Inspection on 01/06/06 for Beech House

This inspection was carried out on 1st June 2006.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Beech House 06/04/09

Beech House 10/06/08

Beech House 16/07/07

Beech House 11/12/05

Beech House 11/08/05

Beech House 04/12/04

Beech House 08/07/04

Beech House 08/01/04

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

CARE HOMES FOR OLDER PEOPLE Beech House Yew Tree Lane Northenden Manchester M23 OEA Lead Inspector Leslie Hardy Unannounced Inspection 1st June 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Beech House DS0000053654.V298768.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 House DS0000053654.V298768.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beech House Address Yew Tree Lane Northenden Manchester M23 OEA 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) 0161 945 2083 S J Care Homes Ltd Care Home 43 Category(ies) of Learning disability (1), Old age, not falling registration, with number within any other category (42) of places Beech House DS0000053654.V298768.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. The service should, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. A copy of the Residenital Forum Guidance on Staffing in Care Homes for Older people must be available. Staffing levels for service users who require personal care only must comply with minimum requirements of the Residential Forum guidance. Staffing levels for service users who require nursing care must comply with the minimum requirements of the staffing notice, served on 15 July 2004, under Section 13 of the Care Standards Act. A maximum of 43 service users can be accommodated at any one time. Of this number a maximum of 28 service users will require nursing care and a maximum of 15 service users will require personal care only. One service user is currently accommodated who is under 65 years years of age and requires nursing care and also care by reason of learning disability (LD). Should this place no longer be required then the category will revert to old age (OP). 11th December 2005 6. Date of last inspection Brief Description of the Service: Beech House Residential and Nursing home is located in the Northenden area of South Manchester, close to local amenities. The home is registered with the Commission for Social Care Inspection to accommodate 43 residents over the age of 65. The large extended detached house is set in its own grounds and has ample car parking spaces. Residents living accommodation is available on the ground and first floor, access to which is facilitated by a passenger lift. The building is accessible to wheelchair users via a ramp and the entire home is wheelchair accessible. Shops and access to public transport is nearby and the home is within 1 mile of the M56. The home has four lounges, a conservatory, and a separate dining room. There are 35 single bedrooms and 4 double rooms, none of which have en suite facilities. Residents have access to their bedrooms at all times. The current fees for the home are £390 to £520 a week Beech House DS0000053654.V298768.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The report brings together information on the home gathered since the last inspection in December 2005, including returns from the home regarding reportable incidents, which was used to inform an unannounced inspection that took place at the home on Thursday 1 June 2006. This inspection started at 7 30 am and lasted for 7 hours. During the inspection, 10 residents, 3 visitors, 8 staff and a district nurse were spoken with. A tour of the building was also carried out. A number of questionnaires together with reply paid envelopes for return directly to the inspector were given to residents and one of these was returned. Some of the requirements from the previous report were found to either have been implemented or action was seen that showed that the home were stating to undertake these. What the service does well: What has improved since the last inspection? The redecoration of all the downstairs communal areas and the entrance hall has been completed and, as one relative said, “has brightened up the home”. The home has introduced two sittings for lunch, which mean that appropriate time can be spent with the more dependent residents. The use of regular review meetings with residents and relatives along with a short comments form means that the home are developing ways of listening to residents and ensuring that their voice is heard in developing the home. Beech House DS0000053654.V298768.R01.S.doc Version 5.2 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 House DS0000053654.V298768.R01.S.doc Version 5.2 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 House DS0000053654.V298768.R01.S.doc Version 5.2 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The development of the homes admission assessment and the inclusion of a social need assessment, is required to complement assessments by referring agencies to ensure that the home are sure they can meet residents needs. The home does not offer intermediate care. EVIDENCE: Residents were admitted to the home following assessments by referring professionals and where residents are admitted for nursing care, a funded nursing care assessment is completed by a trained NHS nurse assessor. The home also completed a brief assessment of the prospective resident’s needs, which did not include