Inspection on 29/09/06 for Beech Court Care Centre

This inspection was carried out on 29th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 Care Centre 02/08/07

Beech Court Care Centre 19/01/06

Beech Court Care Centre 20/06/05

Beech Court Care Centre 14/01/05

Beech Court Care Centre 09/07/04

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

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

CARE HOMES FOR OLDER PEOPLE Beech Court Care Centre 298-304 South Street Romford Essex RM1 2AJ Lead Inspector Ms Gwen Lording Key Unannounced Inspection 29th September 2006 09:00 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 Beech Court Care Centre DS0000015585.V314032.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Beech Court Care Centre DS0000015585.V314032.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beech Court Care Centre Address 298-304 South Street Romford Essex RM1 2AJ 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) 01708 720 123 01708 720 220 Life Style Care Plc Mary Zuwaradoka Care Home 50 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (18), of places Physical disability (12) Beech Court Care Centre DS0000015585.V314032.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th January 2006 Brief Description of the Service: Beech Court Care Centre is a care home with nursing, providing 24 hour nursing care. The home is registered to care for three different service user groups. People who are over the age of 65 and physically frail or who have a diagnosis of dementia and people between 18 - 65 who have physical disabilities. The home is owned by Life Style Care PLC a company, which operates similar homes in London and the Midlands. The home is situated just outside Romford and has good access to local facilities and transport links. The home was purpose built in 1999. It is a three-storey building. The home consists of single bedrooms with en-suite facilities. A large passenger lift services all floors. There is a secure garden for service users with dementia. On the day of the inspection the range of fees for the home was between £520.00 and £900.00 per week. A copy of the Statement of Purpose and service user guide to the home is made available to both the resident and the family. There is a copy of the guide in each bedroom, and copies of both these documents are available at the main reception. Copies of the most recent inspection report are available on request. Beech Court Care Centre DS0000015585.V314032.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced, started at 8.45am and took place over seven hours. The inspection was undertaken by two inspectors. The registered manager was available throughout the visit to aid the inspection process. This was a key inspection visit in the inspection programme for 2006/2007. Discussions took place with the registered manager, several members of nursing and care staff; the head cook; domestic staff and the person in charge of the laundry. Nursing and care staff were asked about the care that residents receive, and were also observed carrying out their duties. The inspectors spoke to a number of residents and relatives. Where possible residents were asked to give their views on the service and their experience of living in the home. A tour of the premises was undertaken, including the laundry and the kitchen. A random sample of residents’ files were case tracked on each floor, together with the examination of other staff and home records, including medication administration and management; staff rotas; training schedules; activity programmes; complaints; accident/ incident records; maintenance records and staff recruitment procedures and files. Information was also taken from a preinspection questionnaire, which was completed and returned by the manager. The inspectors were able to talk to some visiting relatives during the visit, and they expressed satisfaction with the care at Beech Court. Residents on the second floor - Younger People with Disabilities unit, were generally satisfied with their care, bedrooms had been personalised, and residents had a good rapport with both the nursing and care staff. The first floor unit is for service users living with dementia, and due to the illness and mental capacity of the residents it was difficult for the inspectors to have meaningful discussions with those residents spoken to, as to their views of the home and care being received. With regard to the care being provided to service users living with dementia, the inspectors were not satisfied that this was good in relation to their social care needs. Whilst referrals are being made to health care professionals where necessary, basic care is not always being followed and the care plans must be more specific. The social care activities are generally good, but again there must be more focus on enabling residents living with dementia to retain daily living skills. There was very little interaction between service users and staff, and it seems that a television, with the sound turned down, is considered by staff to be an acceptable form of stimulation for people living with dementia. There must be improvements to training for all staff, and senior staff must ensure that such training is implemented. Bedrooms generally were quite bare and did not reflect a person’s cultural or religious needs. Improvements to activities, innovative use of communal spaces, signage and décor and the environment would mean that Beech Court Care Centre DS0000015585.V314032.R01.S.doc Version 5.2 Page 6 the service would be more able to meet the assessed needs of service users living with dementia. The ground floor unit is for older people with nursing needs, and residents spoken to during the inspection were satisfied with the care that they are receiving. Generally the care plans were comprehensive and both nursing and care staff were aware of the needs of service users. Bedrooms had been personalised and suited the needs of the individuals. Generally there were some issues around respecting a person’s dignity, and these were primarily with regard to bedroom doors being left open while residents were still sleeping, and