Inspection on 10/05/10 for Beecholme House

This is the latest available inspection report for this service, carried out on 10th May 2010.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Beecholme House 09/09/09

Beecholme House 14/10/08

Beecholme House 24/04/08

Beecholme House 31/10/07

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

Extracts from inspection reports are licensed from CQC, this page was updated on 29/06/2010.

Key inspection report Care homes for older people Name: Address: Beecholme House 2-4 Beecholme Avenue Mitcham Surrey CR4 2HT     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Lee Willis     Date: 1 0 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 38 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 38 Information about the care home Name of care home: Address: Beecholme House 2-4 Beecholme Avenue Mitcham Surrey CR4 2HT 02086486681 02082889797 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Sharon Egbo Lartey Name of registered manager (if applicable) Type of registration: Number of places registered: care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The Maximum number of servie usres that can be accommodated is 15 The registered person may provide the following category of service only: care home only:Code PC to service users of the follwing 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 Demenia: Code DE 15 Date of last inspection Brief description of the care home Beecholme House is a registered care home for up to fifteen older people. The building is made up of two houses which have been joined together and extended. The home is situated in a residential area of Mitcham with a small number of shops within a short walking distance. Parking is to the front of the building. Public transport bus services Care Homes for Older People Page 4 of 38 2 3 1 1 2 0 0 9 0 0 Over 65 15 15 Brief description of the care home are within a short distance of the home. Two double bedrooms and eleven single bedrooms are available. One bedroom has an en suite bathroom. Weekly fees for this service are £550 to £700 per week. Care Homes for Older People Page 5 of 38 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: From all the available evidence we gathered as part of the process of inspecting this service we have judged it as having a number of strengths, but also areas of significant weakness. We therefore still rate 2-4 Beecholme Avenue as a 1 star ADEQUATE performing service and have asked the providers to supply us with a time specific action plan setting out when and how they intend to address all the issues identified in this and subsequent inspection reports, and improve outcomes for the people who live there. We spent five and a half hours at the service during which time we spoke at length to four people who live at the home, the new manager, two support workers, the cook, the cleaner, two students on nursing placements, and a visiting district nurse and two care managers. We also looked at various records and documents, including: the care plans for three people whose care we selected to case track; needs and risk assessments carried out in respect of these individuals; the services Guide; accident Care Homes for Older People Page 6 of 38 and incident books; the complaints log; staff duty rosters, recruitment checks, certificates of training, and supervision records; fire safety checks, and various health and safety records. The remainder of the site visit was spent touring the premises and the grounds. Seven of our surveys were returned to us by various stakeholders. The majority were completed by the people who use the service with support from their representatives, and the rest came back from staff who worked at the care home. The new manager also completed and returned our Annual Quality Assurance Assessment (AQAA) when we asked for it. This self-assessment document tells what the providers think they do well, what they have improved since their last inspection, and what they could do better in the future. We would like to take this opportunity to thank all those stakeholders who participated in the inspection process and provided us with written and verbal feedback about this care home. Care Homes for Older People Page 7 of 38 What the care home does well: What has improved since the last inspection? The majority of the people who use the service, health and social care professionals, and care staff who gave us feedback about the home all agreed the standard of the service provided had begun to improve since the arrival of the new manager in December 2009. All the outstanding requirements identified in the services last report have been addressed, including: ensuring sufficient numbers of suitably trained and competent staff are on duty at all times; the disposing of a faulty mobile hoist; the training of all staff in safeguarding; redecorating several bedrooms and communal areas; and, notifying us without delay about the appointment of any new managers. Furthermore, the majority of the good practice recommendations we made in the last report have been considered and either fully or partially implemented: Care plans have been improved to make them far more person centred and they now contain more detailed information about how staff should be meeting the needs of people with dementia; the cultural needs of individuals in relation to the food they eat can now be identified from care plans; bathrooms and toilets have been refurbished and these areas are now being cleaned at more regular intervals to ensure they are always kept fresh and clean; the training opportunities staff have to refresh their knowledge and skills has improved; and, the way staff carry out health and safety checks is much better. Other improvements made to the environment since the new manager took over include the creation of a new relaxation room, which has been fitted out with all manner of electrical home entertainment and sensory equipment for people who use the service to enjoy at their leisure. Care Homes for Older People Page 8 of 38 What they could do better: All the positive comments made above notwithstanding about all the improvements the new manager has made in her first six months in charge she still acknowledges the service has a long way to go to ensure better outcomes