Inspection on 18/04/05 for Beech Court

This inspection was carried out on 18th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Beech Court 25/09/08

Beech Court 05/06/07

Beech Court 16/06/06

Beech Court 22/09/05

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Beech Court 52 Church Lane Selston Nottinghamshire NG16 6EW Lead Inspector Jayne Hilton Unannounced 18 April 2005 10:00 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 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. Beech Court C53 C03 S62132 Beech Court V222202 180405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Beech Court Address 52 Church Lane Selston Nottinghamshire NG16 6EW 01623 752 512 01773581445 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Alan Peter Pearce Mr Alan Peter Pearce Care Home 23 Category(ies) of OP Old age, x 23 registration, with number DE (E) Dementia over 65, x 23 of places Beech Court C53 C03 S62132 Beech Court V222202 180405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: The Provider/Manager must undertake training in adult protection procedures as soon as possible Date of last inspection 26/7/04 Brief Description of the Service: Beech Court, 52 Church Lane Selston, Nottinghamshire is a 23 bedded, care home offering personal care for older people with dementia. The building is a converted rectory with a purpose built extension and is on two floors. There is a passenger lift to the first floor. The home has an easy accessed garden and is located in a quiet corner of the village opposite the church. The home was sold in September 2004 and now has new proprietors. The new providers have been re-furbishing parts of the home and has implemented many changes. The change process has presented the providers with many challenges amongst a busy time. Beech Court C53 C03 S62132 Beech Court V222202 180405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out over three visits 0n 18/3/05, 8/4/05 and a full inspection on 18/4/05. The two previous visits were made as part of work undertaken for HM Coroner and the inspection report includes findings from all three visits. The total number of hours taken for the inspections and reading documents is twenty five hours. Report writing time is not included in this number. A tour of the premises was undertaken. In total five service users care plans were examined and several samples of other records kept in the home, were inspected. Both providers, one of which is the registered manager, the care manager and four other staff were spoken with. Four service users were spoken with and one relative. The district nurse also contributed feedback, which has been included in the report. What the service does well: The provision of stimulation and activities in the home, particularly for those service users with dementia is extremely good and service users were relaxed and happy. The provider ensures that staffing levels are maintained to ensure service users needs are met. Training provision is viewed as a priority to enable staff to acquire and develop the skills needed for the current client group and is appropriate for the dependency levels of service users. The provider has refurbished several areas of the home and is planning much more with the aim of improving the appearance and safety of the environment for service users including the outdoor space and gardens. There are some minor repairs to be addressed that may be resolved through further refurbishment. Service users have comfortable, safe and clean bedrooms. Service users stated that they were well looked after, that staff were respectful. All service users spoken with reported that they were happy with the care provided and service users were observed to be relaxed and comfortable throughout the inspection. One service user commented “everything is fine thank you, I’m quite satisfied”. Beech Court C53 C03 S62132 Beech Court V222202 180405 Stage 4.doc Version 1.30 Page 6 A district nurse reported that staff followed instructions left by the district nurse and commented that staff were attentive and that care provided at the home is very good. Observations made of staff, the providers and care manager interacting with service users provided evidence of mutual respect and kindness. Service users were noted to wander into the office and not excluded in any way. The providers are keen to provide a good service and speak fondly of service users. What has improved since the last inspection? The quality of the food provision has been improved by the current provider and service users clearly recognise this. Staff reported that the new owners are keen to provide good food and have insisted on the purchase of brand named items, which were observed in the storerooms in ample supply. Selected various meat joints are provided for Sunday Lunch rather than just chicken. The providers are well respected by service users and staff and are keen to provide a good service and a well managed home. Staff working conditions are clearly improved and appreciated by them. Staff members are appropriately supervised and provide a good level of health and safety standards in the home for the benefit of service users. The Providers have many years experience in care provision and state that they have cared for service users with dementia type illness in their other care home, however Beech Court is more specialised provision and the provider is developing staff to meet the varied needs of the service users. Staff members have undertaken training in dementia care and activities for people with dementia, which they are clearly putting into day to