this meant that staff did not always knock on the bedroom door before entering. Also some rooms overlooked public areas and the windows were not fitted with either a net curtain or blind to give some privacy when the main curtains were open. A tour of the whole premises was undertaken and this included the kitchen, laundry and external grounds. The kitchen and laundry areas were clean and very well maintained. However, the external grounds required attention as the grass was fairly long and the shrubs needed cutting back. There is a paved area that had tables and chairs, but again a flowerbed in the middle of the lawn required weeding. At the end of the visit the inspectors were able to feed back to the manager. The inspectors would like to thank the staff and residents for their input during the inspection. What the service does well: Two activity co-ordinators are employed five days per week between 10a.m. and 5p.m. Between these two people a comprehensive programme of activities has been developed for the three different units. Some of the activities are open to all of the residents and some are for specific groups. A variety of day trips has also taken place and a new programme is being developed for the autumn and winter periods. The manager and staff make every effort to sort out any problems or concerns and makes sure that residents and their relatives feel confident that their complaints and concerns are listened to and will be acted upon. Visiting times are flexible and people are made to feel welcome in the home so that residents are able to maintain contact with their family and friends as they wish. Beech Court Care Centre DS0000015585.V314032.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: The care plans on the unit for people living with dementia were generally very health focused and detailed but staff were not always following the care plans. However, these plans should be more comprehensive to include social care needs and life histories. The care plan should aim to enable the resident to be able to take as full a part as possible in their daily living routines and so allow them to maintain as much independence as is possible. The care plans should also include continence programmes, oral care and more details as to the behaviours of some residents and how staff should deal with these. Consideration must be given to the environment to best use the lay out and design to meet the specialist needs of people living with dementia. For example, through the use of décor, visual clues such as colour, signage and the use of familiar things from a person’s previous setting, such as photographs and ornaments. People living with dementia like to “walk” and would probably enjoy the freedom of being able to walk/sit in a garden that was accessible and well maintained with plants and flowers. People living with dementia should be enabled to personalise their bedrooms and this will be done in conjunction with relatives and friends. Bedrooms should also reflect any religious or cultural needs of service users, and care plans should also reflect such needs. Service users living with dementia would benefit from a wider programme of activities, more individually focused, for shorter periods, and give more stimulation. Also it would be beneficial if some activity resources were left in the lounges so that people could “dip in and dip out” outside of the organised activity times. The development of life histories would be beneficial in individual reminiscence sessions with service users. Activities should not only be the responsibility of an “activities co-ordinator” but these are the responsibility of all staff working in the care home. Activities should be very varied and person centred to ensure that they have real meaning for the person living with dementia. More must also be done to ensure that people living with dementia are enabled to make positive choices, especially with regard to meals. It is pointless asking people living with dementia what they want for dinner the next day, because they will have forgotten by the time the meal is served. The manager Beech Court Care Centre DS0000015585.V314032.R01.S.doc Version 5.2 Page 8 must review the current system of menu selection and enable residents to make choices at the time of the meal. 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 Care Centre DS0000015585.V314032.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Beech Court Care Centre DS0000015585.V314032.R01.S.doc Version 5.2 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 the following standard(s): Standards 3, 4 & 5 Quality in this outcome area is good. This judgement has been made using all available evidence including a visit to the service. Comprehensive assessments are being undertaken for all residents prior to them moving into the home. Care plans are drawn up from the information in this assessment, ensuring that the needs of the residents are identified, understood and met. The home does not offer intermediate care. EVIDENCE: Individual records are kept for each resident. A total of sixteen files were examined, across the three floors. All records inspected have assessment information recorded and the information had been used to continue assessment following admission to the home and develop written care plans. There was some evidence to show that residents, where capable and their relatives are involved in the assessment process. Where appropriate, information provided by the placing authority was also on file. Beech Court Care Centre DS0000015585.V314032.R01.S.doc Version 5.2 Page 11 Prospective residents and their relatives are provided with information about the home and there is always the opportunity to visit the home prior to making any decision to move in. The Care Homes Regulations 2001 have been amended with effect from the 1st September 2006 for new residents, and for existing residents with effect from the 1st October 2006, so that more comprehensive information is to be included in the service users’ guide. Details of information to be included are contained within the amended regulations. Therefore, the service users’ guide must