for all the people who live at 24 Beecholme Avenue. While the service is moving in the right direction we would also like to see the care home have a sustained track record of delivering better outcomes for the people who live there. At the end of this report we have made three new requirements for the provider to address within prescribed time-frames for action and sixteen good practice recommendations for them to also consider implementing: People who use the service and their representatives should have access to a guide that is written in more easy to read plain language. The Guide should also include detailed information about the qualifications of the manager and her staff, as well as the views of various stakeholders about the home. This will ensure people who use the service and/or their representatives have access to all the information they need to know about 2-4 Beecholme Avenue. The cultural and spiritual needs and wishes of prospective new service users, including those pertaining to dying and death, should be ascertained during the initial assessment process and homes findings recorded in individuals care plans. This will ensure staff have all the information they require to meet the cultural and spiritual needs and wishes of the people they support. The way the staff record the outcome of all the medical appointments people who use the service have with various health care professionals should be reviewed. We recommend the service develops separate health care action plans for all the people who use the service to record everyones unique health care needs and wishes, and the outcome of any input they receive from community based health care professionals. This will enable anyone authorised to inspect these records to determine whether or not service users health care needs and wishes are being met by the home and the relevant health care professionals. Staff authorised to handle medication on behalf of the people who use the service should have more detailed guidelines in place that set out exactly under what circumstances as required (PRN) behavioural modification medication should be administered as a last resort. This will minimise the risk of people who use the service being over medicated. The provider should establish a policy that makes it much clearer what students on placement at the home can and cannot do in terms of their roles and responsibilities, especially in relation to providing and/or observing personal care. This will ensure the privacy and dignity of the people who use the service is respected and maintained. People who use the service should be offered more opportunities to choose to participate in meaningful community based leisure activities that reflects their age and social interests. People who use the service should have far more opportunities to express their views about the choice of meals that are included in the weekly menus. This will ensure the food likes and cultural preferences of the people who use the service are reflected in the weekly menus. Furthermore, people who use service should Care Homes for Older People Page 9 of 38 have access to menus that are illustrated with photographs of all the meals available each day to ensure everyone is fully aware of the choices they are being offered. This good practice recommendation was made at the services last inspection, but not fully implemented. The services complaints procedure should be written in plain language and be made available in formats that can be more easily read and understood by all the people who use the service, as well as their representatives. This good practice recommendation was made in the service last report, but not implemented. The service should fit bedroom doors with more suitable locking devices that can be overridden by staff from the outside in the case of emergencies. The provider should replace all the damaged furniture and iron scorched carpets in the main communal areas. This will ensure people who use the service live in a far more comfortable and homely environment. The way the service ensures the grounds are kept tidy, attractive, and safe have improved since the last inspection, but there remain room for further improvement. As recommended in the services last inspection report garden maintenance still needs to be carried out at more regular intervals that it is presently. The provider should consider improving the kitchen environment by establishing a time specific rolling programme to up grade all the old and worn out kitchen units. The manager should assess her staff teams training needs and establish a time specific action plan setting out how she intends to address any gaps identified in their current knowledge and skills, especially with regards fire safety, infection control and moving and handling. This will ensure all staff that work at the service have the right mix of knowledge and skills to meet the needs and wishes of the people who use service, as well as keep them safe. The provider should ensure the person in day-to-day charge of the service is registered with us and subject to a fit person interview. This will ensure the person in day to day charge of the home is fit to run a care service supporting adults who are vulnerable. The provider must ensure unannounced inspections of the service are carried out at monthly intervals by senior representatives of the organisation to assess the services conduct, as well as prepare a written report regarding their findings. These visits should include speaking to the people who use the service and staff, touring the premises, and inspecting records of events and complaints. This will ensure the providers can assess how well the service is performing and develop improvement plans to address any poor practice issues they identified as part of this quality assurance process. The views of the people who use the service and their representatives should be ascertained at more regular intervals and the results of these satisfaction surveys published at least once a year. This will ensure all the services major stakeholders have a greater influence in respect of how the home is run and develops in the future. The provider must ensure the keypad device fitted to the front door is linked to the Care Homes for Older People Page 10 of 38 care homes fire alarm system. The front door is a designated fire exit and must automatically unlock in the event of the fire alarm being sounded to ensure everyone can leave quickly and safely. Finally, the providers must ensure the services water heating system is tested for legionella at regular intervals. