CARE HOMES FOR OLDER PEOPLE
The Beeches 88-90 Oswald Road Scunthorpe North Lincolnshire DN15 7PA Lead Inspector
Beverly Hill Unannounced Inspection 09:30 11 January 2006
th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Beeches DS0000062843.V278393.R01.S.doc Version 5.1 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 Beeches DS0000062843.V278393.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service The Beeches Address 88-90 Oswald Road Scunthorpe North Lincolnshire DN15 7PA 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) 01724 858381 Statepalm Ltd Position Vacant Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places The Beeches DS0000062843.V278393.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 20th May 2005 Brief Description of the Service: The Beeches is registered to provide residential care and support to twentythree service users. The home is situated close to the town centre of Scunthorpe within easy reach of the high street and local amenities. The accommodation is provided over three floors serviced by a passenger lift. The home has four shared bedrooms and fourteen single bedrooms over the first two floors and an additional bedroom on the third floor. All bedrooms have en-suite toilet and washbasin facilities and are furnished to a good standard. There are three bathrooms, two of which have hoists. There is a large lounge separated into four distinct individual sections incorporating a dining area with tables and chairs, two lounge areas and a further smaller lounge area. There is an additional lounge attached to the bedroom on the third floor. The home has a small garden to the front of the building and an enclosed courtyard accessed from one of the lounges. There is parking for two cars at the front and more spaces at the rear. The Beeches has a homely feel, is nicely decorated and is well maintained. The Beeches DS0000062843.V278393.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over one day. The Inspector spoke to the manager, two care staff members who were on duty at the time of the inspection and the proprietor. Throughout the day the Inspector spoke to six people who lived at The Beeches and one relative. The inspector looked at a range of paperwork in relation to staff recruitment, supervision, some training records, staff rotas, complaints, care plans, risk assessments, medication records, accidents and minutes of meetings. The Inspector also checked that people who lived in the home had the opportunity to suggest changes and were listened to and completed a tour of the building. What the service does well: What has improved since the last inspection?
The home had a new manager who had continued to improve the care provision within the home. All the requirements from the last inspection had been met. The home made sure that they received assessments completed by care management prior to admitting people and they wrote to service users stating whether they could meet their assessed needs within the home.
The Beeches DS0000062843.V278393.R01.S.doc Version 5.1 Page 6 The manager made sure that care plans were checked regularly so they were still meeting service users needs and risk assessments were completed. There had been some improvement in the management of service users medication, however there were still some areas to address. See below. The home had utilised the dining area much better by having smaller tables and chairs. This meant that all service users could have their meals at the same time and a second sitting was no longer required. The proprietor had installed call bells in the three lounge areas, which meant that service users were able to call for assistance with greater ease. The home has some staff that has completed vocational training in care and some that are progressing through the course. 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 Beeches DS0000062843.V278393.R01.S.doc Version 5.1 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 Beeches DS0000062843.V278393.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 5 Service users needs were assessed prior to admission, however inconsistencies in the depth of the homes assessment could affect the care planning stage. EVIDENCE: The home completed in-house assessments of potential service users needs and obtained assessments completed by care management prior to admission. They wrote to service users or their representatives informing them of the homes ability to meet the assessed needs. Care plans were produced from the information gathered at assessments. The homes assessments covered all the points in the standard, however some were completed more comprehensively than others. The assessments detailed the service users needs, but in some areas was not explicit in the degree or severity of how the problem affected the person and therefore the level of support required to meet the needs. Service users confirmed they were able to have a trial stay at the home prior to making a final decision about permanent residency. The home offered a
The Beeches DS0000062843.V278393.R01.S.doc Version 5.1 Page 9 respite service when vacancies allowed. The manager confirmed that potential service users could look around the home, stay for a meal and meet people and the first few weeks would be considered a trial. This could be extended if required. Trial visits were referred to in the homes service user guide. The Beeches DS0000062843.V278393.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 and 10 Generally the home managed service users medication well, however the administration of one service users medication compromised policies and procedures. Service users privacy and dignity was promoted within the home by staff awareness and good practice. EVIDENCE: Four care plans were examined to assess the changes since the last inspection. On the whole they contained all assessed needs and were evaluated monthly. There were some areas in one of the care plans that required updates since the service users admission a few months ago. When discussed with staff they were aware of the service users needs and were completing tasks in practice but these had not filtered to the care plan. Risk assessments were in place for activities deemed to pose a risk and these had measures to reduce risk. Generally service users medication was well managed, however there were some issues to be addressed. One service user needed to have their
