CARE HOMES FOR OLDER PEOPLE
Beech Close Care Home Beech Close Desborough Northants NN14 2NP Lead Inspector
Irene Miller Unannounced Inspection 24th April 2006 10:00 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 DS0000060165.V291029.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. DS0000060165.V291029.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Beech Close Care Home Address Beech Close Desborough Northants NN14 2NP 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) 01536 762762 01536 762313 www.shaw.co.uk Shaw Healthcare (de Montfort) Ltd Mrs Rose McClarnon Care Home 42 Category(ies) of Dementia - over 65 years of age (12), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (7), Old age, not falling within any other category (42), Physical disability over 65 years of age (6) DS0000060165.V291029.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. No one falling within the category of DE (E) may be admitted into the home where there are 12 service users who fall within the category of DE (E) already accommodated within the home No one falling within the category of PD (E) may be admitted into the home where there are 6 service users who fall within the category of PD (E already accommodated within the home No one admitted for intermediate care may be accommodated outside of the designated intermediate care unit No one falling within the category MD (E) may be admitted into the home where there are 7 service users who fall within the category of MD (E) already accommodated within the home. Service Users within the category MD (E) can only be accommodated in the area designated as flat 1 bedrooms 1 to 7 as detailed in the plan submitted to the commission on 04.01.05 No one falling within the category of MD (E) can be accommodated in any room outside of the area designated as Flat 1. 16th January 2006 2. 3. 4. 5. 6. Date of last inspection Brief Description of the Service: Beech Close is a home providing personal care to 42 residents in the old age, dementia and physical disability categories. The home is situated within the residential area of Desborough and is close to local facilities and amenities. The premises were purpose built some years ago and provide single rooms and a range of communal areas for the residents. These include small lounge areas within the 6 accommodation areas known in the home as ‘flats’ and ‘the Street’ area offering a variety of services including hairdressing, tea bar, library, shop and quiet room. All admissions to the home come through the local authority and the fees range from £420.20 to £445.00. DS0000060165.V291029.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The primary method of inspection used was ‘case tracking’ which involved tracking the care of three residents, through a review of their records and discussion with them where possible. Observation of care practices, discussion with the registered manager, residents, staff and a limited tour of the building. The inspection took place over a period of approximately six hours following a period of 2 hours preparation, which included reviewing previous inspection reports, and other documentation. What the service does well:
There is a loyal staff team who are very keen to provide high quality care for the residents living at the home, many of whom have long service some staff had worked at the home since it first opened eighteen years ago. Staff said that they felt proud that they worked at the home, and enjoyed helping the residents in whatever way they could. Staff spoke very highly of the registered manager and of the philosophy and values of care that is promoted by the registered manager and the company. Pre assessments are completed prior to residents moving into the home and the residents and their representatives and staff are jointly involved in putting together the residents care plans. Each residents is offered a trial period of one month to assess whether the home is able to meet the identified needs. The residents living at the home are treated with respect and their rights to privacy, dignity and choice are upheld. There is an activity co-ordinator employed at the home, and a monthly newsletter is published at the home, announcing any events taking place, such as bingo, quizzes and visiting entertainers. There is a shop where residents can purchase toiletries and confectionary. The home has good links with the local community recently around 240 children from a local school visited the home, to conduct an Easter Bonnet Parade for the residents. Residents are encouraged and supported in maintaining their independence.