day practice. Staff stated that the providers are very caring and service user focused people who are making the home a nicer place for service users to live and have provided better conditions for staff to work in which promotes staff morale and helps with the provision of a better atmosphere for service users. Service users were observed to move freely around the home and the care manager stated that service users could now access their rooms in the daytime, which was not usual practice previously. Rooms were observed to be personalised and contain service users own personal possessions that had been brought with them to the home. Service users confirmed they went to bed when they chose to. Beech Court C53 C03 S62132 Beech Court V222202 180405 Stage 4.doc Version 1.30 Page 7 Information on advocacy is available and there was a notice on the notice board informing visitors that service users will be asked if they wish to receive visitors and if not this will be respected. The provider is keen to ensure that the staff team are provided with good and appropriate training, staff reported that training provision was much improved. What they could do better: The providers are not currently providing clear information materials of what the home offers and this must be rectified to establish the foundation for setting out its aims and objectives, range of facilities and for fully informing prospective service users/representatives to enable choice about whether the home is suitable and able to meet the individual’s particular needs. Despite the intention to improve the care planning format the provider/manager had not prioritised the implementation of specific care plans to direct staff of how they would meet service users needs. This has resulted in the home failing to provide evidence that service users health care needs and personal needs are being fully addressed and met. Particular shortfalls were found in healthcare evaluation and monitoring, risk assessments, nutritional screening, bowel care, medication management, weight records, behaviour management, mental health and specific identified healthcare needs. Although the provider has made an attempt to protect service users, the staff and management have not followed the homes own policies and procedures, the regulatory requirement for reporting incidents to the CSCI or followed local adult protection protocols. The inspector advised that there was an obvious lack of visual cues for service users with dementia and suggested that the care manager look at implementing pictures and symbols throughout the home. Recruitment procedures require some improvement to ensure that all of the regulatory, required documentation is obtained prior to the employment of staff. Beech Court C53 C03 S62132 Beech Court V222202 180405 Stage 4.doc Version 1.30 Page 8 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. Beech Court C53 C03 S62132 Beech Court V222202 180405 Stage 4.doc Version 1.30 Page 9 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 Standards Statutory Requirements Identified During the Inspection Beech Court C53 C03 S62132 Beech Court V222202 180405 Stage 4.doc Version 1.30 Page 10 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 standard(s) 1,2,3,4 The providers are not currently providing clear information materials of what the home offers and this must be rectified to establish the foundation for setting out its aims and objectives, range of facilities and for fully informing prospective service users/representatives to enable choice about whether the home is suitable and able to meet the individual’s particular needs. EVIDENCE: The statement of purpose and service user guide inspected in the home was inspected and found to have shortfalls, although produced and submitted to CSCI for the new registration, the copy in the home on the day of the inspection, was not sufficient to meet the regulations and NMS. The manager was advised to revisit the documents and provide copies of the service user guide to prospective and existing service users. The provider /manager confirmed service users have not yet been issued with this information. It is recommended that as part of this review the statement of purpose and service user guide makes clear how the needs of people with dementia will be provided for i.e. structured activities, decor and signage helpful to people with dementia. Beech Court C53 C03 S62132 Beech Court V222202 180405 Stage 4.doc Version 1.30 Page 11 The terms and conditions document has been prepared but has not been used as yet. The document examined was comprehensive. All service users should be issued with the terms and conditions and a copy held on their individual file. It was observed during the inspection that a change of rooms was planned and a relative consulted regarding this. The inspector advised that the involvement of the relative and service user in the decision of the room change should be documented and once terms and conditions have been issued further room changes should induce issue of new terms and conditions for the relevant room number. The provider/manager has introduced a new care plan format and has been in the process of transferring existing service users information into the new format. One service user’s file examined had relevant assessment detail, however the care plans from the previous provider had been archived and not re-written into the new structure. There was evidence that although the service users needs had changed that care plans had not been implemented. The provider had not used assessment tools for nutrition, tissue