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 11 of 38 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 12 of 38 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people using the service and/or their representatives do not have access to all the information they need to know about this care home in order to help them decide whether or not 2-4 Beecholme Avenue is the right place for them. The services admission procedures are in the main sufficiently robust to ensure potential service users and/or their representatives can find out about what it might be like to live at the care home, as well as have their needs and wishes assessed before any decision about moving in is taken. Evidence: As recommended in the services previous report the new manager has reviewed the services Guide and up dated it to include more detailed information about its complaints procedure and where you could obtain a copy of the services most recent inspection report. However, the amended version of the Guide we saw did not include enough information about the new manager and her staff teams qualifications and Care Homes for Older People Page 13 of 38 Evidence: experience or the views of the people who use the service regarding their home. Furthermore, the new Guide was not very accessible to the people who use the service and/or their representatives because it was not written in particularly easy to read or plain language, and was not conspicuously displayed in any of the care homes communal areas. The majority of the people who use the service who completed our surveys told us they had been given written information about the homes terms and conditions. Information about the current range of fees the provide charges for services and facilities was also made available on request by the manager. The manager stated in the services AQAA that she had accepted one new service user on a permanent basis since taking over at Beecholme Avenue. The manager told us all prospective new service users are always offered the chance to visit the care home with their representatives to have a look around and meet the other service users and staff. Then manager also showed us the needs assessments she had obtained in respect of the new service users from their care manager and the one she had undertaken herself as part of the admission process. These needs assessment contained most of the information the service should know about a new referral, although they lacked details about this particular new service users cultural and spiritual needs and wishes. Future needs assessments should capture this information before anyone moves in. Care Homes for Older People Page 14 of 38 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans have improved to make them far more person centred. They also contain more detailed information about the individualised support each service user requires to ensure their unique personal care needs and wishes are recognised and met. The services arrangements for ensuring the existing and changing health care needs of the people who use the service are continually met are now much better. Nonetheless, the way staff record the outcome of medical appointments people who use the service attend with various community based health care professionals should be reviewed. Current arrangements make it difficult to access and reference the outcome of these appointments. Overall, staffs medication handling and recording practises are suitably robust to keep the people they support safe. However, we recommend protocols detailing the exact circumstances under which it would be deemed appropriate to administer as required medication should be developed to minimise the risk of people using the service being over medicated. Care Homes for Older People Page 15 of 38 Evidence: All the care staff who completed our survey told us they were always given enough up to date information about the people who use the service to enable them to meet their assessed needs. We looked at the new care plan formats in depth for three pople who use the service. As recommended in the services last inspection report these plans had been made far more person centred (i.e. individualised). All three plans set out in greater detail what support each of these pople who use the service required to ensure their needs and wishes were fully met. An individual who completed our survey with support from a representative wrote in the section entitled what the service does -the care is generally exceptional here, they support me, and help me live quite independently. The manager told us three-quarters of care plans had now available in the new person centred format and was confident this transition process would be completed by July 2010. We will continue to monitor progress made by the service to achieve this aim. Care plans we looked at all contained detailed risk assessments and associated management strategies to help staff minimise the likelihood of any of these identified risks and/or hazards occurring. Staff we met were all aware which service users were more at risk of falling within the home or going missing, and what action they should take to prevent these incidents occurring and/or deal with them once they had happened. The manager told us care plans are continually reviewed and up dated to reflect any changes in an individuals needs and/or circumstances. The three care plans we looked at in depth each contained evidence that showed us service users designated keyworkers are reviewing care plans on a monthly basis, and up dating them accordingly. Furthermore, as recommended in the services last report all the staff we met told us they had been provided with clear guidelines they should follow in the event of anyones needs significantly altering. A senior member of staff we met was very clear who they should notify without delay if they became aware that someones needs had significantly changed. One hundred percent of people who use the service who returned our surveys told us