be reviewed and amended by the stated timescales. Beech Court Care Centre DS0000015585.V314032.R01.S.doc Version 5.2 Page 12 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): Standards 7, 8, 9, 10 & 11 Quality in this outcome area is adequate. This judgement has been made using all available evidence including a visit to the service. Residents’ health and personal care needs are set out in individual care plans but not all plans accurately reflected the current needs and did not provide staff with sufficient information to ensure that care needs were being met on a daily basis. There are clear medication policies and procedures for staff to follow. However, there are some inconsistencies in the recording of medication, which may result in unsafe practices. EVIDENCE: General From discussions with staff and viewing care plans it was evident that care plans are generated from a comprehensive assessment. All records seen indicated that residents are seen by health professionals such as GP; speech and language therapist; dietician; tissue viability and diabetic nurse specialists; Beech Court Care Centre DS0000015585.V314032.R01.S.doc Version 5.2 Page 13 and care from community health services and hospitals. During the visit the inspectors’ were able to speak with a visiting GP who said” I have no concerns about the care at this home”. In the care plans examined of those residents on both the second and ground floor there was evidence of continence programmes where necessary and of oral hygiene. A care plan for a resident on the second floor around catheter care was very detailed, with all recordings in order. Another care plan examined was for a resident who had a hearing aid and, again this was very detailed. However, generally these areas were missing from the care plans of those residents living with dementia. There are several residents accommodated on different floors whose care plans did not accurately and comprehensively reflect cultural needs. It is essential for the general well being of residents from ethnic communities that staff are sensitive to and recognise the need for the different religious and/ or cultural needs to be met through the delivery of both health, personal and social care. Bedrooms should reflect the cultural and/ or religious identity of the resident, and care plans must include any particular needs to be met through the delivery of care. There was no evidence in the files of ‘End of Life’ care plans and the importance of developing these was discussed with the nurses, during the inspection. More work is required on all three units regarding end of life care for residents since this was generally poorly documented, other than perhaps “for burial”, “for cremation” or “contact family”. However, through discussions with staff the inspectors were confident that appropriate care and comfort is given to residents who are dying, and that their death would be handled in a sensitive and dignified manner, both for the individual and relatives, with spiritual needs being observed. There are clear medication policies and procedures for staff to follow. An audit was undertaken of the management of medicines and a random sample of Medication Administration Records (MAR) charts were examined on each of the three floors. The following issues were discussed with the manager and the nurses in charge of the respective units: • • Hand written entries on Mar charts must be signed and dated by the person making the entry. The entry must also include the source of the information e.g. directed by GP. When directions for administering medicines are variable e.g. one or two tablets, then the dose given is to be entered on the MAR chart. All controlled drugs are stored centrally in the second floor treatment room as are the medicines requiring storage in a fridge. The following concern was discussed with the manager and the nurse in charge: Beech Court Care Centre DS0000015585.V314032.R01.S.doc Version 5.2 Page 14 • There was no witnessed counter signatory for the receipt of six Fentanyl patches received in the home on the 27/09/06. The receipt of all Controlled Drugs must be recorded in a Controlled Drugs register by a registered nurse and be witnessed and counter signed by another registered nurse. The registered manager must ensure that all nursing staff abide by the home’s medicine policies and procedures; and the Nursing and Midwifery Council (NMC) standards for administration of medicines. The inspectors had the opportunity to speak with a visiting pharmacist from the Primary Care Trust (PCT) who is currently undertaking reviews of residents medication. The information from these reviews is then fedback to their GP’s with recommendations. For example, changes, reductions or discontinuation of medicines currently prescribed. He commented very positively on the care provided in the home and its management by the registered manager, Mary Zuwaradoka. During a tour of the premises at the start of the inspection, the inspectors were concerned to find many of the bedroom doors open but many of the residents were still in bed asleep. Because of this many staff did not knock on the bedroom doors before entering. Some of the bedrooms overlooked public areas but had no net curtains or blinds at the windows, only the heavy curtains. When these heavy curtains were open there was no privacy for residents who were still in bed asleep. On the second and ground floor units there appeared to be good interaction between residents and staff and it was apparent that staff treated residents with respect. However, this was not always apparent on the first floor unit and this is commented on in more detail in this report. Second Floor Individual care plans were available for each resident and the records of six residents were examined, and some of these residents were spoken to as part of case tracking. The records for these residents were found to be generally detailed and comprehensive. There was evidence that care plans were being reviewed at least monthly and updated to reflect changing needs and current objectives for health and personal care. It was evident, that where possible, residents