viability, however these are now being introduced within the care package. A newly admitted service users assessment was completed well and covered the required needs as specified in Standard 3.3 of NMS. The service users social needs, likes and preferences were also well covered. The assessment however was not dated when completed, neither was it endorsed by the service user or representative. There was no evidence on service users files that the provider /manager had provided written confirmation to the service user that they could meet their needs. The assessment was reviewed but the present format does not allow for comment if service users needs change and this is recommended. The provider/manager reported that prospective service users are visited in their existing environment by himself or the care manager/or both. All service users spoken with reported that they were happy with the care provided and service users were observed to be relaxed and comfortable throughout the inspection. One service user commented, “everything is fine thank you, I’m quite satisfied”. A relative commented that staff were very kind but there had been occasions where new staff had not observed such things as service users, removing continence pads, dressings needing changing and when a sore had become infected and that this indicated a lack of observation and monitoring skills, which were very much needed when caring for people with dementia. The Providers have many years experience in care provision and state that they have cared for service users with dementia type illness in their other care home, however Beech Court is more specialised provision and the provider is developing staff to meet the varied needs of the service users. Staff members have undertaken training in dementia care and activities for people with dementia. The inspector advised that there was an obvious lack of visual cues for service users with dementia and suggested that the care manager look at implementing pictures and symbols throughout the home. Beech Court C53 C03 S62132 Beech Court V222202 180405 Stage 4.doc Version 1.30 Page 12 Beech Court C53 C03 S62132 Beech Court V222202 180405 Stage 4.doc Version 1.30 Page 13 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 standard(s) 7.8,9,10,11 Despite the intention to improve the care planning format the provider/manager had not prioritised the implementation of specific care plans to direct staff of how they would meet service users needs. This has resulted in the home failing to provide evidence that service users health care needs and personal needs are being fully addressed and met. Particular shortfalls were found in healthcare evaluation and monitoring, risk assessments, nutritional screening, bowel care, medication management, weight records, behaviour management, mental health and specific identified healthcare needs. Service users are treated with respect and their privacy upheld. The policies for dealing with service users who are dying examined in the home require consolidation and are clearly not being followed by the management and staff. EVIDENCE: As already stated, the care plans for existing service users were not continued shortly after the new provider took over the home which left serious gaps in meeting service users needs. Brief, daily record notes were kept, however Beech Court C53 C03 S62132 Beech Court V222202 180405 Stage 4.doc Version 1.30 Page 14 staff were not provided with clear direction as to how to meet the needs of service users, in the form of identified risks and care planning. The process of transferring the information to the new structure has been time consuming, however interim care plans should have been either continued or implemented. One service users needs changed dramatically and although was referred appropriately to the GP and District nurse services, the documentation did not identify how the care was being delivered. As there were no specific care plans implemented from the needs assessment, the care was therefore not appropriately evaluated or reviewed. On all files examined there were failures in identified needs and risks being addressed in specific care plans. Service users spoken with were not aware of their care plans. There were no signed agreements within care plans. From inspecting all notes in relation to service users health care needs, despite poor documentation in relation to specific care plans and risk assessments, there were good records kept regarding outside professional input such as GP and district nurse visits, however some GP visits were not followed up or cross referenced to the daily reports or care plans implemented. A district nurse reported that staff followed instructions left by the district nurse and commented that staff were attentive and that care provided at the home is very good. Observations made of staff, the providers and care manager interacting with service users provided evidence of mutual respect and kindness. Service users were noted to wander into the office and not excluded in any way. The providers are keen to provide a good service and speak fondly of service users. Nutritional assessments and tissue viability tools, which were absent initially, are now being introduced. Service users mental health needs and any challenging behaviour appears to be identified, however not all had been implemented into specific care plans to monitor and evaluate service users well being. One service user who had poor nutritional intake had no care plan or risk assessment implemented, neither had detailed monitoring of nutritional intake been