CARE HOMES FOR OLDER PEOPLE
Beech Court 37 Newland Street Eynsham Oxon OX29 4LB Lead Inspector
Philippa MacMahon Unannounced 14th July 2005 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 H57_H08_S27140_Beech Court_V238947_140705_Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Beech Court Address 37 Newland Street Eynsham Oxon OX29 1LB 01865 883611 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) Dr Brian Cheung Glynis Dunbar Care Home (CRH) 26 Category(ies) of Care Home with Nursing (N) registration, with number of places Old age, not falling into any other category (OP) 26 Beech Court H57_H08_S27140_Beech Court_V238947_140705_Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. On admission persons should be aged 60 years and over. 2. Admission of two named residents under the age of 60. Date of last inspection 22nd March 2005 Brief Description of the Service: Beech Court is a large listed building of architectural and historical note. It is situated in the village of Eynsham a village five miles west of Oxford, and is close to shops, Post Office and 3 Churches. Beech Court is home to 26 older people who are frail, and require nursing care 24 hours a day. The home offers convalescence, holiday breaks, long, and short stay care. The accommodation is provided in single and shared rooms on 2 floors, and there is a passenger lift to provide access to all areas. The communal rooms are spacious and large picture windows afford a good view of the delightful garden. There are spacious, well kept grounds on both sides of the house, which the service users have access to. Beech Court H57_H08_S27140_Beech Court_V238947_140705_Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, and the inspector found the home busy preparing for a garden party to celebrate VE Day. Care plans were examined, and the inspector spoke to a number of residents, relatives, and friends, and a physiotherapist who regularly visits the home. Staff members were also spoken to during the course of the inspection. Records required by regulation were examined. What the service does well: What has improved since the last inspection?
That the domestic staff are aware of the need to close fire doors, and not to leave cleaning substances unattended. Beech Court H57_H08_S27140_Beech Court_V238947_140705_Stage 4.doc Version 1.40 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Beech Court H57_H08_S27140_Beech Court_V238947_140705_Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Beech Court H57_H08_S27140_Beech Court_V238947_140705_Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) The inspector did not make a judgement about this outcome as none of the outcomes were inspected. EVIDENCE: None of these standards were assessed on this occasion. Beech Court H57_H08_S27140_Beech Court_V238947_140705_Stage 4.doc Version 1.40 Page 9 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) 7,8,10. Each resident has a care plan in which their care needs are identified and the action required to meet those needs On the whole the residents health care needs are met. There are some areas particularly in relation to risk assessment for falls, and the implementation of the nutritional screening tool that is being rolled out, that require improvement. There is very open communication between relatives, significant carers and the staff in ensuring that the residents care needs are met. Beech Court H57_H08_S27140_Beech Court_V238947_140705_Stage 4.doc Version 1.40 Page 10 EVIDENCE: A sample of care plans were examined and overall found to give a good picture of the individual residents care needs and how these are met. Discussion with a number of residents and relatives revealed that they were very happy with the care provided and appreciated how friendly and helpful the staff are. A number of relatives expressed that they were always made to feel very welcome in the home and kept up to date by the staff on the progress of their relative. One of the care plans examined identified that the resident had difficulty in mobilising and no risk assessment had been carried out in respect of moving and handling and falls. Another care plan of a resident who was admitted on a short term basis, identified in the assessment that the person had poor nutritional status, and yet no weight had been recorded, or a nutritional assessment made. A number of nutritional assessments were incomplete, and as this is a recognised system of assessing a resident’s nutritional status it is important that the system is followed through. It is recommended that the new nutritional assessment tool should be used for all new residents, and incrementally rolled out across the remaining residents according to need. The inspector met with a private physiotherapist who visits the home once a week to carry out treatments. She expressed that there is good communication between the staff and herself, and that the residents are well cared for. The inspector observed staff caring for the residents in an appropriate and respectful manner, and noted that they always