were involved in the development of their care plans, and where this was not possible relatives were involved. Risk assessments are routinely undertaken on admission around nutrition, manual handling, continence, risk of falls and pressure sore prevention; and reviewed on a regular basis. Nutritional screening is undertaken on admission and weight gain or loss is recorded on a monthly basis, with appropriate action being taken where Beech Court Care Centre DS0000015585.V314032.R01.S.doc Version 5.2 Page 15 necessary. Fluid intake/output monitoring, turning regimes and blood sugar monitoring records were up to date and being adequately maintained. Food intake charts are maintained where necessary however, staff must record the amount of food intake as well as the type of food. For example, entries included “porridge, soup, sandwich”. The amount of food taken by the resident must be clearly recorded for example, two tablespoons; large bowl; size and number of sandwiches. This detail of recording will ensure that an accurate record is being maintained of nutrition. First Floor Individual care plans were available for each resident and the records of six residents were examined. Because the care plans did not show evidence of a person’s current ability and level of functioning, staff were not able to ensure that the correct care was being given to residents. There was some evidence that relatives had been involved in the development of care plans but the involvement of residents was limited. Whilst it was not possible to have meaningful discussions with some of the residents living with dementia, the inspectors were able to observe many care practices. The quality of care, which is experienced by someone living with dementia, can be improved by the way staff use and understand care plans. A comprehensive care plan can only enhance the care experience of a resident living with dementia. Because the label of “dementia” tends to prompt very negative responses, care plans tend to be couched in terms of risk, dependency or disability. The assumption that people with dementia cannot do much leads to dependence on care staff to do tasks that they could actually be encouraged to do for themselves. It is therefore, essential that comprehensive care plans are compiled, with the assistance of relatives and friends of the resident, to ensure that staff provide the correct level of care. Although there was evidence that care plans were reviewed monthly, there was limited evidence that the reviews were meaningful as they did not always reflect changes to the care required or detail the progress of an individual. Nutritional screening is undertaken on admission and weight gain or loss is recorded on a monthly basis. If action is required, such as referral to a dietician, then appropriate referral is made. However, from viewing one care plan, it was apparent that advice is not always being followed. For example, because of a resident’s refusal to eat the GP had prescribed a nutritional drink, and also an instruction to “Use full cream milk and mix 4-5 tablespoons of dried milk powder in to this. Aim to give 1 pint of milk throughout the day in drinks”. On checking the refrigerator in the unit’s small kitchen/ servery there was no such milk available for drinks for this resident. The inspectors also noted at the start of the inspection on this floor at approximately 9am; and a subsequent visit to the unit at approximately 11.15am; this particular resident Beech Court Care Centre DS0000015585.V314032.R01.S.doc Version 5.2 Page 16 was still asleep in bed in exactly the same position, and with what appeared to be the same glass of orange drink by the bed. During the inspection it was possible for the inspectors to have some interaction with residents living with dementia, and when looking at some photographs of residents displayed in the communal areas, it was apparent that this resident wore spectacles. When asked by the inspectors if she could see the photographs displayed, she said “no because I can’t find my glasses”. It is essential that nursing and care staff ensure that residents have aids such as spectacles, dentures and hearing aids on waking each day. The failure of staff to ensure this will add to the confusion of residents living with dementia and can also affect their behaviour. There was little interaction observed between the care staff and residents. A great deal of the care was delivered in silence or with little communication or explanation afforded to residents. For example, one resident was observed being hoisted from a lounge chair into a wheelchair by two care staff, without one word being spoken to the resident by either member of staff, or between the care staff. When delivering care it is essential that the individual resident is involved in this activity and communicated with. It is extremely frightening for a resident if a member of staff just starts moving them, or washing them without talking them through each action. These areas around effective communication must be adequately covered through training, and monitored through supervision. Ground Floor Individual care plans were available for each resident and the files of four residents were case tracked. Care plans were found to be detailed and comprehensive and there was evidence to show that care plans were being reviewed at least monthly and updated to reflect changing needs. Where possible, residents were involved in the development of their care plans, and where this was not possible relatives were involved. Risk assessments are routinely undertaken on admission around nutrition, manual handling, continence, risk of falls and pressure sore prevention; and were being reviewed on a regular basis. Nutritional screening is undertaken on admission and a record was being maintained on nutrition, including weight loss or gain with appropriate action being taken when necessary. A number of fluid intake/ output monitoring charts were examined. At 13.00hrs on the day of the visit the last recorded entry on some charts was 08.00hrs. For some residents this may indicate that fluids had not been given for a significant period. This concern