initiated in the form of daily notes or in a care/intake chart. Nutritional supplements had been prescribed, however this had not been recorded on either a medication record or in the care documentation as offered or taken. There was no evidence of bowel health monitoring and an absence of weight records. There was evidence in other service users personal records that nutritional needs of service users were not being appropriately documented and monitored. There was evidence of a lack of cross - referencing of accident records and daily notes and no indication in some notes of service users having the accident which had been recorded on the accident form. It is recommended that where service user sustain injury to the face or head that medical opinion should be sought in the form of NHS direct GP visit or accident and emergency evaluation and that any advice given is fully documented. Copies of accident records are kept in personal files. 9 incidents of falls were recorded since October 2004. It is recommended that more detail be kept regarding time of fall and treatment sought etc for quality monitoring purpose etc. Beech Court C53 C03 S62132 Beech Court V222202 180405 Stage 4.doc Version 1.30 Page 15 A service user commented,“ we are looked after very well” The providers have recently installed a new medication system, which was examined. Policies and procedures for medicines management are in place although these need to be further developed in line with the Royal Pharmaceutical Societies Guidance for Medicine Administration in Care Homes. The home is registered with a local pharmacy and a blister pack system is in use. There were some concerns noted, including regarding the duplication of the medication record sheets and that staff are signing the record as instructed when potting up medication and not after visibly observing the medication being taken, which must be rectified. Not all received medication had been signed in and there was concern that a service user’s, prescribed medication from hospital discharge, had not been fully documented as received. There was no record that the GP had been informed regarding a service users continual refusal to take medication and no care plan regarding this identified risk. The British National Formulary needs replacing with an up to date version of less than twelve months old. The temperature of the medication storage room must be taken. The care manager reported that there are, no service users currently able to self medicate. There was no indication on service users files to support this. The CSCI pharmacist inspector has been consulted and will make a visit to the home in the near future to assess the new system and advise on good practice. Staff members were, also booked on a medicines management course. Service users spoken with confirmed that staff were, respectful and polite. Staff were observed respecting service users privacy and knocked before entering their rooms. This standard was not fully inspected. There are policies and procedures in place for dealing with dying and death, however these were duplicated and need consolidating into one policy. The homes policy for Physical Care of the dying which states care charts will be implemented to record nutritional intake, turns, oral care etc. There was evidence that management and staff had not followed this policy. Service users files did not contain the wishes of individuals at the end of life. Although spiritual needs are covered within the assessment documentation. A relative had brought in a thank you card for a deceased relative and reported that overall she was happy with the care offered. Arrangements were made for staff to attend the funeral. There was no indication that any service users would be attending. Beech Court C53 C03 S62132 Beech Court V222202 180405 Stage 4.doc Version 1.30 Page 16 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 standard(s) 12, 14, 15 The provision of stimulation and activities in the home, particularly for those service users with dementia is extremely good. The quality of the food provision has been improved by the current provider and service users clearly recognise this. EVIDENCE: Service users and staff reported that the provision of activities at the home has greatly improved. A craft session was observed during the inspection, which service users were happy participating. Staff, have recently undertaken training on activities provision for people with dementia and had found this beneficial and clearly staff were being innovative regarding the range of activities now being provided. A service user confirmed that there was something different to do everyday and told the inspector he had been for a walk to the park the day before with a member of staff, plays football, dominoes and bingo and enjoyed creating a picture. Staff endorsed that activities take place every afternoon. Service users choice of whether to participate is respected and this is documented in a social activities record. This needs to be transferred to the individuals care plan records. Beech Court C53 C03 S62132 Beech Court V222202 180405 Stage 4.doc Version 1.30 Page 17 Service users were observed to move freely around the home and the care manager stated that service users could now access their rooms in the daytime, which was not usual practice previously. Rooms were observed to be personalised and contain service users own personal possessions that had been brought with them to the home. Service users confirmed they went to bed when they chose to. Information on advocacy is available and there was a notice