they got all the medical care they needed. Feedback we received from a visiting health care professional was also in the main very positive about the service and improvements made by the new manger in the past six months. Typical comments, included -the attitude of staff has improved here lately, and staff are now much better following our instructions and doing all the routine medical tasks we ask them to perform. Care Homes for Older People Page 16 of 38 Evidence: The manager confirmed that based on professional advice from a qualified Occupational Therapist the service no longer used any mobile hoists and had recently disposed of the faulty hoist the previous inspector had required the service to maintain at more regular intervals. We saw the Oxford Midi hoist in question stored in the shed at the bottom of the garden awaiting disposal. Staff continue to check and record the weight of all the people who use the service at least once a month. It was also evident from records kept that all the accidents involving the people who use the service had been appropriately dealt with in a very prompt and professional manner by staff on duty at the time. Information regarding the outcome of all the appointments people who use the service attend with various health care professionals staff record in each service users daily diary notes. We looked at all the medical appointments the three people whose care we were case tracking and were unable to find the outcome of all the meetings the manager assured us she knew had taken place with various community based health care professionals. We therefore recommend the service develops separate health care plans for all the people who use the service to record the outcome of medical appointments and make referencing this information easier. No recording errors or gaps were noted on any of the Medication Administration Records (MAR) we looked at. Staff we met told us it was custom and practice within the service for senior staff on duty to carry out a medication audit of all the medicines handled that day at the end of each shift. The manager confirmed that as she had stated in the services AQAA no Controlled Drugs are currently held in the home on behalf of any of the people who use the service. Two staff we met who are authorised to handle medication within the care home were both very clear that as required behavioural modification medicines should only ever be administered as a last resort when all other deescalation techniques had failed. medication records we saw revealed staff who had administered as required medication always signed and recorded the reason why they felt it was necessary to take this course of action on the back of an individuals MAR sheet. No written guidelines setting out what signs and triggers staff should look out for before they took the decision to administer as required medication are available in the home, which we recommend the service develops as an aid memoir for staff. During the course of this site visit we always observed staff knocking on bedroom doors to ask the permission of the person who occupied the room whether or not they could enter. We also saw staff interacting with all the people who used the service in a very kind, respectful, and professional manner. However, it was evident from Care Homes for Older People Page 17 of 38 Evidence: comments made by the manager and the two nursing students we met that the service had not developed any clear rules regarding what roles and responsibilities students on placement at the care home had. We recommend the service establishes a policy setting out exactly what students on placements can and cannot do, especially with regards the providing and/or observing personal care. Care Homes for Older People Page 18 of 38 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have lots of opportunities to participate in age appropriate and meaningful leisure pursuits within their home, but there is a lack of community based social activities for people to engage in. The services arrangements for consulting people using the service and their relatives remain sufficiently robust to ensure these major stakeholders can affect the running and future development of Beecholme. I the main dietary needs and preferences are well catered ensuring the people who use the service are provided with daily variation, choice, and nutritionally wellbalanced meals. However, there is room for the service to improve its arrangements for ensuring all the people who use it are far more involved in planning the weekly menus and have greater access to easy to read pictorial menus. This will ensure people who use the service can make more informed choices about the food they eat each at mealtimes. Evidence: During the visit we observed a student playing dominos in the lounge with several people who use the service. We also noted a varied selection of board games, books Care Homes for Older People Page 19 of 38 Evidence: and a wide screen television in the main communal areas. Since the services last inspection a new relaxation room has been created in a spare room on the ground floor. The room contains all manner of electrical home entertainment and sensory equipment, including - a foot massager, aromatherapy oil burner, a light projector, and music centre. The manager told us everyone who uses the service has the opportunity to spent time in the room either on their own or with one to one staff support. An individual who uses the service told us they often spent time alone in the new relaxation room listening to their music. Staff we met confirmed an activity coordinator continues to visit the home each week to arrange various in-house activities. It was evident from all the activity records we inspected that people who use the service have the opportunity to choose to engage in a wide variety of in-house social and leisure activities. These positive points made above notwithstanding it was also evident from activity records inspected and the feedback we received from staff that there remains very few opportunities for people who use the service to participate in any meaningful social activities in the wider community. The manager told us a number of people who use the service often attend services at a local church, but acknowledged opportunities