Inspection on 01/09/05 for Beech House

This inspection was carried out on 1st September 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 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 22/09/07

Beech House 20/12/06

Beech House 20/02/06

Beech House 01/03/05

Beech House 18/06/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Beech House 21 Gravelly Hill North Erdington Birmingham B23 6BT Lead Inspector Donna Ahern Announced 1 September 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 E54 S28592 BeechHouse V241582 010905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Beech House Address 21 Gravelly Hill North Erdington Birmingham B23 6BT 0121 428 5000 0121 382 7290 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) Birmingham Focus on Blindness Mrs Lyn Eshelby Care Home 6 Category(ies) of Younger Adults, Learning Disability [6], Sensory registration, with number Impairment [6] of places Beech House E54 S28592 BeechHouse V241582 010905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents must be aged under 65 years. Date of last inspection 1 March 2005 Brief Description of the Service: Beech House is a large detached house situated in the Erdington area of Birmingham, and is within easy walking distance of the local shopping centre. Star city entertainment village with cinemas, shops, restaurants and bowling alleys is a five-minute drive away. The home offers accommodation to six residents with sight loss and learning disabilities. Each resident has his or her own personalised bedroom with en-suite bathroom. The home has a large car park to the front with attractive flower borders; the rear of the home can be accessed via a conservatory and is mostly laid to lawn with flower borders and attractive garden furniture. Beech House E54 S28592 BeechHouse V241582 010905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was announced and took place over one long day. The inspector met and spoke to all the residents. A partial inspection of the physical standards was undertaken. Residents care plans and risk assessments were inspected. Staff records were examined, and a number of Health and Safety records were inspected. The inspector had the opportunity to talk to the manager and three care staff. What the service does well: What has improved since the last inspection? What they could do better: The provider must demonstrate that they can meet the needs of the recently admitted resident. The staff must improve the care plans that they have on residents. These tell the staff how to support each resident. They must be clear about what help and support each residents needs and what the staff must do to help the resident. These must be kept up to date. Beech House E54 S28592 BeechHouse V241582 010905 Stage 4.doc Version 1.40 Page 6 Some of the risk assessments required development so that they are really clear about what the risk is and the support required from staff. Resident’s health information required development including information on how best to support residents who have epilepsy. There were a lot of concerns regarding how staff manage residents medication. Advice and support was provided by the CSCI pharmacist and improvements must be made to ensure that residents are protected by the homes procedures. The complaints procedure required some development so that the provider can demonstrate that all residents are listened to and any concerns are recorded and dealt with. Staff must receive regular supervision so that residents benefit from a well supported staff team. It would be really good if the provider reviewed the layout of the kitchen so that it was better equipped and if a dishwasher was provided to assist staff at the busy times of the day and to promote good standards of hygiene. 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 E54 S28592 BeechHouse V241582 010905 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Beech House E54 S28592 BeechHouse V241582 010905 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4 Information about the home required some minor updating so that prospective residents have the information they need to make an informed choice about the home. The provider must demonstrate their capacity to meet resident’s assessed needs. EVIDENCE: The registered numbers have been increased from five to six people. The statement of Purpose required updating and must include the increase in registered numbers for the home. The document must be dated and kept under review. There have been two recent admissions. The care plan for one of the new residents was examined and it contained details of the single assessment and Social Care and Health care plan. There were no details of the resident’s visits to the home prior to admission. The manager confirmed that introductory visits had taken place. The manager must keep details on the file of these visits. There was some concern regarding one of the residents who had recently moved into the home. The residents assessed needs fall broadly within the registration of the home. Due to the residents physical disabilities bathing and showering presents difficulties. These issues should have been identified prior to admission. The manager said that an assessment of their