on the notice board informing visitors that service users will be asked if they wish to receive visitors and if not this will be respected. The menu was set over a four- week cycle but had been changed on the day of the inspection. There was only choice of main meal on the menu. Service users clearly stated that they do not have a choice of meals and they eat what is put in front of them. One service user stated that although he has no choice he likes most things and if not he would tell staff and they would bring him something else, another stated that the food is good and has improved in quality since the new owners took over, there is plenty to eat, plenty of drinks and has a jug of water in the bedroom, another stated there is no choice but the food is very nice, has no jug of water in the bedroom and didn’t think a drink was offered on rising and had to wait until breakfast. The service user thought that staff might bring a drink in the night if requested. There was no records of where service users had actively chosen alternatives and where service users were noted to have poor nutritional intake in daily notes only brief statements were recorded, i.e. ‘ate and drank quite well’, ‘eating and drinking better’, ‘ate small amount of dinner, ’started to eat and drink a little’, ‘didn’t eat much’. Which are not satisfactory and are open to interpretation. Actual detailed amounts should be documented. Where service users refuse meals other options must be offered and this must be documented. Encouragement should be promoted for poor nutritional intake by looking at what the service users likes and preferences are and what they may fancy and by introducing supplements as prescribed by the GP and documenting when this is taken or not taken amounts etc. Service users must be given opportunity to exercise their choice in relation to food meals and mealtimes. Care should be taken to document fully where service users have problems with dentures. Staff reported that the new owners are keen to provide good food and have insisted on the purchase of brand named items, which were observed in the storerooms in ample supply. Selected various meat joints are provided for Sunday Lunch rather than just chicken. The menu should be developed with service user preferences and offer at least two options which service users can be offered and make an informed choice, which must be recorded. Two staff members were, observed to be assisting service users with eating in a standing position rather than sitting with service users. Service users were observed to be relaxed and happy. Service users are helped to make choices Beech Court C53 C03 S62132 Beech Court V222202 180405 Stage 4.doc Version 1.30 Page 18 and take control over most aspects of their lives apart from meal options, which is a basic fundamental right and is outstanding from the previous inspection requirements. Beech Court C53 C03 S62132 Beech Court V222202 180405 Stage 4.doc Version 1.30 Page 19 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 standard(s) 16, 18 The complaints procedure needs reviewing to meet the standard and citing in a more prominent position. Despite service users and relatives not being given copies in the service user guide, they were clear about making a complaint should they need to. Although the provider has made an attempt to protect service users, the staff and management have not followed the homes own policies and procedures, the regulatory requirement for reporting incidents to the CSCI or followed local adult protection protocols. Several policies and procedures require further development. EVIDENCE: The complaints procedure was displayed although would be better viewed if cited close to the visitor’s book. Unfortunately it does not meet the standard, as it does not state all complaints will be responded to within 28 days. There were no recorded complaints since the new Providers took over the home. Service users and relatives all confirmed they would make a complaint through staff if they were unhappy about anything. 9 staff has attended training in adult protection since January 2005. A policy for adult protection and whistle-blowing is in place and needs further development as it is brief. There had been a disclosure made by a service user that had not been followed up or reported as required under the Vulnerable Adults procedures, neither had the incident been reported to CSCI under regulation 37. Another incident regarding a service user attacking another Beech Court C53 C03 S62132 Beech Court V222202 180405 Stage 4.doc Version 1.30 Page 20 service user was also not reported appropriately despite the homes policy instructing this be done. Three service users reported that they felt safe in the home. There is a policy for restraint, this needs to be expanded to include use of bedrails, lap belts etc. The confidentiality policy needs to address when information must be passed on/reported and that the service user or other individual making a disclosure is informed of this. The policy for staff benefiting from wills or accepting gifts should inform staff that this is not acceptable practice rather than just recommend they do not accept gifts etc. Beech Court C53 C03 S62132 Beech Court V222202 180405 Stage 4.doc Version 1.30 Page 21 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 standard(s) 19, 20, 21, 22, 24, 25, 26 The provider has refurbished several areas of the home and is planning much more with the aim of improving the appearance and safety of the environment for service users including the outdoor space and gardens. Service users