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Inspection on 04/11/05 for Beech Court Nursing Home

Also see our care home review for Beech Court Nursing Home for more information

This inspection was carried out on 4th November 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides a homely environment in a lovely old house set in attractive grounds. The individual staff are very kind, friendly, and have good relationships with the residents. The registered manager is committed to Staff training and development.

What has improved since the last inspection?

The inspectors were not aware of any improvement on this occasion.

What the care home could do better:

Improve the every day maintenance of equipment, and general tidiness of the environment. Inform and update staff on the guidelines for safe administration storage and disposal of medication. To have the record of food provided readily available for inspection. To ensure that there are always sufficient numbers and skill mix of staff on duty to meet the care needs of the residents.

CARE HOMES FOR OLDER PEOPLE Beech Court Nursing Home 37 Newland Street Eynsham Oxfordshire OX29 4LB Lead Inspector Philippa MacMahon and Kate Harrison Unannounced Inspection 4th November 2005 8.30 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 Nursing Home DS0000027140.V265428.R01.S.doc Version 5.0 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 Nursing Home DS0000027140.V265428.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Beech Court Nursing Home Address 37 Newland Street Eynsham Oxfordshire OX29 4LB 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) 01865 883611 Dr Brian Cheung Glynis Lynette Dunbar Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Beech Court Nursing Home DS0000027140.V265428.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. On admission persons should be aged 60 years and over. Admission of two named residents under the age of 60. Date of last inspection 14th July 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 Nursing Home DS0000027140.V265428.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that was carried out by two inspectors. The inspection was the second one in the inspection year and the key standards not addressed previously were the focus of the visit. The inspectors toured the premises, looked at care plans and followed this by meeting with the residents and speaking to staff in order to ascertain if the care needs were being met. Staff rosters were examined and the homes medication system. The inspectors also discussed the running of the home with the registered manager and the proprietor. What the service does well: What has improved since the last inspection? What they could do better: Improve the every day maintenance of equipment, and general tidiness of the environment. Inform and update staff on the guidelines for safe administration storage and disposal of medication. To have the record of food provided readily available for inspection. To ensure that there are always sufficient numbers and skill mix of staff on duty to meet the care needs of the residents. Beech Court Nursing Home DS0000027140.V265428.R01.S.doc Version 5.0 Page 6 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 Nursing Home DS0000027140.V265428.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beech Court Nursing Home DS0000027140.V265428.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 All resident’s admitted to the home do so after an assessment of their care needs have been undertaken. The home does not provide intermediate care. EVIDENCE: Pre-admission assessments of care needs were found in the care plans of the sample examined. Beech Court Nursing Home DS0000027140.V265428.R01.S.doc Version 5.0 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 the following standard(s): 7,8,9. Care plans need to be more detailed to meet all the residents’ health needs. The sample of residents’ whose care was “tracked”, did have their health care needs met. The homes medication systems are in need of reviewing. EVIDENCE: The inspector checked one file and found care plans based around the Activities of Daily Living model. Most of the plans contained sufficient detail for care staff to deliver appropriate care, but some plans needed more detail, especially those for pressure wounds and catheter care. There was no evidence that the care plans had been discussed with the resident or the relatives? Medication prescribed for a deceased resident was found in a residents’ room and the inspector understood that the cream was being used for another resident. A further medication was found in the office also with a deceased residents name and the inspector was informed that this was being used by one of the care assistants. Beech Court Nursing Home DS0000027140.V265428.R01.S.doc Version 5.0 Page 10 This is not in accordance with guidelines from the British Pharmaceutical Society or the Nursing and Midwifery Council. It is a requirement that medicines prescribed for an individual resident must only be used by that person. The inspector examined the medicines stored in the controlled drug cupboard and checked these with the registered manager against the running total of tablets. A discrepancy was found in that one tablet was unaccounted for. An immediate requirement was made that an investigation must take place into the reason for the missing tablet of Temazepam. Following the inspection the registered manager reported to the inspector in writing the outcome of her investigation and that the correct number of tablets could be accounted for. The inspector found two out of date medicines in use and made an immediate requirement that the registered manager must dispose and reorder the out of date medication. The inspectors observed a nebuliser machine in one of the residents’ room and a large quantity of Ventolin nebules on the bedside table and some in the nebuliser box. This in the inspectors view is not good practice and a requirement was made that the number of Ventolin nebules that are readily available to a resident must be restricted, usage monitored, and stored in a safe place. It is recommended that further training in the administration, and storage of medicines should be provided for all staff. Beech Court Nursing Home DS0000027140.V265428.R01.S.doc Version 5.0 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 the following standard(s): 15 Records of the home’s menus are not kept according