any social needs so that staff were aware of these. The assessment must be developed and to include a social assessment enable the home to form their own full picture of residents’ needs. These assessments were used to formulate care plans, which were found to meet the assessed needs of the residents. From discussions with staff and an observed handover Beech House DS0000053654.V298768.R01.S.doc Version 5.2 Page 9 between day and night staff, staff were aware of residents needs and how these were to be met. Beech House DS0000053654.V298768.R01.S.doc Version 5.2 Page 10 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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents at the home are respected and treated as individuals, but the home need to ensure that care planning and risk assessments are completed and that all residents have social assessments and plans to ensure that all needs are known and met. Medication practices are generally safe but the acceptance of verbal instructions from doctors must cease as this could put residents at risk. EVIDENCE: All residents had care plans, which had been written to meet their assessed needs. As well as the pre admission assessments, appropriate risk assessments which included a recently introduced tool for nutritional assessment of residents, were used to identify areas which could be of risk to the resident so care could be planned to help. This included areas such as pressure ulcer prevention, as well as nutrition. Care plans were not found to be regularly reviewed with a comment made on progress, but also comments were recorded as residents responded to the plan. Risk assessments showed they had been regularly reviewed, but frequently, where a score was needed Beech House DS0000053654.V298768.R01.S.doc Version 5.2 Page 11 as an outcome to an assessment, this was not shown. Without a new score the assessment is not completed and any changed risk to the resident not fully stated which could put the resident at risk. New care plans would be written to taking into account the residents’ acute changing needs and assessed risks. However where a resident’s needs had changed over time, as shown by a recent funded nursing assessment, the plan did not identify the changes necessary to ensure residents’ needs are being met. The home should take steps to ensure that all care plans identify the current and changing needs of the residents. A new social care assessment for residents was being implemented at the time of the inspection. This is needed to ensure more rounded and holistic care plans as these were currently nursing oriented for all residents, including those admitted for care only. This meant that staff were not fully aware of the social needs and ambitions of residents and these were therefore not being met. The daily reviews written by staff gave a picture of how the resident had been and included information on visitors and contact by the home with relatives. District nurses were involved in delivering care to care only residents. A district nurse visiting at the time of the inspection felt staff were excellent and had confidence in their ability to meet residents’ needs. Another specialist nurse who visited the home was confident that staff listened to her and followed her guidance. The home had systems in place for the receipt and disposal of medication. Appropriate entries were being made in the medication administration record when medication was given, or for a stated reason omitted. On the day of the inspection a resident was found to be given medication at a different time from that shown on the medication administration record. This was stated to be undertaken following a discussion with the residents’ GP the previous day so that the medication was given to meet the residents assessed needs. No written instructions had been made in the records by the by the GP, although the nurse had recorded this. All changes to medication must be made in writing by the GP to safeguard both residents and staff. Staff respected the residents as individuals and ensured that their dignity was maintained. All personal treatments were noted to be given in private behind closed doors. Residents appearance was generally smart. Residents had clean mouths and eyes and trim fingernails. Beech House DS0000053654.V298768.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home should ensure a range of appropriate activities, which would enhance the resident’s day and enable further choice as to how they are able to spend it. Good visiting arrangements are in place to meet resident’s needs. Meal times are a positive experience for residents and the standard of food served is good. EVIDENCE: Residents were able to get up and go to bed when they wished. About 15 residents were up at the start of the inspection at 7. 