The Beeches DS0000062843.V278393.R01.S.doc Version 5.1 Page 11 medication with food and when it was administered to her would request staff leave it in the pot on her table until her meal arrived. This did not meet the homes policies and procedures, as staff must sign only when the medication has been administered. Also if a service user was prescribed medication mid month the staff wrote the instructions straight onto the medication record sheet. This transcribing of instructions was not fully completed in all cases. Some prescribed topical creams had, ’as directed’ on the label and needed clearer instructions for staff. Medications were signed on admission to the home and after administration. Stock control was appropriate and all medication was stored correctly. Senior care staff administered medication and all had completed a safe handling of medication course. Service users spoken to described care that was delivered in a way that protected and promoted their privacy and dignity. Staff members were able to say how they supported people in a discreet way, how they encouraged people to do as much as they possibly could for themselves, how they always knocked on doors and closed them for privacy, how they ensured mail was delivered unopened and how service users could see visitors in private if they chose to. The shared bedrooms had privacy screens. Maintaining and promoting privacy and dignity formed part of the homes induction process for new staff members. The Beeches DS0000062843.V278393.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 and 14 The home promoted community links and encouraged contact with family and friends. Service users were able to make decisions and have choices about aspects of their lives. EVIDENCE: Service users and a relative spoken to confirmed that visitors were welcomed into the home at any time and there were no fixed routines. Some service users had maintained existing contacts in the community, for example, one person continued to attend the local Mothers Union and another the local Parkinson’s Society. Clergy visited the home to conduct services and one person continued to attend their own church with support from family and friends. The home has visiting entertainers. The manager confirmed that the activity coordinator had started a process of discussing activities with service users to find out their specific needs in order to tailor activities to them. Service users accessed local amenities such as pubs and the library visited to exchange books. The staff described an event that took place late last year, which was a fancy dress wheelchair push around the town. Staff members spoken to described how they tried to ensure service users had choices about the home and their lives, for example people were asked if they were ready to get up and go to bed, what clothes they would like to wear that
The Beeches DS0000062843.V278393.R01.S.doc Version 5.1 Page 13 day, what choices they would like at mealtimes and whether they would like to join in activities. Service users confirmed they were asked about rising and retiring and the meals they would like to have. Service user meetings were held were suggestions could be made. Some service users managed their own personal allowance and all had lockable facilities for this. Bedrooms were personalised and two service users chose to have their own telephone installed. Some service users smoked and an area had been designated for them away from the main communal area. One service user occasionally chose to sleep in a recliner chair and staff respected this decision. The Beeches DS0000062843.V278393.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 The home provided an environment whereby service users and relatives felt able to complain. EVIDENCE: The home had a complaints policy and procedure that was on display. All complaints however minor were logged on forms and signed off by the manager. Those examined tended to be of a minor nature and all had been resolved. The manager maintained a log of complaints in order to look for patterns and the proprietor advised that complaints were a set agenda item at monthly managers meetings. Service users spoken to were aware of whom to complain to and stated they felt able to complain. Documentation showed that relatives and staff felt able to complain. There were no unresolved complaints on the day of inspection. The Beeches DS0000062843.V278393.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 and 24 The home provided clean, safe and well maintained surroundings with accessible communal areas and service users had the opportunity to personalise their bedrooms. EVIDENCE: The home was well maintained inside and out. The proprietor described plans for future expansion including renovation of the homes’ kitchen but these were currently in the planning stage. The home employed a maintenance person for day-to-day repairs and staff reported that they had enough equipment to fulfil their roles. The home was well decorated with furniture of a comfortable standard. The homes dining area had been reviewed and the two large tables replaced with new smaller tables and chairs. This enabled all service users to take their meals in one setting. The home had a quiet area in the entrance and a further small sitting room attached to a bedroom on the second floor. This bedroom tended to be used for respite services. There was access to an enclosed garden area from one of the lounges.