DS0000060165.V291029.R01.S.doc Version 5.1 Page 6 The routines at the home are flexible residents are supported in following their own interests. Residents were observed making choices about how they filled their day; such as, reading, helping in the small kitchens making tea, watching television, knitting, completing word puzzles, whilst others preferred to spend their time in the ‘street’ area of the home, having coffee and socialising with their friends. The home provides a four-week menu, with two alternative choices of the main meal. Breakfast and tea are lighter meals. The catering staff are knowledgeable of the dietary needs of the residents, and special diets can be catered for. The kitchen area is well maintained, clean and tidy and systems are in place to ensure that high food safety standards are applied. The Registered Manager is a well respected by residents, staff and visitors; and operates an open door policy it was evident through discussion and review of documentation that she is very skilled and competent to manage the home. Residents said that the manager and the staff are very approachable and said that if they were dissatisfied or had any concerns about the care at the home, that they would not hesitate to speak directly with the registered manager or any of the staff. The records held by the home and by the Commission of Social Care Inspection confirmed that no complaints had been received, since the last inspection. The home has a strong commitment to staff training. The environment is homely and maintained to an acceptable standard. Facilities are available for residents who are able to make drinks on the units, and staff and residents were seen preparing mid morning drinks in the individual units. The ‘street’ area, provides a good-sized comfortable communal space where residents can meet each other for coffee, visit the hairdresser or purchase items from the shop. There is variety of portable hoists, and moving and handling equipment in use throughout the home. The garden is well maintained and pleasant to include a raised fishpond and outdoor seating. What has improved since the last inspection?
DS0000060165.V291029.R01.S.doc Version 5.1 Page 7 Staff have been employed to prepare the evening meals, which has provided the care staff with more time to spend with residents. Work has taken place on the care plans to improve the information contained within them. 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. DS0000060165.V291029.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000060165.V291029.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this area is good. This judgement has been made using available evidence including a visit to the service. The assessment of prospective residents prior to their admission to the home ensures that residents and their families can be confident that the home can meet their needs. EVIDENCE: There was evidence in the residents care plans that pre assessments had been made prior to their admission, and that the prospective residents had been involved in putting together the care plans. Prospective residents are encouraged to visit the home prior to moving in, one prospective resident was visiting on the day of inspection and staff were observed being supportive and sensitive to their feelings. DS0000060165.V291029.R01.S.doc Version 5.1 Page 10 An emergency admission took place on the day of inspection and the registered manager had ensured that all the necessary information was available for the home to fully care for the residents needs. Each admission is followed by a trial period to assess whether the home is able to meet the identified needs. DS0000060165.V291029.R01.S.doc Version 5.1 Page 11 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): 7,8,9 & 10 Quality in this area is good. This judgement has been made using available evidence including a visit to the service. The assessment and care planning systems in place identify the health and personal care needs of the residents. EVIDENCE: Care plans contained the practical personal care needs of residents but were not detailed on how the home was to meet the social and emotional support required for those who have mental health and dementia care needs. Some residents are supported in going out unescorted into the local community, however no risk assessment or care plan had been put into place, in support of this activity. Residents have access to their own General Practitioner; residents spoken to said that if they were ill they were confident that they would be seen by the doctor, this was demonstrated through the records of visits by the General Practitioner within the individual care plans.
DS0000060165.V291029.R01.S.doc Version 5.1 Page 12 Systems are in place for staff to report any changes in the resident’s condition that requires healthcare support such as the District Nurse or Community Psychiatric Nurse. The care plan of one of the residents case tracked contained information on past hobbies and interests, which was verified during discussion with the resident. Care plans outlined the night care support required, however one resident who was case tracked had entries within the daily notes that indicated changes in their sleep pattern and emerging night care management issues which had not been addressed in the care plan or assessment documentation. Staff have worked hard to adapt to a new medication administration system that has been set up in the home, however on checking the storage and administration records of the controlled drugs held in the home a discrepancy was found within the recording of medication received by the home. The balance for one of the controlled drugs in use was record in the controlled drugs register as twelve tablets in stock when there were actually forty tablets in stock. There were controlled drugs held within the controlled drugs cupboard that were no longer in use. Each flat had a safe secure medication storage facilities, and the recording and administration records were all in good order. Team leaders and the registered manager are responsible for the administration of medication and all have received appropriate training. Systems are in place for recording the handing over of medication keys from one team leader to the other. The registered manager conducts spot checks on the medication systems as part of the organisations quality assurance systems. From discussion with the registered manager and staff, and residents it was clear that the residents living at the home are treated with respect and their rights to privacy, dignity and choice are upheld. Residents said that staff always knock an their bedroom doors and at the front door of their flat before entering. DS0000060165.V291029.R01.S.doc Version 5.1 Page 13 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): 12,13,14 & 15 Quality in this area is good. This judgement has been made using available evidence including a visit to the service. The residents live in a home that matches their lifestyles, expectations and preferences. EVIDENCE: There is an activity co-ordinator employed at the home, and a monthly newsletter is published at the home, announcing any events taking place, such as bingo, quizzes and visiting entertainers. There is a shop where residents can purchase toiletries and confectionary, the activity co-ordinator takes responsibility for replenishing the stocks. Each of the flats has small kitchenette facilities available should residents wish to be involved in continuing daily life skills such as washing and drying up, and preparation of snacks. A group of residents were asked whether they would like to do some home baking, the residents said that they had no interest in doing such an activity, but would be happy to sample any baking should it take place.
