needs were met. EVIDENCE: Individual records are kept for each person with a plan of care setting out the action that is needed to be taken by support staff to ensure all aspects of health, personal and social care needs of the people living at the home were met. Significant events had been recorded and daily entries made setting out the care given. The care plans were structured and were being reviewed with the people or their relative/advocate and updated to reflect any changing needs and these were being actioned as required. The care plan of one person recently reviewed confirmed that following a trial period the person had settled and had agreed to remain at the home permanently. The records of three people were looked at and these described their healthcare needs. Discussion with staff members on duty confirmed they were The Lemon Tree DS0000062940.V367101.R01.S.doc Version 5.2 Page 11 fully aware of the healthcare needs of people living at the home and these are monitored and their care plans kept up to date. Entries made on care plans showed good communication between the home and healthcare professionals. Daily entries made on the care plans confirmed staff members were following the instructions of healthcare professionals and an appropriate level of care was being provided. Two healthcare professionals visiting the home said they were satisfied with the care being provided and had no concerns. People spoken to said they liked living at the home and were well treated by staff members. One person said, “ I really cannot find fault with anything. The girls are very attentive and caring. We are well looked after”. Medication practices observed were safe and good records had been maintained. The staff members responsible for the administration of medicines had received accredited training to ensure they had basic knowledge of how medicines are used and how to recognise and deal with problems in use. People spoken to said the staff team respected their privacy and they could spend time on their own if that was their wish. One person said, “ I like being in my room but will go down stairs when I feel like it. They know I like to be in my room and always respect my privacy. I like being able to do what I want when I want”. The Lemon Tree DS0000062940.V367101.R01.S.doc Version 5.2 Page 12 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities and meals are both well managed, creative and provide daily variation and interest for people living in the home. EVIDENCE: People spoken to said routines within the home were flexible and they were able to make their own decisions about how to live their lives. One person said, “I have the same daily routine I had before moving into the home. I go out every day to the pub as I have done for many years and the staff save my lunch for when I return. I enjoy my pint and look forward to my lunch on my return”. People spoken to said they were happy with arrangements in place for receiving their visitors. The relative of one person commented, “ I visit the home every week and I am always made welcome. The staff are very friendly and helpful. I feel very comfortable when I visit and find the atmosphere at the home very relaxed”. The Lemon Tree DS0000062940.V367101.R01.S.doc Version 5.2 Page 13 People spoken to confirmed they enjoyed the food provided by the home. The staff members responsible for the preparation of meals were able to confirm they had information about people with special diets and personal preferences. One person commented, “ Always look forward to my meals. Good home cooking and plenty to eat”. Meal times were served in a relaxed and unhurried manner. Staff members were observed being very attentive to the needs of people. People spoken to were very happy with the arrangements in place for social activities. These were varied and arranged individually and in groups. The Lemon Tree DS0000062940.V367101.R01.S.doc Version 5.2 Page 14 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements for complaints are handled well and taken seriously ensuring people feel listened to. EVIDENCE: The home has a detailed complaints procedure, which is made available to everyone on his or her admission. People spoken to were aware of how to make a complaint and felt these would be listened to and acted upon. The relative of one person commented, “My aunt hasn’t been in the home very long but I am very happy up to now and have no complaints. I am sure if we had any concerns they would be dealt with appropriately”. At the time of this site visit no complaints had been referred to the Commission for Social Care Inspection. The home has a procedure in place for dealing with allegations of abuse. Staff members have received training in the protection of vulnerable adults and showed a good understanding of the procedures to be followed in the event of any allegations or suspicion of abuse or neglect. The staff member on duty said they wouldn’t hesitate to report any concerns they had about care practices to ensure people living at the home are protected from potential harm or abuse. The Lemon Tree DS0000062940.V367101.R01.S.doc Version 5.2 Page 15 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a planned maintenance and renewal programme for the redecoration and refurbishment of the home to ensure people live in a comfortable, homely, clean and safe environment. EVIDENCE: The home has been well maintained and decorated for the comfort of the people living there. All furnishings were of a good standard and helped to provide a homely environment. Satellite television is available in the dining room