bathing needs had taken place recently and funding for specialist bathing had been submitted to Social Care and Health. There was evidence that the resident was settling into Beech House E54 S28592 BeechHouse V241582 010905 Stage 4.doc Version 1.40 Page 9 the home and can express their own views about their care. The provider will be undertaking a review after three months to assess the settling in period and to make a decision about the permanency of the placement and if their needs can be met. CSCI must be informed of the outcome. Beech House E54 S28592 BeechHouse V241582 010905 Stage 4.doc Version 1.40 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 9 Further development of residents care plans was required so that an up to date plan of care is in place to ensure that resident’s needs, aspirations and goals are clearly documented and monitored. Some further development of risk assessments was required so that the home can evidence that the risks residents face are well managed. EVIDENCE: Three residents care plans were assessed. There was a lot of information on file and information had been added to the care plan over recent years and presented in different formats. One care plan had not been updated following input from other professionals however the letter from the professionals with their recommendations had been put on the residents file. Daily records were not available for all residents. It was advised that the daily recording systems were reviewed to ensure that a system is in place that promotes the confidentiality of information and ensures that the daily records reflect the residents care plan. A profile on an assessed file was dated 16th April 2003 and required updating. Some files had a care plan structure that referred to “Primary Care Plans” which identified areas that residents required support with as “problems”. Beech House E54 S28592 BeechHouse V241582 010905 Stage 4.doc Version 1.40 Page 11 Development of the care plans was required so that staff can follow a clearly recorded care plan that details how best to support residents with all aspects of their care. Some advice regarding how to develop the care plan structure was shared at the feedback session. The care plans must be kept under review with evidence of a formal review at least every six months or when needs change. The care plan should cross reference to risk assessments and any relevant policies and procedures. Risk assessments required further development. Assessed files had different formats in use. Risk assessments that had been implemented more recently were found to be more comprehensive. Risk assessments must be detailed about what the risk is and the required action by staff to manage the risk. Risk assessments must be specific about the level of staff support. When risk assessments are reviewed there must be evidence that the control measures in place to manage the risk have been reviewed. Residents risk assessments must be reviewed six monthly or when an incident has occurred that may impact on how the home is managing the risk. Beech House E54 S28592 BeechHouse V241582 010905 Stage 4.doc Version 1.40 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: Not assessed. Beech House E54 S28592 BeechHouse V241582 010905 Stage 4.doc Version 1.40 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 20 Some improvements to the recording of resident’s healthcare was required so that there is documented evidence that their health care needs have been met. The arrangements in place for the recording, storage, handling and administration of medication were of concern and had the potential to place residents at risk. EVIDENCE: As stated under standard 6 care plans required further development and must include how to best support residents with their personal support. Health Action Plans commenced in April 2005. It was advised that these require further development including details of what action must be taken to support the resident. Progress on these will be monitored at future inspections. The protocol that was in place for one resident which had been written by the community nurse and required some clarification. It must be clear what action is required by staff. One resident’s epilepsy was under review the manager had requested a referral to a consultant so that the management of their epilepsy could be fully reviewed. Risk assessments in place for residents with epilepsy required further development and must include that staff supervise and remain with residents after a seizure. Beech House E54 S28592 BeechHouse V241582 010905 Stage 4.doc Version 1.40 Page 14 One care plan had not been updated following an assessment by the Speech and Language Therapist. Records of resident weight were infrequent. The manager said that all residents are weighed each month at the day centre. It was agreed that this information would be forwarded to the home and would be documented on resident’s health records. The pharmacist inspector undertook an inspection of the homes medication on the 12th August 2005. A number of matters of concern were raised. It was not possible to demonstrate that the medicines had been administered as prescribed in all instances. Not all quantise of medicines received