DS0000060165.V291029.R01.S.doc Version 5.1 Page 14 Staff said that they would be happy to help any resident who should like to carry out a baking activity. Residents spoke fondly of a recent visit to the home from a local school when approximately 240 children conducted Easter Bonnet Parade. Residents said that there has been some changes to the afternoon staffing arrangements with the aim of releasing the care staff from the task of preparing the evening meal, the residents spoken with said that they would welcome the staff to sit and spend time with them, residents said that if they needed any help in any way all they would have to do was use the call alarm and they would be confident that staff would respond. Residents said that they were happy with the routine at the home and felt able to follow their own interests when they wished. Residents were observed to be making choices about how they filled their day; such as reading, watching television, helping in the kitchenettes making tea, whilst others preferred to spend their time in the ‘street’ area of the home, having coffee and socialising with their friends. Most of the residents were positive in their comments about the food, the home provides a four-week menu, with two alternative choices of the main meal. Breakfast and tea are lighter meals and again choices are available. The menu for lunch on the day of the inspection, was Lamb with mint sauce, potatoes and fresh vegetables, followed by rhubarb and custard, fresh fruit was readily available. There was a cook and a kitchen assistant on duty, who where knowledgeable of the dietary needs of the residents, and could offer a range of special diets. The kitchen was clean and tidy and systems were in place to ensure that high food safety standards are applied. DS0000060165.V291029.R01.S.doc Version 5.1 Page 15 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 & 18 Quality in this area is good. This judgement has been made using available evidence including a visit to the service. Residents can be confident that any concerns or complaints they may have will be listened to, taken seriously or acted upon. EVIDENCE: A complaints procedure is available, and includes the timescales of when the home will respond in writing to any complaints. The registered manager operates an open door policy, residents said that they would not hesitate to speak directly with the registered manager or any of the staff should they have any concerns. Staff said that the registered manager is always willing to listen and act upon any concerns they may have and are confident that confidentiality would be respected. The records held by the home and by the Commission of Social Care Inspection confirmed that no complaints had been received, since the last inspection. There were several cards available to view complimenting the staff on the care provided at the home from families of past residents.
DS0000060165.V291029.R01.S.doc Version 5.1 Page 16 On the day of inspection a staff training session was to take place on the Protection of Vulnerable Adults, the registered manager said that all staff were to undertake this training. DS0000060165.V291029.R01.S.doc Version 5.1 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25 & 26 Quality in this area is adequate. This judgement has been made using available evidence including a visit to the service. The environment is homely and maintained to an acceptable standard. EVIDENCE: Within the home the furnishings and décor are beginning to look worn, the Company plan to commence total refurbishments throughout the home that are due to begin in May 2006. The home is divided into six separate units each having seven flats/ bedrooms and a communal lounge and kitchen area. Facilities are available for those who are able to make drinks on the units, and staff and residents were seen preparing mid morning drinks in the individual units.