have comfortable, safe and clean bedrooms. EVIDENCE: The new provider has commenced a programme of refurbishment of the home and is keen to improve the standard of accommodation and facilities of the home. New chairs and carpets have already been purchased to improve the comfort and appearance of the home for service users. The small lounge has been fully refurbished and creates a homely and quiet sitting area, which overlooks extensive gardens. The owner reported there are plans to change the dining room and lounge areas to create an activity area and improved layout of smaller group seating. There was missing window restrictors on the Beech Court C53 C03 S62132 Beech Court V222202 180405 Stage 4.doc Version 1.30 Page 22 small lounge window, which may have been removed in the recent refurbishment and not replaced. The garden area is pleasant and spacious and this is to be made more accessible for service users and extended to provide safe and secure outdoor space for service users who wish to spend time in the garden. The grass was ready for cutting. The provider reported that the kitchen is to be re-furbished in the near future and the owner has planned this with care to ensure minimum disruption to the service users. Sluicing facilities, toilets and bathing facilities are sufficient. One bathroom is not being used for bathing and equipment is being stored in the room. It is recommended that this be closed off for safety reasons. Handrails and call alarms are sited around the home and there is assisted bathing for those that may require this. Call alarms in bathrooms must be in reach of the service user and staff member and not tied up out of reach as observed on the day of the inspection. The bath on the ground floor has a patch of missing enamel caused by the bath hoist and this should be addressed. Service users bedrooms examined were clean, personalised and equipped to meet service users needs. One service user did not have a lockable facility and a service user stated he did not have a key to his lockable facility. Staff personal files did not address whether service users have been offered keys to their rooms or whether risk assessed as not able. The water system has been problematic for the new owner, which is being assessed currently by plumbing contractors. Temperature of water outlets is not consistent and records of these temperatures must be kept with any action taken. The temperature of the home was warm and lighting sufficient and domestic in type. The home was found to be clean and free from mal odour. The laundry facilities are sited appropriately but should have an approved safety lock, rather than a bolt on the outside. The staff toilet door should also have the bolt removed and be replaced with an appropriate safety lock or keypad Beech Court C53 C03 S62132 Beech Court V222202 180405 Stage 4.doc Version 1.30 Page 23 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30 The provider ensures that staffing levels are maintained to ensure service users needs are met. Training provision is viewed as a priority to enable staff to acquire and develop the skills needed for the current client group and is appropriate for the dependency levels of service users. Recruitment procedures require some improvement to ensure that all of the regulatory documentation is obtained prior to the employment of staff. EVIDENCE: Staff rotas were briefly examined and three care staff, are rostered on each shift. The provider manager and care manager work in addition to this usually and cover shifts where needed to maintain safe staffing levels. Domestic staff and a handyman are also provided. A cook works 5 days and care staff, cover the other days. The provider has reviewed the shift patterns and staff reported that they no longer work several days without days off and that terms and conditions are much improved. Learning Direct are involved in the home regarding NVQ training and induction to meet skills for life standards. There have been some previous problems with the local college in accessing training for staff. A sample of staff files was examined and although most were completed satisfactory there was one file that was outstanding of completion from the previous inspection. Two other staff members, files were absent of two references. Beech Court C53 C03 S62132 Beech Court V222202 180405 Stage 4.doc Version 1.30 Page 24 The provider is keen to ensure that the staff team are provided with good and appropriate training, staff reported that training provision was much improved. Evidence was seen of training for food hygiene, adult protection, continence management, manual handling, dementia care, activities for people with dementia, care planning and evidence that medicines management training is booked. Beech Court C53 C03 S62132 Beech Court V222202 180405 Stage 4.doc Version 1.30 Page 25 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 34, 35, 36, 37, 38 The providers are well respected by service users and staff and are keen to provide a good service and a well managed home. Staff working conditions are clearly improved and appreciated by them. Staff members are appropriately supervised and provide a good level of health and safety standards in the home. General records are maintained to a satisfactory level but the care records need much improvement. There are minor areas to address in relation to financial procedures and accident recording and completion of the health and safety poster. The health and safety of service users is overall safe-guarded, however the fire risk assessment process needs to address the need to