The Beeches DS0000062843.V278393.R01.S.doc Version 5.1 Page 16 New call bells had been installed in the three lounge areas to enable service users easier and quicker access to staff. Service users spoken to were happy with their bedrooms and these were personalised to varying degrees. Comments were, ‘its very nice and comfortable’, ‘I like living here’, ‘I’m happy with the home and the way I’m looked after’. The home was clean and tidy with only a slight odour in one of the bedrooms. The manager was aware of this and was addressing the problem. All bedrooms had lockable facilities and privacy locks on the doors. The Beeches DS0000062843.V278393.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 and 29 Generally the staffing complement at the home met service users needs, however episodes of short staffing could place service users at risk of insufficient care. Service users were protected by the homes good recruitment procedures and a commitment to a trained workforce. EVIDENCE: Staff rotas were examined and highlighted that the home had experienced episodes of short staff by one on six separate days since December. This was in part due to short notice sickness and maternity leave. The proprietors were aware of the situation and were actively recruiting to expand the bank staff list to support the three homes in the company and policies and procedures regarding sickness notification had been discussed with staff. Service users spoken to were complimentary about the staff. Comments were, ‘the lasses work hard, they are pleasant and tell me things’, ‘the staff are excellent, they do a very good job’, ‘they look after us very well, they are beautiful and do an excellent job’, ‘it’s a difficult job done well’ and ‘the staff are very nice, I have no complaints’. A relative spoken to confirmed that staff were, ‘very good’ and made them feel welcome. The Beeches DS0000062843.V278393.R01.S.doc Version 5.1 Page 18 The home had seventeen care staff out of which three had completed NVQ level 2 training and six were progressing through either NVQ Level 2 or 3. When the staff members who are progressing through the course complete the training the home will have over the required 50 of care staff trained to this level. Recruitment documents for new staff were examined and detailed that the home obtained the correct information about potential staff members prior to the start of employment. These included application forms whereby gaps in employment and proof of identity were checked, two references, POVAfirst and Criminal Record Bureau checks. The Beeches DS0000062843.V278393.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 and 36 The new manager’s approach, supervision, leadership and guidance to the staff team, and the provision of consistent support by the proprietors ensure that service users’ wellbeing is safeguarded. EVIDENCE: The new manager had been in post for two months and prior to this had managed another residential home for fifteen months. The manager had many years experience working in the private care sector, was a registered nurse and had completed a safe handling of medication course. The new manager was settling into their role and the proprietor advised that a support network was available during their induction and afterwards as required. This included peer support from another manager in the company, weekly visits by the training manager and the proprietors, who documented the one-one meetings.
The Beeches DS0000062843.V278393.R01.S.doc Version 5.1 Page 20 The manager had made enquiries at a local college for registration onto the Registered Managers Award and will be making an application to be registered with CSCI. Service users spoken knew the new manager and stated they were, ‘very nice’ There was evidence that care staff members were on target to receive the required six supervision sessions per year. A new supervision form had been devised and the discussion covered the care workers key worker role with the service user, training needs, absence monitoring, guidance required, any suggestions the worker may have, feedback on their work and a reminder of the homes philosophy of care. A record of the discussion and an action plan with timescales was maintained. The manager and proprietor advised that guidance sheets have been developed within the company to record discussions with staff on any practice issue that may have been observed that required attention. These records formed a part of the supervision process and ensured it was ongoing rather than just a discussion every two months. Staff members spoken to confirmed that they received supervision every two months and had to take in care plans for their supervisor to check. They stated that the manager was approachable and offered good support and advice, and the proprietors were available if they needed to see them. Since the last inspection the home had addressed some health and safety issues by installing a call bell system in the lounge areas and completing a risk assessment on a particular service user. The Beeches DS0000062843.V278393.R01.S.doc Version 5.1 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 2 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x 3 3 x x x 3 x x STAFFING Standard No Score 27 2 28 2 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x x x x 3 x x The Beeches DS0000062843.V278393.R01.S.doc Version 5.1 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 OP3 Regulation 14 Requirement The registered person must ensure that the homes assessments of need prior to admission are expanded to give a comprehensive view of the need identified and the support required to meet it. Social profiles to be completed soon after admission. The registered person must ensure that care plans are updated consistently when needs change. The registered person must ensure that policies and procedures are followed when administering medication, there are clear instructions for prescribed topical products and full instructions are written when transcribing medication onto record sheets. The registered person must ensure that the correct numbers of staff members are on duty during the day. The registered person must ensure that the manager applies
DS0000062843.V278393.R01.S.doc Timescale for action 11/01/06 2. OP7 15 11/01/06 3 OP9 13(2) 11/01/06 4 OP27 18 11/01/06 5 OP31 9 17/02/06 The Beeches Version 5.1 Page 23 for registration with the CSCI. 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 2 Refer to Standard OP28 OP31 Good Practice Recommendations The home should continue to work towards 50 of care staff trained to NVQ level 2. The manager should complete registration for the Registered managers Award. The Beeches DS0000062843.V278393.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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