was raised with the nurse in charge and she indicated that the completion of these charts was the responsibility of care staff. If the recording of fluid intake is indicated for a resident then this must be considered to be a clinical record and must be monitored by nursing staff accordingly. It is essential that all monitoring Beech Court Care Centre DS0000015585.V314032.R01.S.doc Version 5.2 Page 17 records are maintained accurately and up to date. Discussion with staff suggested that residents were receiving fluids but that staff were failing to record this on each occasion or being completed retrospectively. The inspectors’ observed these individual residents being given fluids during the inspection. Beech Court Care Centre DS0000015585.V314032.R01.S.doc Version 5.2 Page 18 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): Standards 12, 13, 14 & 15 Quality rating in this outcome area is adequate. This judgement has been made using all available evidence including a visit to the service. There is a varied programme of activities available. However, more consideration needs to be given to planning individual and small group activities which are suitable for those residents with a specialist need such as dementia, to ensure that all residents have a sufficiently stimulating and varied choice of activities. The meals in the home are well presented and there is always a choice of meal. Residents on the dementia unit may benefit from the use of, for example picture menus, finger foods, small nutritious snacks and more flexible eating times to maintain independence, exercise choice around food and eating and still provide a healthy balanced diet. Visiting times are flexible and people are made to feel welcome in the home so that residents are able to maintain contact with their family and friends as they wish. EVIDENCE: It was apparent when inspecting all three floors that the routines of daily living and activities are generally very flexible. Residents can choose when to get up Beech Court Care Centre DS0000015585.V314032.R01.S.doc Version 5.2 Page 19 in the mornings, and breakfast is served at times that are suited to meet the needs of individual residents Some chose to have breakfast in the dining rooms while others chose to have breakfast in their bedrooms. One resident spoken to was having her breakfast at 10.15 am as it suited her to have breakfast later in the morning. Residents are encouraged to receive visitors at any reasonable time and some residents are able to maintain links with the local community. This is especially true for those residents accommodated on the second floor. One resident attends a day centre operated by the local authority. Activities are also organised for trips into the community for leisure and shopping and this is extended to all residents within the home. There are two activity co-ordinators who work very hard in organising and delivering activities to suit the needs of a diverse group of residents. Quizzes are held on a regular basis, and one particular resident spoken to said: “I really enjoy the quizzes and I have many certificates to show”. There is a sensory room situated in the activities room on the first floor that is sometimes used by residents living with dementia. Generally, the activity coordinators are very aware of the interests of individual residents and records are maintained of the activity and those participating. However, the development of life histories for those residents with dementia would greatly assist in the provision of appropriate activities to these residents. Staff must be aware that such residents have a very short concentration span and therefore the activities need to be more individual or small group focused. It would be beneficial if some resources were left in the lounges so that residents are able to “dip in and dip out” as necessary. It is also essential that care staff recognise that activities within a care home are not solely the responsibility of activity co-ordinators. It is important that care staff are also engaged in enabling residents living with dementia to retain daily living skills such as washing, dressing and choosing clothes. Also to support residents to be involved in activities that focus on the individual’s needs, level of functioning and have some relevance to the individual’s likes, preferences and interests, past and present. This may be time consuming for staff but it is an important element in the care of residents. A visit was made to the main kitchen and the inspectors were able to discuss the storage and preparation of food and menus with the cook. She demonstrated a good knowledge and understanding of the importance of well balanced and well presented meals, and the special dietary needs of all residents. Menus were varied and balanced and printed menus were available for the residents on both the second and ground floors. However, printed menus are not available on the first floor “because residents tear them up”. There is very little reliance on processed or frozen foods. Fresh fruit is available twice a week, but in discussions with the manager it was recommended that fresh fruit be made available daily. Beech Court Care Centre DS0000015585.V314032.R01.S.doc Version 5.2 Page 20 Generally meals are served in the dining rooms on all three units but some residents eat in their bedrooms or the lounges. Dining tables were nicely laid with tablecloths, napkins, flowers, condiments and cutlery on both the second and ground floor units. Again, the first floor unit was different in that tables were not covered with a tablecloth and were not routinely laid to make the eating of meals a pleasant experience. It is acknowledged that once tables have been laid on this unit, there may be some service users who then proceed to move things, which makes extra work for staff in re-laying the tables. Staff should discuss this and agree on strategies to distract service users rather than act negatively by not routinely laying tables. The inspectors were able to observe meals being served to those residents living with dementia on the first floor. Many of the residents needed either supervision