DS0000060165.V291029.R01.S.doc Version 5.1 Page 18 There is a no smoking policy for staff however smoking is permitted for residents within a designated area on the ground floor; although separate this area permeates smoke into the nearby non-smoking communal areas. The registered manager said that as part of the refurbishment programme the intention is to have an extractor fitted within the smoking lounge. Residents said that they were satisfied with the standard of their rooms, and resident’s rooms visited during a limited tour of the building were pleasantly decorated and contained the resident’s personal possessions. The ‘street’ area, provides a good-sized comfortable communal space where residents can meet each other for coffee, visit the hairdresser or purchase items from the shop. The bathrooms and lavatories were clean and plans are in hand to install specialist-bathing equipment, suitable to the needs of the residents as part of the refurbishment programme. There is variety of portable hoists, and moving and handling equipment in use throughout the home. The garden is well maintained and pleasant to include a raised fishpond and outdoor seating. The home is clean pleasant and hygienic. DS0000060165.V291029.R01.S.doc Version 5.1 Page 19 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): 27,28,29 & 30 Quality in this area is excellent. This judgement has been made using available evidence including a visit to the service. There is a loyal and motivated staff team who are very keen to provide high quality care for the residents living at the home. EVIDENCE: Many of the staff spoken with had worked at the home for many years some had been at the home since opening eighteen years ago. Staff spoke very highly of the registered manager and of the philosophy and values of care that is promoted by the registered manager and the company. Staff said that they enjoyed coming to work and said that they felt proud that they worked at the home, helping the residents in whatever way they could. The staffing levels on the day of inspection were sufficient to care for the number of residents within the home, however staff were not seen to be sitting beside, socialising with the residents, within the dementia care unit. This was discussed with the registered manager who said that a two-day dementia care training course is planned to take place, with the aim to develop the staff’s interpersonal skills in communicating with people living with dementia. DS0000060165.V291029.R01.S.doc Version 5.1 Page 20 However staff was observed, to provide excellent emotional support to a prospective resident, who was anxious about their admission into the home. Observations were made of staff responding to resident’s practical needs and engaging appropriately with residents who seemed comfortable and relaxed in their company. 2 staffs files were looked at and both demonstrated that thorough recruitment process are in place, with appropriate references and Criminal Records Bureau clearances being obtained before appointment. In discussions with the Registered Manager, it was clear the home maintains a good supervision system, and that training is targeted and specific to individual staffs development needs. DS0000060165.V291029.R01.S.doc Version 5.1 Page 21 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): 31,33,35 & 38 Quality in this area is excellent. This judgement has been made using available evidence including a visit to the service. Residents live in a home where the values of person centred care are promoted and encouraged. EVIDENCE: The Registered Manager is a well respected by residents, staff and visitors; it was evident through discussion and review of documentation that she is very skilled and competent to manage the home. The home has undergone a extensive period of change and uncertainty, through a change of ownership; nevertheless staff interviewed stated they feel there is an open and inclusive atmosphere within the home, and that they feel supported and able to make suggestions openly.
DS0000060165.V291029.R01.S.doc Version 5.1 Page 22 During the inspection the Registered Manager was observed communicating and interacting with residents and staff and visitors in a relaxed and professional way. There are a number of quality assurance systems in place in the home. These include management checks, and audits, supervision for staff, staff meetings, and questionnaires. It is the Home’s policy only to look after small amounts of spending money. Where such assistance is requested all transactions and receipts were recorded Records of recent staff training fire drills did not contain the staff signatures to verify that they had participated in the fire drill. The registered manager said that staff would sign that they had taken part in the drill; the home had recently had an inspection from the fire authority that was satisfactory. The home has a health and safety representative, who meets with other health and safety colleagues within the company and conducts audits of the health and safety systems in the home. Accident reports were seen to be completed and appropriate action taken. DS0000060165.V291029.R01.S.doc Version 5.1 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 DS0000060165.V291029.R01.S.doc Version 5.1 Page 24 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 OP9 Regulation 13 (2) Requirement Records must be kept of all controlled drugs received and administered within the controlled drugs register. Controlled drugs that have been discontinued must be returned back to the pharmacy and their disposal recorded within the controlled drugs register. Timescale for action 05/05/06 2 OP9 13 (2) 05/05/06 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 OP38 OP8 Good Practice Recommendations Risk assessments should be in place identifying any significant risks to resident’s safety whilst unsupervised out in the community. The social and emotional support for residents who have mental health and dementia care needs should be recorded in more detail within the care plans. DS0000060165.V291029.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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