knocked on doors before entering the resident’s private room, and addressed them by their preferred term of address. Beech Court H57_H08_S27140_Beech Court_V238947_140705_Stage 4.doc Version 1.40 Page 11 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) 12,13. The residents spoken to felt that the lifestyle experienced in the home matched their expectations. The registered manager makes every effort to provide an interesting and varied activities programme to meet the resident’s needs and expectations, and to involve the wider community in the life of the home. EVIDENCE: Residents spoken to during this inspection were excited at the prospect of a garden party that had been organised to celebrate VE Day and was to take place later in the day. Invitations had been extended to friends, families, and other people in the village. There is a programme of activities that are organised, and the residents said “there is enough to keep us interested.” Beech Court H57_H08_S27140_Beech Court_V238947_140705_Stage 4.doc Version 1.40 Page 12 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 The homes complaints procedure was incomplete, inconsistent and in need of revision and update. EVIDENCE: A recent complaint had been lodged with social services care management, and concerns about the complaints procedure were apparent. Examination of the complaints procedure found that there were 3 different versions available in the home. In each of the versions it was not explicit that anybody can approach the Commission for Social Care Inspection at any point in time to raise concerns or issues. An immediate statutory requirement was made that this procedure must be rewritten to include a statement that anybody wishing to raise concerns or issues may approach The Commission for Social Care Inspection at any stage. This was completed by the registered manager and submitted to the inspector by the due date. Beech Court H57_H08_S27140_Beech Court_V238947_140705_Stage 4.doc Version 1.40 Page 13 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) The inspector did not make a judgement about this outcome as none of the outcomes were inspected. EVIDENCE: None of these standards were assessed on this occasion. Beech Court H57_H08_S27140_Beech Court_V238947_140705_Stage 4.doc Version 1.40 Page 14 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) 27,28,30. The home is staffed at the minimum safe levels to meet the needs of the present group of residents. This does not allow for the increase in the dependency level of these residents, or for any sickness or unplanned absence of staff. The registered manager is firmly committed to training and development of staff, and this contributes to the small numbers of staff who leave. EVIDENCE: The inspector examined the staff rosters and found that there were the minimum numbers required on duty on each shift. In accordance with the staffing establishment agreed previously with Oxfordshire Health Authority. Over 50 of the care staff have achieved NVQ 2 or 3 in care, and a further 3 are registered on the programme but have not yet completed the course. The trained nurses have attended courses to update their practice. There is a very small turn over of staff. Beech Court H57_H08_S27140_Beech Court_V238947_140705_Stage 4.doc Version 1.40 Page 15 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) 31,32,33,36,37. The home is well managed and the registered manager is very experienced in running the home and caring for this client group. EVIDENCE: The staff team work very much as a team and there are clear lines of accountability. There is a system of staff supervision and the records are kept in the member of staffs personal file. All records required by regulation are up to date complete and stored in a safe manner. Beech Court H57_H08_S27140_Beech Court_V238947_140705_Stage 4.doc Version 1.40 Page 16 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 x x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x
COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x 3 3 3 x x 3 3 x Beech Court H57_H08_S27140_Beech Court_V238947_140705_Stage 4.doc Version 1.40 Page 17 No 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. Standard 16 Regulation 22(5) Requirement It is a statutory requirement that the complaints procedure must be rewritten to include a statement that anybody wishing to raise concerns or issues may approach the Commission for Social Care Inspection at any stage. A copy of the revised procedure to be forwarded to the inspector by 22.07.05. A copy of this must be provided to each resident, or person acting on behalf of the resident. Timescale for action Immediate 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 Good Practice Recommendations Beech Court H57_H08_S27140_Beech Court_V238947_140705_Stage 4.doc Version 1.40 Page 18 Commission for Social Care Inspection Burgner House 4630 Kingsgate Oxford Business Park (South) Cowley, Oxford, OX4 2SU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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