to participate in any other community based activities was limited. During a tour of the building we noted a suggestions box conspicuously displayed on a table in the entrance hall. The manager showed us the minutes of the last three service users meetings, which are held once a month. The manager also confirmed that as she had stated in the services AQAA the views of the relatives of people who use the service continue to be sought every fortnight. It was evident from information recorded in the visitors book and the feedback we received from people who use service and staff that the home operates an open visitors policy. The majority of all the written and verbal feedback we received from the people who use the service about the standard of the meals provided was in the main very complimentary. Typical comments, included - i like the food served here, the meals are OK - no complaints, and i like my eggs scrambled, which i sometimes help staff to make. We observed staff writing what meal choices were available for lunch that day on a wipe clean board in the main lounge. However, it was evident from the comments made by a number of pople who use the service they were unable to easily read and/or understand the information written on this board. As recommended in the Care Homes for Older People Page 20 of 38 Evidence: services last inspection report we still suggest the home develops menus with photographs of the meal choices available at mealtimes. The manager told us people who use the service are encouraged to help staff plan the weekly menus at their monthly service user meetings. We therefore also recommend the people who use the service have far more opportunities to get involved in helping staff plan the menus, and suggest their views about the food they eat is ascertained at least once a week. As recommended in the services last report we found evidence in care plans we looked at that showed us the cultural needs of individuals in relation to food they eat could now be identified in their care plan. The current service user group is quite ethnically and culturally diverse and it was therefore positively noted that the choice of meals advertised on the menus we saw reflected the groups varied food heritage and tastes. Care Homes for Older People Page 21 of 38 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes arrangements for dealing with concerns and complaints are sufficiently robust to ensure the people who use the service can feel confident any concerns they raise will be taken seriously and acted upon. The way in which the service deals with safeguarding matters ensures people who use the service are kept safe. All the services staff team have now received safeguarding training ensuring they have the right knowledge and skills to prevent, recognise, and report vulnerable adult abuse if they witness or suspect it. Evidence: One hundred percent of the people who use the service who completed our survey told us they knew who to speak to informally if they were not happy with anything at Beecholme and how to make a formal complaint if they needed too. Copies of the services complaints procedures are included in its Guide and conspicuously displayed on notice boards in communal areas. However, the complaints procedure is still not available in an easy to read format that is written in plain language and can be easily understood by everyone who uses the service. The manager was able to show us documentary evidence to confirm that as she had stated in the services AQAA she had not received any formal complaints about the homes operation since the last key inspection. All the staff who returned our survey informed us they knew what to do if someone raised a concern with them. Care Homes for Older People Page 22 of 38 Evidence: The manager and all the staff we spoke with about safeguarding matters demonstrated a good understanding of what constituted abuse and who they needed to notify if they witnessed or suspected it was happening within the home. It was clear from comments made by the manager that the two safeguarding incidents that had occurred since the last key inspection had both been dealt with in a very prompt, open and professional manner -in accordance with Nationally agreed safeguarding protocols. All the relevant external agencies were notified without delay, including the local safeguarding adults team and us, and appropriate disciplinary action taken against the staff involved. As required in the services last report the manager was able to provide us with documentary evidence that showed us sufficient numbers of the current staff team have now received training in safeguarding vulnerable adults. Care Homes for Older People Page 23 of 38 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The interior layout and design of the home, which includes recent improvements made to the decor of the landings and some bedrooms, ensures the people who use the service live in a safe and non-institutional environment. Nonetheless there remains significant room to improve the interior of the home by replacing all the damaged furniture and carpets in the communal areas, and the worn out units in the kitchen. The rear garden also still needs to be tidied up to make it a much more pleasant area for people who use the service to sit and enjoy their garden. The services arrangements for controlling infection are sufficiently robust to ensure the people who use the service live in a clean environment, which also free of any offensive odours. Evidence: During a tour of the premises we noted the upstairs landing and some bedrooms had all been redecorated as required in the services last inspection report. However, there remains some damaged furniture and iron scorched carpets in the main communal areas. A member of staff who returned our survey told us the service would be improved by - redecorating the place, and replacing worn out carpets and furniture. The requirement is made that damaged carpets and furniture in the main communal areas are replaced. The manager told us all the worn out chairs in the dining room Care Homes for Older People Page 24 of 38 Evidence: were recently replaced with a new set of matching chairs. The service employs a part-time gardener to look after its external grounds. However, despite the