or balances carried over had been recorded so audits could not confirm correct administration. Medicines had been signed as administered when they had not been. For instances Arthrotec 50, 45 had been recorded as received and 15 recorded as administered therefore 30 should have been left on the premises 33 were counted. There were no written protocols for occasional “when required” medicines for staff to adhere to for the correct and safe administration. Medicines had not been recorded on the Medicine Administration Record (MAR) chart despite being prescribed and available for ambulance staff to administer. Controlled drug entries had not been completed at the time of the inspection but were completed during the inspection. Temazepam elixir was returned on the 8th August 2005 but not recorded in the CD register. The medicine policy did not specify how long to keep dispensed medicines resulting in drugs inappropriately kept on the premises. Gaps were found on the MAR sheets. Prescriptions had not been coordinated to all start at the same time resulting in problems with ordering and supply. One duplicate MAR sheet was found which may lead to the resident receiving the medicines twice and Hydroxyzine was recorded on two separate MAR sheets. There were no staff drug audits undertaken to demonstrate staff competence in medicine management. Beech House E54 S28592 BeechHouse V241582 010905 Stage 4.doc Version 1.40 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, 23 Minor development of the complaints procedure was required so that it clearly states the timescales that the organisation will investigate within so that any resident or complainant is fully informed and the procedure is effective. EVIDENCE: The complaints procedure required some minor development. It must include the timescales that complaints will be addressed in. The complaint log indicated that no complaints had been received since the last inspection. The provider must explore how the procedure could be developed so that it is more accessible to residents. Most residents would not be able to verbally raise a concern or a complaint and are reliant on the staff team to promote and protect their well being. The organisation had an Adult Protection Policy, which was reviewed last year. The Multi- Agency Guidelines were also available. Adult Protection training is scheduled to take place in September 2005. Beech House E54 S28592 BeechHouse V241582 010905 Stage 4.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 26, 30 Residents live in a homely, comfortable and safe environment. EVIDENCE: The home meets all the required minimum physical standards. It was furnished and decorated to a satisfactory standard. Registration has been increased from five to six and two of the bedrooms had been fully refurbished to accommodate the increase. These were found to be very spacious well equipped rooms with ensuite facilities. As raised in previous reports the layout of the kitchen is disappointing. There is minimum work surface space for food preparation and a single drainer sink. It was once again advised that the provider strongly considers the installation of a dishwasher to assist staff at the pressured time following meals. West Midland Fire Services undertook an inspection of the premises on 10th August. They raised some matters that required attention. These had all been actioned appropriately. Beech House E54 S28592 BeechHouse V241582 010905 Stage 4.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34, 35, 36 Staffing levels had appropriately been increased to meet the needs of the new residents. Some additional information was required on staff files so that the provider can demonstrate that residents are protected by the organisations practices. Staff must receive the required supervision so that residents benefit from a well supported staff team. EVIDENCE: Staffing levels have been increased to meet the needs of residents. The manager stated and the rota indicated that there were six support workers on in the morning until all the residents go out to the day centre. In the afternoon/evening there were four staff on duty. At the weekend there were four staff on duty, which is increased, to five in the evening if residents are going out. At night there is one waking night staff and one sleeping in on call. The manager recognised the need to continue to monitor staffing levels to ensure that they are appropriate to meet resident’s needs. The training department is registered with the Learning Disability Awards Framework. The staff training records were examined and indicated that mandatory training is provided to all staff. Some updates and refreshers were required and these were said to be in hand and are scheduled to take place over the forthcoming months, so that staff have the up to date knowledge and skills to support resident’s needs. Beech House E54 S28592 BeechHouse V241582 010905 Stage 4.doc Version 1.40 Page 18 Four staff files were examined and these contained the required information including application form, references, CRB check and proof of identity. Dates of previous employment must include the full details of the dates and not just a year. One staff member’s health declaration was