by staff or assistance with eating. Although there were sufficient staff on duty, there were times when residents were just left with little or no assistance. The meals were well presented but it appeared that it was the staff who decided what somebody would eat. Service users living with dementia may benefit from the use of, for example pictorial menus, finger foods, small nutritious snacks, smaller portions and more flexible eating times to maintain independence and exercise choice around food and eating. This area does need to be developed through the provision of pictorial menus or other methods such as making available to residents before the actual mealtime, small portions of the meals so that they can see, smell or touch the food and thereby make a more informed choice. The taking of meals should be an enjoyable experience for all residents, and the manager’s attention is drawn to the Commission’s recent report Highlight of the day that is about food and nutrition within care homes. Each unit is equipped with a small kitchen/servery where drinks and snacks are provided for residents. It is the responsibility of the chef to ensure that the refrigerators are clean and that there are sufficient stocks of foods and drinks. This was found to be the case during the inspection with everything in good order. During a visit to the laundry, it was very clear that the laundry persons are doing an excellent job and clothes are obviously being well cared for. However, because of the lack of “marking” clothes with the name of the resident many clothes are not being returned to the correct owner. In some instances these are being left in “lost property”. The inspectors understand that it is the responsibility of the keyworker to ensure that clothes are marked with the resident’s name and it is essential that this task is undertaken in the interests of each resident. Beech Court Care Centre DS0000015585.V314032.R01.S.doc Version 5.2 Page 21 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): Standards 16 & 18 Quality in this outcome area is good. This judgement has been made using all available evidence including a visit to the service. The manager and staff make every effort to sort out any problems or concerns and makes sure that residents and their relatives feel confident that their complaints and concerns are listened to and will be acted upon. Staff working in the home have received training in adult protection/ abuse awareness. However, this must be extended to all staff including ancillary and administrative staff to ensure that there is a proper response to any suspicion or allegation of abuse. EVIDENCE: The home has a written complaints policy and procedure and the complaints log inspected indicated the number of complaints received and included details of investigation, action taken to resolve them and the outcome for the complainant. The manager also maintains a register of issues and concerns, which enables her to address any expressions of concern or dissatisfaction with any element of the service without delay. Complaints and concerns made to the manager are always taken seriously and she actively addresses all concerns and aims to resolve to the satisfaction of the complainant. There is an in house training programme for staff in adult protection and recognising and reporting abuse. This must be extended to all staff including administrative and ancillary staff. Those staff spoken to during the inspection Beech Court Care Centre DS0000015585.V314032.R01.S.doc Version 5.2 Page 22 were aware of the action to be taken if they had concerns about the safety and welfare of residents. Beech Court Care Centre DS0000015585.V314032.R01.S.doc Version 5.2 Page 23 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): Standards 19, 24, & 26 Quality in this outcome area is adequate. This judgement has been made using all available evidence including a visit to the service. Generally the standard of the environment within the home provides residents with an attractive, safe and comfortable place in which to live. The environment on the first floor – dementia unit, must be improved to meet the specialist needs of people living with dementia. EVIDENCE: General The building was toured by the inspectors, unaccompanied, at the start of the visit, and all areas were visited again later during the day. Some bedrooms were seen either by invitation of the resident, or with permission, whilst others were seen because the doors were open or being cleaned. There were no offensive odours in the home and the home was clean and tidy. The standard of the décor, furnishings and fittings are generally being maintained to a good Beech Court Care Centre DS0000015585.V314032.R01.S.doc Version 5.2 Page 24 standard, with the exception of the first floor – dementia unit, which were not always to an acceptable standard. In good weather more thought should be given to the use of the external areas of the home. The external grounds required attention as the grass was long and the shrubs needed cutting back. There is a paved area that had tables and chairs, but the flowerbed in the middle of the lawn required weeding. The laundry area was visited and this was found to be clean, with soiled articles, clothing and infected linen being appropriately stored, ending washing. Laundry staff were aware of health and safety regulations with regard to handling and storage of chemicals. Personal Protective Equipment (PPE) such as clothing, gloves, masks and goggles were available and in use. Hand washing facilities are prominently sited and staff were observed to be practising an adequate standard of hand hygiene. First Floor Some bedrooms were seen to be very personalised but this was in stark contrast to other bedrooms visited, which gave no indication, nor were they representative of the occupant’s culture, religious or personal interests. Relatives should be encouraged to bring in items that are familiar to the person living with dementia, as this will make their environment more personal and meaningful. Bathrooms and toilets had no appropriate signage and other forms of identification as recommended in all practice