gardeners input and the good practice recommendation made in the services last report about keeping the homes grounds tidy, attractive, and safe - we still noted the fish pound in the rear garden was over flowing, a lot of he garden paths were over grown with weeds, and a large metal ladder had been inappropriately left lying in a shrubbery. The good practice recommendation that more frequent maintenance be carried out on the homes gardens is repeated in this report. The units in the kitchen are quite old and are starting to look rather worn and shabby. We recommend the service establishes a time specific rolling programme to up grade the kitchen. The recommendation that bathrooms and toilets are refurbished and the general decor of these areas be improved has been implemented by the service. Since the last inspection the service has employed a cleaner who was on duty at the time of this inspection. All the bathrooms and toilets we viewed during a tour of th premises looked clean, and smelt fresh. All the bedroom doors we viewed had been fitted with dead locks, which must be replaced with more suitable locking devices that can be overridden by staff from the outside in case of emergencies. The homes laundry room is suitably positioned so staff do not have to take foul or soiled laundry through any areas where food is prepared, stored or eaten. Care Homes for Older People Page 25 of 38 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be sure their needs will be met because they are now supported at all times by sufficient numbers of suitably competent staff. Staff recruitment checks and vetting arrangements are sufficiently robust to ensure the risk of employing people who are not fit to work with vulnerable adults is minimised. The services arrangements fro ensuring sufficient numbers of its staff team are suitably trained to effectively meet the needs and wishes of pople using the service have improved in the past six months, but there remains considerable room for further improvements to be made in this area. The training needs of the current staff team need to be assessed and a time specific action plan developed to address any identified gaps in their knowledge and skills to enable staff to meet the needs and wishes of the people they support. Evidence: The service was issued with an immediate requirement at the time of its last unannounced inspection because not enough suitably trained staff were on duty when the previous inspector arrived at Beecholme. The manager stated in the services AQAA that staffing levels were no longer a problem. On arrival at the home we found the manager working on the floor with another support worker, the cook, cleaner, and Care Homes for Older People Page 26 of 38 Evidence: two student nurses on placement. The manager and other staff we met told us having at least two support staff working across the day was adequate to meet the needs of all the people who currently use the service and that normally they would have three support staff working at peak periods of activity. The manager told us the reason why there was only herself and another support worker on duty that morning was because the additional third member of staff had rung in sick. Staff duty rosters we sampled at random revealed that the service usually employed three support workers to cover peak periods of activity across the day, along with the cook and recently recruited cleaner. The majority of people who use the service and care staff that returned our surveys told us there were always enough staff available. All the verbal feedback we received from the people who use the service and a visiting health care professional was in the main very compliment about the attitude of staff who worked at Beecholme Avenue. We observed all the staff on duty during this site visit interacting with the people who use the service in a very kind, respectful, and professional manner. The manager told us the service had experienced relatively high levels of staff turnover in the past six months, but following a recent recruitment drive the manager had recently achieved a full compliment of staff. The manager was able to provide us with documentary evidence on request that showed us satisfactory pre-employment checks had been carried out on all the staff she had recently employed, which included up to date Criminal Record Bureau (CRB) checks, two written employments references, photographic proof of identity, and Home Office approved work permits (where applicable). The new cleaner confirmed they had been required to provide their new employer with an up to date CRB and two written references from their previous employers before being allowed to start working at the home. All the staff who completed our surveys told us their induction had covered everything they needed to know very well and the on going training they received was relevant to their role. A member of staff told us they believed the service was good at training and retaining staff. The manager provided us with documentary evidence on request that showed us all new staff received a structured induction and that as stated in the services AQAA all staff have now either achieved a National Vocation Qualification (NVQ) in dementia care (Level 2 or above) or were enrolled on an approved NVQ course. The manager also told us sufficient numbers of her current staff team have received training in basic food hygiene, first aid, handling medication, and equality and diversity. These positive points made above notwithstanding, we identified a number of gaps in Care Homes for Older People Page 27 of 38 Evidence: the current staff teams knowledge and skills. The good practice recommendation made in the services last report that an annual training plan is produced to ensure staff receive all the statutory and refresher training they need has not been implemented. We strongly recommend the manager carries out this training assessment of her staff team and develops a time specific action plan setting out how she intends to address any gaps identified in the teams knowledge and skills. In the interim, sufficient numbers of staff must receive training in fire safety, infection control, and moving and handling. Care Homes for Older People Page 28 of 38 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service