30 am. but all were awake. Residents stated that they got up when they wanted and staff confirmed that they only got residents up when they were awake and wanted to get up. The home has four lounges and a conservatory. One of the lounges is not regularly used by residents as it is away from the centre of the home, the other lounges and conservatory are around the centre of the home. There were little organised activities undertaken by residents during the inspection, but following a recommendation in the last inspection report, a survey of residents wishes in relation to activities had been undertaken, and changes to meet these wishes was said by the administrator, to be imminent. This must Beech House DS0000053654.V298768.R01.S.doc Version 5.2 Page 13 be implemented to ensure that activities that meet resident’s needs are available. Staff did spend time talking to residents, and in the case of a newly admitted resident this was particularly important as staff spent time with him and got to know him. The home operated a policy of encouraging visiting at any reasonable time. Visitors were seen in the home from about 10.00 am. and positive relationships between visitors and staff were observed. Visitors spoken to were very positive about the home and how it was meeting the needs of the resident they were visiting. Residents did go out with family and friends or if able to, on their own, but currently no out of the home activities are organised by staff, so if residents do not have someone who can take them out, they do not get out of the home. The home has gardens to the front, along with a terrace facing this area which has tables chairs and parasols available. This area was used by residents to enjoy the fine weather on the day of the inspection. Resident’s spoke positively about food in the home. The cook was known to residents, who also knew residents likes and dislikes. There were two choices of dishes on the menu at lunch and evening meal, and other lighter choices were available if requested. The cook served meals that meet resident’s medical needs, such as diabetic diets. The daughter of a newly admitted African Caribbean resident stated that she was in discussion with staff about her mother’s dietary needs, but said that her mother did like the food available in the home. A lot of residents took their meals in the dining room, at one of two sittings. Dining tables were set with table clothes, cutlery condiments and a flower arrangement. Staff encouraged residents with their meals if required. Beech House DS0000053654.V298768.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The fact that no complaints were made directly to the home is positive, but residents could be put at risk by the lack of knowledge of staff on the recognition and reporting of adult abuse. EVIDENCE: The home keeps a record of complaints, examination of which showed that there had been no complaints made directly to the home since the last inspection. a copy of the complaints was displayed on each bedroom door. The recognition and reporting of adult abuse was discussed with the acting manager and some staff. This showed that though staff had an awareness of what could constitute adult abuse, they were unsure however how they should report such concerns and who to. This could put residents at risk. It is required that training in the recognition and reporting of adult abuse is made available to staff. Beech House DS0000053654.V298768.R01.S.doc Version 5.2 Page 15 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, 24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The decor of the home has improved recently, though further work is required. The provision of locks on bedroom doors and the drawer or cupboard of a bedside cabinet needs to be enhanced by the use of risk assessments so that residents can lock their doors if they are able. Soap, preferably liquid, must be available in all toilets to cut down on the risk of cross infection and aid to other measures already in place. EVIDENCE: The communal areas of the home as well as the entrance hall and main stairs have recently been decorated. As one relative said they make the home look much brighter and cheerful. The downstairs carpets, particularly the one in the dining room were dirty and needed to be deep cleaned and if this is not effective, replacing. The home employed a handy person who appropriately maintained the home. The home is accessible to wheelchair users and hoists Beech House DS0000053654.V298768.R01.S.doc Version 5.2 Page 16 are available and used to transfer residents to and from beds and chairs and into the bath. The bedrooms in the home are appropriately furnished. Where bedrooms include furniture or other personal items, they look homely, but where no personal possessions of residents were in the room, they could look quite bare. All rooms were capable of being locked though not many residents had a key. All rooms had a lockable drawer or cupboard. There were no assessments available to show if residents had been assessed as to their ability to use a key that would give them the ability to maintain their own privacy. These should be undertaken. The home was found to be clean and tidy and generally free from offensive odours. The home appeared to have appropriate infection control regimes in place including the washing and disinfection of commodes. Communal toilets all had hand towels available some did not have soap including liquid soap. It is recommended to help prevent cross infection that liquid soap is available in all communal toilets, as bar soap can harbour bacteria in any cracks that develop on its surface. Beech House DS0000053654.V298768.