prop the fire doors open. EVIDENCE: Beech Court C53 C03 S62132 Beech Court V222202 180405 Stage 4.doc Version 1.30 Page 26 The registered manager is also the registered provider who has many years experience in the caring profession and in running and managing a care home. The manager must provide evidence of attending adult protection training to remove the condition of registration. Staff stated that the providers are very caring and service user focused people who are making the home a nicer place for service users to live and have provided better conditions for staff to work in which promotes staff morale and helps with the provision of a better atmosphere for service users. Evidence was seen to support that staff meetings are held, and staff members are appropriately supervised. A sample of service users financial records was examined and found to be satisfactory apart from not always having two signatures for transactions. It is recommended that procedures for safeguarding staff and service users are amended to include a checking system for when staff do any shopping for service users. Insurance certificates were examined and found to be satisfactory. The provider had produced a business plan for the purchase and transfer of registration of the home. A sample of records were examined, as discussed within the report, but also including fire safety records, Portable appliance testing records, lift and equipment servicing, all were satisfactory. Service users personal information was stored securely. Service users care records require much improvement in their detail. Observations made at the inspection was that staff practices were appropriate of health and safety policies, staff were observed to wear protective clothing for attending to service users personal care and when serving food. Health and safety policies were in place, however a health and safety poster was observed to be, not completed. The provision of training is good and the maintenance of equipment seen to be satisfactory. The environmental Health Officer visited recently he left no requirements and one recommendation to defrost the freezer, which had been met. It is recommended that an appropriate health and safety, standard accident book is used to record all accidents. Some fire doors were propped open to assist staff observation and autonomy of service users. The provider must risk assess this practice and seek other safe options such as magnetic door closures which release when the alarm is triggered. Risk assessments and fire risk assessments were not examined due to time constraints. Beech Court C53 C03 S62132 Beech Court V222202 180405 Stage 4.doc Version 1.30 Page 27 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 2 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 2 15 2 COMPLAINTS AND PROTECTION 3 3 3 3 x 2 3 3 STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 3 3 x 3 2 3 2 2 Beech Court C53 C03 S62132 Beech Court V222202 180405 Stage 4.doc Version 1.30 Page 28 yes, St 9, St29 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP1 OP1 Regulation 4 5 Requirement Timescale for action 18/7/05 18/7/05 3. 4. OP2 OP3 5 14, 25 5. 6. OP7 OP7 14, 15 12, 13, 14, 15 12, 13, 14, 15 15 12, 13, 14, 15, 7. OP7 8. 9. OP7 OP8 The Statement of Purpose must be completed as specified in Schedule 1 of the Regulations A Service user Guide must be produced to meet Regulation 5 requirements and to be issued to prospective and existing service users Ensure that terms and conditions are issued to service users on admission Ensure that service users or their representatives are involved in the assessmnet and care planning process and sign to say they agree to what is written Ensure that care plans are implemented for all service users in line with their assessed needs Ensure care plans inform staff of what action needs to be taken to meet the individual needs of service users Ensure that risk assessments are completed and appropriate care plans implemented to minimise risk. Ensure care plans are reviewed appropraitely and regularly Ensure that where service users 17 have poor nutritional intake that 18/7/05 18/6/05 18/6/05 18/6/05 18/6/05 18/6/05 18/6/05 Page 29 Beech Court C53 C03 S62132 Beech Court V222202 180405 Stage 4.doc Version 1.30 10. 11. OP8 OP8 12, 13, 17 12, 13, 14, 15, 17 12. OP9 Medicines Act, 13 13. 14. OP9 OP9 Medicines Act, 13 Medicines Act, 17 Medicines Act, 12, 13 12, 13, 17 15. OP9 16. OP9 17. OP9 Medicines Act, 12, 13, 17 14,25 17 No Secrets, CSA Section 62 No Secrets, CSA Reg 18. 19. 20. OP15 OP15 OP18 21. OP18 detailed monitoring and evaluation is implemented. Ensure that GP visits are appropriately documented and followed up in care notes. Where the service user is prescribed nutritional supplements, appropriate records and monitoring must be in place. Improve the medication management policies as specified in the RPS guidance on medicine management in care homes Ensure all medicines entering the home is appropriaitely recorded as received and balanced. Ensure that medication administration records are completed after medication has been dispensed. Ensure that staff only sign the medication record after visibly observing that the medication has been taken Where service users refuse medication, the GP must be consulted and the events fully documented Ensure that medication is stored at the correct temperature [and records are kept] THIS IS OUTSTANDING FROM THE PREVIOUS INSPECTION Service users must be consulted regarding their choice of meal options A record must be kept of service users dietary intake Ensure that appropriate Adult Protection protocols are followed where service users or staff make disclosures Ensure the incident regarding two service users is reported as required by Vulnerable Adults 18/6/05 18/6/05 18/6/05 18/6/05 18/6/05 18/6/05 18/6/05 18/6/05 18/6/05 18/6/05 18/6/05 18/6/05 Beech Court C53 C03 S62132 Beech Court V222202 180405 Stage 4.doc Version 1.30 Page 30 37 22. OP18 37 23. OP25 12, 13, 16,17 7,9,19 24. OP29 25. OP29 7,9,19 26. OP30 7,18 27. 