have benefited from living in a care home that has been well run in the past six months by a suitably competent, qualified, and experienced manager. Care staff that work at the home receive enough supervision and support from their manager and fellows peers to perform their duties care well. The providers internal quality assurance systems are inadequate and must be improved if the views of the people who use the service are to be ascertained and taken seriously. In the main the services health and safety arrangements are sufficiently robust to keep the people who use the service are kept safe, although the front door keypad device needs top be linked to the fire alarm system and the water heating system tested for legionella. Evidence: The services new manager, Margaret Akoyon, was appointed in December 2009 and the feedback we received from people who use the service and staff that work there Care Homes for Older People Page 29 of 38 Evidence: was in the main very positive about her leadership style. Typical comments, included i think the manager has done a good job, the place has definitely improved since the arrival of Margaret, and i quite like the new manager, shes firm, but usually fair, and at least you know were you stand with her. Mrs Akoyon has nearly ten years experience supporting vulnerable adults, has managed nursing homes for people with dementia for nearly two years, was previously registered with us as a manager, and has achieved her Registered Managers Award. The new manager dealt very promptly and appropriately with both the safeguarding incidents that occurred within the service in her first six monthly in charge and is clearly not afraid to take tough decisions and discipline and/or dismiss staff for misconduct. All these positive comments about the new managers approach notwithstanding Mrs Akoyon told us she was being promoted to the position of operations manager for her current employer and would be responsible for overseeing all three of this providers care services from July 2010. Mrs Akoyon told us a new manager for 2-4 Beecholme Avenue has already been appointed and will start in June 2010 under her direct supervision. The new manager will need to submit their registered manager application to us as soon as they can in order for us to process it. As required in the services last report the providers notified us in writing about the name, qualifications, and dates of the services last two managers were appointed. The manager told us only one unannounced inspection visit had been carried out by the provider in the past six months. These internal inspections should be undertaken at least once a month by a senior representative of the provider and form an integral part of the organisations quality assurance systems. The manager assured us as soon as she commences work as the providers new operations manager she will ensure these monthly quality monitoring visits are reinstated. The manager also conceded that despite developing a new satisfaction survey for people who use the service and their representatives to express their views about their home, these questionnaires had yet to be distributed. We recommend these questionnaires are given out and the results analysed and published. All the staff who completed our surveys told us they regularly met with the manager to discuss their work. All the staff files we inspect at random each contained a record of these individuals last three one to one supervision sessions with their manager, which were being carried out approximately once every two months. Furthermore, the minutes of the services last three staff meetings revealed they had been well attended and were also being held approximately once every two months. The manager was able to produce well maintained records staff were keeping that set Care Homes for Older People Page 30 of 38 Evidence: out in detail all the financial transactions they had taken on behalf of the people who use the service, which included receipts for all goods and services purchased. The manager was able to produce a recently updated fire risk assessment for the building on request. The services other fire records revealed the fire alarm system is tested on a weekly basis and fire drills undertaken on a quarterly basis in line with recommended good fire safety practises. All the staff we met told us they had been involved in at least one fire drill practise in the past six months. The services relatively new keypad device fitted to the front door is not linked to the fire alarm system and is in breach of good fire safety regulations because the door would not automatically be unlocked in the event of the fire alarm being sounded. The service is required to rectify this fire safety breach as a matter of urgency. During a tour of the premises we noted that all products hazardous to health were being kept securely locked away and that all the food taken out of its original packaging were correctly labelled, dated, and stored in accordance with basic food hygiene standards. We also noted that the temperature of hot water emanating from a first floor bath was a safe 43 degrees Celsius when we tested it after lunch. The manager told us all the homes baths had been fitted with fail-safe thermostatic mixer valves that prevented hot water temperatures exceeding 43 degrees Celsius. Up to date Certificate of worthiness were made available on request that revealed that in line with the manufactures recommendations and current legislation routine checks had been carried out by suitably qualified professionals on the services gas installations, fire extinguishers, and portable electrical appliances. The manager told us the services water heating systems had not been tested for legionella, which must be rectified as soon as practicable. Care Homes for Older People Page 31 of 38 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 32 of 38 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 33 26 The provider must ensure 01/10/2010 unannounced monthly visits are carried out by senior representatives of the organisation to assess the services conduct and prepare a written report regarding their findings, The visits should include speaking to the people who use the service and staff, touring the premises , and inspecting records of events and complaints. This will ensure the providers can assess how well the service is performing and develop improvement plans to address any poor practice issues they identified as part of this process. The service must ensure the keypad device fitted to the front door is linked to the fire alarm system. 