guidance. Assisted bathrooms were also used as storage rooms for wheelchairs and hoists and therefore not available or accessible to residents wishing to use them independently. As the ability of people living with dementia to communicate with words decreases, the use of non-verbal cues and the environment are important in enabling them to cope better with daily life and aids to orientation. The general environment on this floor must reflect good practice guidance on dementia care within care homes. Consideration must be given to utilising the existing design and layout of this unit to meet the specialist needs of people living with dementia. For example, through the use of visual cues such as colour and signage. Containers with suitable materials could be located around the unit so that those service users who can walk can touch and feel things. The use of calming equipment such as lighting or a small aquarium could be used. Staff must be aware of the factors such as noise. On the day of the inspection the majority of residents were sat in the lounges with the television on and the sound turned off, but music was also being played on an audio tape. Residents were not watching Beech Court Care Centre DS0000015585.V314032.R01.S.doc Version 5.2 Page 25 the television but care workers were totally oblivious to this fact. It appeared to the inspectors that staff felt that if the television was on residents were being entertained. It would have been more beneficial for residents for the television to be turned off, and for appropriate music to be played, or for staff to be interacting with them. Lack of a stimulating environment can have a direct impact on a resident’s behaviour. There were no appropriate pictures in the corridors, lounges or dining room. The manager must give consideration to ensuring that there are items of interest for residents throughout the home. Pictures of parts of London, that would have been familiar to residents in their younger days, can be obtained from local libraries and other such outlets. These can also be used as points of discussion with residents living with dementia. The physical environment has an enormous impact on how the strengths and skills of people living with dementia are supported or not. Changes mentioned above if implemented can help to support people living with dementia, and help to maximise independence and minimise confusion. Therefore, since the service is registered for the provision of care to people living with dementia, and this is viewed as a specialist service the organisation must consider improvements to the environment as follows: Using changes in colour in different areas to help with orientation Having toilet seats that are a different colour to the rest of the room to help with identification, and this includes the en suites. Using pictorial signs as well as written signs and ensuring these are at the right height to help with identifying different rooms and areas Providing freedom to walk about in areas that are interesting and that have pictures and sitting areas, together with times when staff will take residents, especially those who are prone to “walking” into a garden that is safe and is planted with plants and flowers that have colour and smells. Beech Court Care Centre DS0000015585.V314032.R01.S.doc Version 5.2 Page 26 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): Standards 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using all available evidence including a visit to the service. The home employs staff in sufficient numbers to meet the personal and nursing care needs of the residents. However, nursing and care staff on the first floor- dementia unit, are not sufficiently trained or skilled to understand and effectively meet the needs of people living with dementia. EVIDENCE: The staffing levels of qualified nurses and care staff on all floors were sufficient to meet the nursing and personal care needs of residents. In addition to qualified nurses and care staff Beech Court employs two activity co-ordinators, catering, laundry, housekeeping, maintenance and administrative staff. The home has a relatively stable workforce, there is no use of agency staff and any gaps in the rota are covered by permanent bank staff. This is clearly to the benefit of residents since it provides consistency of care, which is very important to all residents and particularly for those people living with dementia. The majority of staff have received some training in dementia awareness, and all qualified nurses are scheduled to undertake a twelve-week training course on caring for people living with dementia, which will then be cascaded to all care staff working in the home. However, this training must be considered to be a priority training need for all care staff on the first floor – dementia unit. Beech Court Care Centre DS0000015585.V314032.R01.S.doc Version 5.2 Page 27 All care staff must receive comprehensive and certificated training in caring for people living with dementia. Care staff must be supported and enabled to develop the skills, knowledge and abilities required to successfully enable residents to continue to exercise choice in their daily lives and reach their full potential. A record is maintained of staff training and records showed that staff have undertaken training in essential areas such as fire training, manual handling, infection control and health and safety. Other staff have undertaken training in continence management, pressure sore prevention and management, stroke care and diabetes management. Approximately 65 of care staff have been trained to NVQ level 2 or above. A random sample of staff personnel files were inspected and these were found to be in good order with necessary references, criminal records bureau disclosures, and application forms duly completed. It was evident that the recruitment procedures are robust and in accordance with the Care Homes Regulations. Beech Court Care Centre DS0000015585.V314032.R01.S.doc Version 5.2 Page 28 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): Standards 31, 32, 33, 35, 36, and 38. Quality in this outcome area is adequate. This judgement has