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Staff within the home have a good knowledge of the residents and their needs and are able to meet these. EVIDENCE: The home was found to be staffed appropriately and at least to the requirements of the staffing notice currently in force. Staff were found to be up to date in their knowledge of conditions suffered by residents at the home and trained nursing staff had been on courses to update their knowledge. Carers had undertaken training, which included fire safety and moving and handling. The inspector was informed that no new staff had commenced since the last inspection so the home had not been able to put into practice requirements on undertaking required checks on staff made in the last inspection report to ensure residents were safeguarded from inappropriate staff. Four of the care staff at the home had National Vocational Qualification in care at Level 2. The home also employed as cares 4 qualified nurses from Eastern Europe who cannot currently practice in this country without further training. The knowledge and experience of these carers is evident in how they interact with residents and was recognised by other registered nurses who visited the Beech House DS0000053654.V298768.R01.S.doc Version 5.2 Page 18 home. The level of carers with training, in addition to registered nurses ensures that residents receive appropriate care. Beech House DS0000053654.V298768.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The running of the home does not appear to have been affected by the retirement of the manager but it is important that another permanent manager is appointed to ensure continuity and development for residents. The use of the information collected from residents in reviews and audits should be further developed so that residents’ views are seen to be acted on. Good servicing and maintenance ensures that as far as possible, residents are not put at risk. Beech House DS0000053654.V298768.R01.S.doc Version 5.2 Page 20 EVIDENCE: The manager of the home who had been in charge of the home for some time retired recently. One of the registered nurses is currently acting into the manager’s role, and the post is being advertised. The district nurse and also a specialist nurse who visited the home did not think that care to the residents had deteriorated following the manager’s retirement and were positive about the way the acting manager was undertaking the role. The home did not currently keep any cash on the premises belonging to residents. Any spending money was given directly to residents. The home’s accountant was currently revising the homes procedure for the handling of residents benefit accounts. The home had recently implemented two ways of obtaining views from residents as to how they felt the home was caring for them. One of these was a regular monthly review undertaken by the resident’s key worker. The results of discussions are currently kept in the resident’s case file as part of the daily entry. It is recommended that a short form be devised to record this information and that these forms are kept centrally so that they can be reviewed regularly by the manager and the proprietor. The home also uses a short questionnaire to residents and visitors to obtain views. The results of both these audits should be made available to residents. The home has appropriate servicing and maintenance agreements in place for services and appliances in the home to try and ensure that they are safe for residents. Appropriate fire checks are also carried out. Beech House DS0000053654.V298768.R01.S.doc Version 5.2 Page 21 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Beech House DS0000053654.V298768.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? YES 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 Regulation 14, 15 Requirement The home must undertake social care assessments and formulate social care plans for all residents. (Previous timescale of30/11/05 and 01/03/06 not met). Timescale for action 30/07/06 2. OP7 14, 15 The home must undertake social 30/07/06 care assessments and formulate social care plans for all residents. (Previous timescale of30/11/05 and 01/03/06 not met). Care plans must reflect the current needs of residents. Written instructions by the Dr of any alterations to the time medication are administered must be obtained and available in the record. The provider must make available appropriate training to staff in the recognition and reporting of adult abuse. All appropriate checks must be completed on employees before they commence duty). 01/07/06 30/06/06 3 4 OP7 OP9 14, 15 13 5. OP18 12, 13 30/08/06 6. OP29 19 and schedule 2 30/06/06 Beech House DS0000053654.V298768.R01.S.doc Version 5.2 Page 23 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 OP3 Good Practice Recommendations The home should develop and expand the current the current assessment tool. Risk assessments that involve a score must show this score in any review. The manager should review the availability of activities with residents to ensure that the low availability of activities is what the residents want. All residents should have an assessment on their ability to use and retain a key. Soap, preferably must be in liquid form, available at all times in all toilets. The home should let residents, visitors and staff know the overall outcome from reviews and audits to residents. 2. 3. OP8 OP12 4. 5 6 OP24 OP26 OP33 Beech House DS0000053654.V298768.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ 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 House DS0000053654.V298768.R01.S.doc Version 5.2 Page 25 - 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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