01/07/2010 2 38 23 Care Homes for Older People Page 33 of 38 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action The front door is a designated fire exit and must be automatically unlocked in the event of the fire alarm being sounded in allow everyone leave quickly and safety. 3 38 23 The providers must ensure 01/07/2010 the services water heating system is tested for legionella at regular intervals. This will ensure the people who use the service are kept safe. 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 1 1 People who use the service and their representatives should have access to an easy to read and understand Guide that is written in plain language, and includes detailed information about the qualifications and experience of the manager and her staff team, and what the pople who use the service think about their home. This will ensure people who use the service and/or their representatives have access to all the information they need to know about 2-4 Beecholme Avenue. 2 2 The cultural and spiritual needs and wishes of prospective new service users, including those pertaining to dying and death, should be ascertained during the initial assessment process and findings recorded in care plans. This will ensure staff have all the information they require Care Homes for Older People Page 34 of 38 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 to meet the cultural and spiritual needs and wishes of the people they support. 3 8 The way the staff record the outcome of all the medical appointments people using the service have with health care professionals should be reviewed. We recommend the service develops separate health care action plans for all the people using the service to record individuals unique health care needs and wishes, and the outcome of any input they receive from community based health care professionals. This will enable anyone authorised to inspect these records to determine whether or not service users health care needs are being met by the relevant health care professionals. 4 9 Staff authorised to handle medication on behalf of the people who use the service should have protocols in place that set out exactly under what circumstances as required (PRN) behavioural modification medication can be administered as a last resort. This will minimise the risk of people using the service being over medicated. 5 10 The provider should establish a policy that makes it clear what students on placement at the home can and cannot do in terms of supporting the people who use the service. This will ensure the privacy and dignity of the people who use the service is respected and maintained. 6 12 People who use the service should be offered more opportunities to choose to participate in meaningful community based leisure activities that reflects their age and social interests. People who use the service should have far more opportunities to express their views about what meals choices are included in the menus, which staff plan each week. This will ensure the food that reflects the tastes and cultural preferences of the people using the service is included in the planned weekly menus. 7 15 Care Homes for Older People Page 35 of 38 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 8 15 People who use the service should have access to more easy to read menus that use photographs and pictures. This will enable them to make more informed choices about the meals they eat at mealtimes. This good practice recommendation was made at the services last inspection report, but not fully implemented. 9 16 The services complaints procedure should be written in plain language and be made available in formats that can be easily read and understood by all the people who use the service. This good practice recommendation was made in the service last report, but not implemented. 10 19 The provider should consider improving the environment in the kitchen by establishing a time specific rolling programme to up grade all the old and worn out kitchen cupboards. The provider should replace all the damaged furniture and scorched carpets in the main communal areas. This will ensure people who use the service live in a far more comfortable and homely environment that is well furnished. 11 19 12 19 The way the provider ensures the grounds are kept tidy, attractive, and safe remain inadequate and maintenance still needs to be carried out on a more regular basis. This good practice recommendation was made in the services last inspection report, but was not fully implemented. 13 24 The provider should fit bedroom doors with more suitable locking devices that can be overridden by staff from the outside in the case of emergencies. The manager should assess her staff teams training needs and establish a time specific action plan setting out how she intends to address any gaps identified in their knowledge and skills, especially with regards fire safety, infection control and moving and handling. This will ensure all staff that work at the service have the 14 30 Care Homes for Older People Page 36 of 38 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 right up to date knowledge and skills to meet the needs and wishes of the people who use the service, as well as keep them safe. 15 31 The provider should ensure the person in day-to-day charge of the service is registered with us and is subject to a fit person interview. This will ensure the person in day to day charge of the home is fit to run a care service supporting adults who are vulnerable. 16 33 The views of the people who use the service and their representatives should be ascertained at more regular intervals and the results of these satisfaction surveys published at least once a year. This will ensure all the services major stakeholders have a greater influence in respect of how the home is run and develops in the future. Care Homes for Older People Page 37 of 38 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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