outstanding. Supervision records were assessed and indicated infrequent supervision over the last twelve months. Regular supervision must be provided for all staff at least six per year with records kept. Beech House E54 S28592 BeechHouse V241582 010905 Stage 4.doc Version 1.40 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 42 The health, safety and welfare of residents were generally well managed with specific areas requiring further development. The provider must keep CSCI informed of the progress of appointing a manager who is competent and experienced so that residents benefit from a well run home. EVIDENCE: The registered manager had resigned her position and was due to leave just after the inspection. The provider had informed CSCI of the temporary management arrangements, which included support from a manager from another, registered service and support from a senior staff member who works within the organisations day services. The post for a permanent manager had been advertised. A number of required records were examined including risk assessments for the environment, fire records, gas safety, lift maintenance and were all found to be in good order. Beech House E54 S28592 BeechHouse V241582 010905 Stage 4.doc Version 1.40 Page 20 Some further development of residents risk assessments was required. The Work Place Fire Risk assessment had been developed as required by West Midland Fire services. The management of medication was a concern as stated under standard 20. The development of resident’s documentation was required as raised under standard 6 and 9. Beech House E54 S28592 BeechHouse V241582 010905 Stage 4.doc Version 1.40 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 2 2 2 x Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x 3 x x x 3 Standard No 11 12 13 14 15 16 17 x x x x x x x Standard No 31 32 33 34 35 36 Score x x 3 2 3 1 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Beech House Score 2 2 1 x Standard No 37 38 39 40 41 42 43 Score 3 x x x x 2 x E54 S28592 BeechHouse V241582 010905 Stage 4.doc Version 1.40 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Standard 1 3 4 6 9 and 42 18 19 19 19 20 Regulation 4 (1) c Schedule 1 14 (1) and (2) 14 (1) 15 (1) (2) Requirement The Statement of Purpose required some updating. The provider must demonstrate their capacity to meet one residents needs. The provider must keep written details of any visits to the home prior to admission. Care plans required further development. Timescale for action 31 October 2005. 30 November 2005. 30 September 2005. 31 December 2005. 30 November 2005. 30 September 2005. 30 September 2005. 30 September 2005. 30 November 2005. 19 August 2005 and ongoing. Page 23 13 (4) abc Risk assessments required further development. 13 (1) (b) 13 (4)abc 12 (1) ab 12 (1) (2) 13 (2) Care plans must be updated following input and advice from other professionals. Risk assessments for residents with epilepsy required some development. Clarification was required regarding the management of one residents epilepsy. Health Action Plans required further development. All medicines received into the home must be accurately recorded to ensure there is no mishandling. Beech House E54 S28592 BeechHouse V241582 010905 Stage 4.doc Version 1.40 11. 12. 20 20 13 (2) 13 (2) 13. 20 13 (2) 14. 20 13 (2) 15. 20 13 (2) 16. 17. 18. 23 34 36 22 (4) 7,9,19 schedule 2 18 (2) All medicines the service users are currently prescribed and administered must be recorded The prescriptions must be seen prior to dispensing, checked and a system installed to check the prescribed medication against the dispensed medication received. The manager must undertake staff drug audits to confirm staff competence in medicine management and take appropriate action when discrepancies are found. The receipt, administration and disposal of controlled drugs must be recorded in a controlled drug register and witnessed by a second member of staff. Protocols must be written for the safe administration of “when required” medicines in liaison with a clinician. The complaint procedure required some additions. Staff files must contain all the required information. Staff must receive supervision six times per year with records kept. 19 August 2005 and ongoing. 10 September 2005. 10 September 2005 and ongoing. 13 August 2005 and ongoing. 10 september 2005. 31 October 2005. 31 October 2005 31 November 2005 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 20 Good Practice Recommendations It is advised that the prescriptions are synchronised and dispensed to start at the same time for all the service users within the home to simplify the ordering and receipt of medicines. It is advised that a dishwasher is provided and a review of the layout of the kitchen takes place. E54 S28592 BeechHouse V241582 010905 Stage 4.doc Version 1.40 Page 24 2. 24 Beech House Beech House E54 S28592 BeechHouse V241582 010905 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection Birmingham & Solihull Local Office 1st Floor, Ladywood House 45-46 Stephenson Street Birmingham, B2 4UZ 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 E54 S28592 BeechHouse V241582 010905 Stage 4.doc Version 1.40 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!