to Schedule 4(13) of the Care Homes Regulations 2001. EVIDENCE: The Home’s usual cook was not on duty on the day of inspection, and the registered manager was not able to produce a record of menus served recently. The inspector understood that the chef writes the menus in a book, which the home recognises as the record of menus. The inspector understood from the manager that the cook regularly sees residents to discuss the day’s menu and offer an alternative. It is a requirement that the record of menus required in Schedule 4(13) are available to inspection and a copy of this must be forwarded to the inspector. Beech Court Nursing Home DS0000027140.V265428.R01.S.doc Version 5.0 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 the following standard(s): X No judgement was made as none of these outcomes were inspected. EVIDENCE: Beech Court Nursing Home DS0000027140.V265428.R01.S.doc Version 5.0 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 the following standard(s): 19 The day-to-day small maintenance jobs are not being attended to and give the home an appearance of not being cared for. EVIDENCE: The inspectors toured the building and overall found the level of cleanliness to be of an acceptable level. However they saw several areas of the home and noted instances where action had not been taken to replace or mend equipment, such as a broken soap dish and towel rail, a stained sling and a rusty commode. In one residents’ room the counterpane was ripped and in another a bed rail protector was frayed and unsightly. Several of the windows were observed to be dirty. It is recommended that the registered manager and her staff should make a note of any maintenance required and ensure that these are completed. Beech Court Nursing Home DS0000027140.V265428.R01.S.doc Version 5.0 Page 14 Several areas of the home had an unhygienic smell, and one room was very untidy with nursing equipment packaging and medication left about the room. The laundry was untidy with a black bin bag overflowing on the floor. Net pants for use with incontinence pads were stored together and not kept for particular individuals. This in the inspectors view is not good practice and it is recommended that an alternative way of securing incontinence pads be explored. Beech Court Nursing Home DS0000027140.V265428.R01.S.doc Version 5.0 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 The staff roster is not in accordance with the minimum staffing levels agreed with Oxfordshire Health Authority, and more staff are needed to meet the needs of the residents’. EVIDENCE: The inspectors discussed the staff rota for the day and night with the registered manager and the provider. It was clear that sufficient numbers of staff are not available at key times of the day and night to care for all the residents’ needs, particularly between the hours of 8am and 10am, and between 8pm and 10pm. Staff spoken to felt that the shortage at these key times was not conducive to good quality care, and this put a lot of pressure on the remaining staff. One resident told the inspector that she would prefer to go to bed later than at present, and that sometimes bedtime was much too early. An immediate requirement was made that the staffing of the home must be in accordance with the agreed staffing notice. Beech Court Nursing Home DS0000027140.V265428.R01.S.doc Version 5.0 Page 16 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): 35,38. The residents’ finances are handled appropriately. There is evidence of staff training in issues related to health and safety, and the registered manager and proprietor are committed to improving the standards required by the Health and Safety Executive. EVIDENCE: Relatives manage most residents’ finances, and the registered manager invoices relatives for purchases such as toiletries. The inspector saw copies of receipts issued when small amounts of petty cash are handled. A lockable drawer is provided in the residents’ rooms to store personal items. Staff have received regular training and updates in fire safety, moving and handling, and food hygiene. Beech Court Nursing Home DS0000027140.V265428.R01.S.doc Version 5.0 Page 17 An inspector from the Health and Safety Executive has recently carried out an inspection and sent the inspector a report of that visit including an improvement notice. Beech Court Nursing Home DS0000027140.V265428.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X 2 Beech Court Nursing Home DS0000027140.V265428.R01.S.doc Version 5.0 Page 19 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 OP9 Regulation 13(2) • Requirement It is a requirement that medicines prescribed for an individual resident must only be used by that person. Timescale for action 02/12/05 2. OP9 13(2) 3 OP15 17(2) Schedule 4(13) That an investigation must take place into the reason for a missing tablet of Temazepam. • That the registered manager must dispose and reorder out of date Oramorph, and Chloramphenicol eye ointment. • Ventolin nebules readily available to a resident must be restricted and monitored, and stored in a safe place. It is a requirement that the record of menus required in Schedule 4(13) are available to inspection and a copy of this must be forwarded to the inspector. • 05/11/05 02/12/05 Beech Court Nursing Home DS0000027140.V265428.R01.S.doc Version 5.0 Page 20 4 OP27 18(1)(a) An immediate requirement was made that the staffing of the home must be in accordance with the agreed staffing notice. 05/11/05 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 Refer to Standard OP19 Good Practice Recommendations It is recommended that the registered manager and her staff should make a note of any maintenance required and ensure that these are completed. • • • 3 OP9 It is recommended that an alternative way of securing incontinence pads be explored. The management of the laundry should be improved. The management of spillages should be reviewed to prevent any unhygienic smells. 2 OP26 It is recommended that further training in the administration, and storage of medicines should be provided for all staff. • Beech Court Nursing Home DS0000027140.V265428.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way 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 © 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 Nursing Home DS0000027140.V265428.R01.S.doc Version 5.0 Page 22 - 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. 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