for the entertainment of those people who wish to watch it. People spoken to were very happy with the standard of accommodation being provided and said they felt at home. The Lemon Tree DS0000062940.V367101.R01.S.doc Version 5.2 Page 16 Since the last inspection five bedrooms have been redecorated and refurbished. The owner said the refurbishment of the home was ongoing and there were further plans for refurbishment throughout the home to ensure the present standards are maintained. People spoken to were happy with the improvements being made. A tour of the building confirmed people had personalised their bedrooms with their own belongings. People spoken to were happy with their rooms and said they had the choice of spending time on their own or in the lounge area’s. Hot water temperatures throughout the home were checked and found to deliver water at a safe temperature in line with health and safety guidelines. It was observed during the visit the home was clean and hygienic ensuring a pleasant environment in which to live. The Lemon Tree DS0000062940.V367101.R01.S.doc Version 5.2 Page 17 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The deployment of a well-trained staff team throughout the day is sufficient to meet the needs of people living at the home. EVIDENCE: Staffing levels were sufficient for the number of people living at the home. People spoken to said they were happy with the care they were receiving and were well treated by the staff. One person said, “ I really cannot find fault with anything. The girls are very attentive and caring. We are well looked after”. The staff member on duty said they were clear about their role and the staff work well as a team to ensure the individual and collective needs of residents are met. One person spoken to about the owners and staff commented, “They are very good”. Records show all staff members have access to a structured training and development programme ensuring the people in their care are being supported by a well trained and competent staff team. In addition 90 of staff members have achieved National Vocational Qualifications (NVQ) ensuring people are in the safe hands of qualified and competent staff. The Lemon Tree DS0000062940.V367101.R01.S.doc Version 5.2 Page 18 The owner was reminded that induction-training records should be signed and dated by the staff member confirming they have participated in the training. Examination of staff records confirmed the home has thorough and robust systems in place for recruiting staff members ensuring the protection of people living there. The Lemon Tree DS0000062940.V367101.R01.S.doc Version 5.2 Page 19 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): 31,33,35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run and has policies and procedures in place to ensure the health and safety of staff and people living there are promoted and protected. EVIDENCE: The owner of the home has many years experience in caring for elderly people and has achieved a degree in Health Services Management and is also a Registered Nurse. She has access to training to ensure her knowledge and skills are updated and the home continues to be well run and for the benefit of residents. The owner was reminded that she must inform the Commission in writing about events that take place in the home including the death or serious injury of people who live there. The Lemon Tree DS0000062940.V367101.R01.S.doc Version 5.2 Page 20 People spoken to were very positive in their comments about the owner and her staff who were described as being friendly, approachable, very helpful and professional. The home has effective quality assurance systems in place to monitor the level of service being provided for its residents. An annual quality assessment of standards is undertaken by a professionally recognised organisation who completes an audit of the care being provided and seek the views of the people who live at the home and their relatives. In addition the home has in place its own quality assurance systems in place to gather the views of people and keep them informed about events being organised by the home. People spoken to confirmed they are consulted about any changes taking place within the home and kept fully informed about forthcoming events being organised. Financial records were well maintained and up to date ensuring the interests of people are safeguarded. Inspection of maintenance records confirmed facilities and equipment was being maintained as required by health and safety legislation to provide a safe environment for people and staff. The Lemon Tree DS0000062940.V367101.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 The Lemon Tree DS0000062940.V367101.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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 OP31 Regulation 37 Requirement The homeowners must ensure serious events including the death or serious injury of people who live there are reported to the Commission in writing. Timescale for action 09/09/08 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 OP30 Good Practice Recommendations Staff induction training records should be signed and dated by the staff member confirming they have participated in the training. The Lemon Tree DS0000062940.V367101.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection North West Region 3rd Floor Unit 1 Tustin Court Port Way Preston PR2 2YQ 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 The Lemon Tree DS0000062940.V367101.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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