been made using all available evidence including a visit to the service. The manager is a very experienced and well-qualified person. However, because of the size of the establishment it is essential that the manager develop a more effective system to monitor practice and compliance with the home’s policies and procedures, and in line with the Statement of Purpose. This will ensure that she is fully appraised of any issues relating to the day-today management of the home and the specialist needs of residents; and ensure that residents benefit from a home that is run in their best interests. EVIDENCE: The registered manager is an experienced, well-qualified person and holds a registered nursing qualification. She has been the manager of the home for a number of years. It was evident from discussion with her that the service is Beech Court Care Centre DS0000015585.V314032.R01.S.doc Version 5.2 Page 29 planned to be service user focused and aims to work in partnership with the family of residents and professionals. The home’s Statement of Purpose sets out the aims and objectives of the service however, the manager must develop more robust and effective systems for monitoring practice and compliance with the home’s policies and procedures and in line with the Statement of Purpose, particularly on the first floor – dementia unit. From discussions with staff and records inspected it was evident that staff receive regular formal supervision, and staff meetings take place on a regular basis. The responsible individual undertakes Regulation 26 monthly monitoring visits and a copy of the report is sent to the Commission. Currently the manager does not act as an appointed agent for any resident. Residents financial affairs are managed by their relatives/ representatives. The home has responsibility for the personal allowance of several residents. There is a computerised financial system in place, which is managed by the home’s administrator. A random sample of records were inspected and there was evidence to show that residents’ financial interests are safeguarded. Secure facilities are provided for the safekeeping of money and valuables held on behalf of residents. A wide range of records were looked at including fire safety, water temperature checks, health and safety audits and accident/ incident reports. These records were found to be detailed, up to date and accurate. Beech Court Care Centre DS0000015585.V314032.R01.S.doc Version 5.2 Page 30 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 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X 2 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 2 X 3 Beech Court Care Centre DS0000015585.V314032.R01.S.doc Version 5.2 Page 31 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 OP4 Regulation Requirement Timescale for action 31/01/07 2. OP7 OP8 OP11 3. OP7 OP8 OP15 4. OP8 5. OP9 14, 12, 18 The registered manager must ensure that staff individually and collectively have the required skills, experience and training to deliver the service and care which the home offers to provide on the dementia unit. 12 & 15 The registered manager must ensure that all residents have individual plans of care, which show how all their health, personal and social care needs are to be met, and to include ‘End of Life’ choices. 12 The registered manager must ensure that any specific directions/ advice given in respect of a residents health care needs is undertaken in accordance with such advice. 12 Where the record of food/ fluid intake is indicated for a resident, these recordings must be accurately maintained and up to date. 13 The registered manager must ensure that: • All hand written entries on Medication Administration DS0000015585.V314032.R01.S.doc 31/01/07 29/09/06 29/09/06 29/09/06 Beech Court Care Centre Version 5.2 Page 32 Records (MAR) charts must be signed and dated by the person making the entry. • When directions for administering medicines are variable i.e. one or two tablets. Then the dose given is to be entered on the MAR chart. 6. OP12 16 7. OP15 18 & 19 8. OP18 13 & 18 9. OP19 OP24 23 10. OP27 OP30 18 The receipt of all Controlled Drugs must be recorded in a Controlled Drugs register by a registered nurse and be counter signed by another registered nurse. The registered manager must ensure that a more varied programme of activities be provided for those residents with a specialist need such as dementia. The registered manager must ensure that meals served on the first floor unit are in congenial surroundings and that staff have the skills to give an appropriate level of assistance when required. The registered manager must ensure that all staff working in the home, including ancillary and administrative staff, have training in adult protection/ abuse awareness. The registered persons must ensure that the existing layout and design on the dementia unit reflect good practice guidance on dementia care within care homes, to ensure that the specialist needs of residents on this unit are met. The registered manager must ensure that all staff working on the dementia unit receive DS0000015585.V314032.R01.S.doc • 31/01/07 31/10/06 31/01/07 31/01/07 31/01/07 Beech Court Care Centre Version 5.2 Page 33 11. OP31 OP32 OP33 OP36 9 & 24 comprehensive and certificated training in caring for people living with dementia. The registered manager must ensure that there are robust and effective systems in place for monitoring practice and compliance with the home’s policies and procedures and in line with the Statement of Purpose. 31/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP15 Good Practice Recommendations Residents living with dementia may benefit from the use of, for example pictorial menus, finger foods, small nutritious snacks and more flexible eating times to maintain independence and exercise choice around food and eating. Beech Court Care Centre DS0000015585.V314032.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Scrapbook Road Ilford IG1 4PU 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 Care Centre DS0000015585.V314032.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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