28. OP37 OP38 17 16, 23 reporting procedures and to CSCI under regulation 37 notification. Ensure that the CSCI is appropriatly notified of incidents and occurance of death as required by regulation 37 Ensure the hot water system problems are resolved and temperatures are taken and documented Ensure that staff files contain all documentation as required by schedule 2 prior to the employment of individuals Ensure that the outstanding information required at the last inspection, pertaining to one staff member is finalised The Registered Manager must provide evidence of attendance at Adult Protection Training regarding the set condition of Registration Ensure that service users records of care are fully completed, detailed and up to date. Ensure that fire safety risk assessments include the issue of propping fire door backs and look at other options such as door guards 18/6/05 18/8/05 18/6/05 18/6/05 18/8/05 18/6/05 18/6/05 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 OP1 OP2 Good Practice Recommendations Include how the needs of service users wilth dementia will be met in the Statement of Purpose ie structured activities etc Document when service users and relatives are consulted regarding room changes and issue a new terms and conditions document for the new room C53 C03 S62132 Beech Court V222202 180405 Stage 4.doc Version 1.30 Page 31 Beech Court 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. OP2 OP3 OP3 OP4 OP4 OP7 OP8 OP8 OP8 OP8 OP8 OP9 OP9 OP11 OP11 OP11 OP15 OP15 OP15 OP15 OP16 OP16 OP18 A copy of the terms and conditions document should be kept with the care plan Ensure dates and signatures are always in place on documentation Ensure service users have written confirmation that the home can meet the service users needs [keep a copy on file] Staff should take on board visitors observations regarding their own monitoring and observations of service users as reported in the main body of the report Provide visual cues around the home for assistance to service users with dementia Ensure that the daily notes report on the holistic needs of service users and include daily events such as accidents and incidents Ensure that nutritional risk assessment tools are used for assessing all service users Weight records should be completed regularly and as part of nutritional and well being monitoring Bowel monitoring should be implemented to ensure of service users health and well being where service users sustain injury to the face or head medical advice should be sought and documented Incidents of falls should be monitored. Update the British National Formulary Include the option for service users to self medicate within the assessment documntation or a risk assessment stating thay are not able. Consolidate the many policies and procedures for dealing with dying and death Ensure staff are familiar with the policies to be followed Ensure service users files contain information for their wishes at the end of life Re-write the menus to include various options of meal types Care staff should be aware when service users have problems with dentures and ensure nutritional intake is sufficient Care staff should encourage nutritional intake by offering different foods,where service users are refusing meals and record what has been offered Staff should be seated when assisting service users to eat Site the complaints procedure with the visitors book Amend the complaints procedure to include a response of 28 days Further develop the adult protection and whistleblowing policies so staff are clear about actions to follow C53 C03 S62132 Beech Court V222202 180405 Stage 4.doc Version 1.30 Page 32 Beech Court 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. OP18 OP18 OP18 OP19 OP19 OP21 OP22 OP22 OP24 OP24 OP35 OP35 OP38 OP38 Expand the ploicy for restraint to include use of bedrails and lap belts etc Expand the policy on confidentiality as stated within the report Review the policy for staff benefiting from wills and gifts as stated in the report Replace the window restrictors in the small lounge Mow the lawn If the unused bathroom is to be used as a store, this should be closed off Call alarms should be in reach of srevice users and staff when placed over bath Attend to the worn enamel patch on the bath Ensure that keys are provided to those who want them unless a risk assessment identifies this is not possible [this should be documented within the care plan] Lockable facilities with keys should be provided for all service users unless care plans justify otherwise Financial procedures should include a checking system when staff carry out shopping on service users behalf Two signatures should be in place for all transactions on srevice users personal allowance records Complete the health and safety poster Use the recommended accident book. Beech Court C53 C03 S62132 Beech Court V222202 180405 Stage 4.doc Version 1.30 Page 33 Commission for Social Care Inspection Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Beech Court C53 C03 S62132 Beech Court V222202 180405 Stage 4.doc Version 1.30 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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