CARE HOMES FOR OLDER PEOPLE
Beech House Chapel Lane Barton upon Humber North Lincolnshire DN18 5PJ Lead Inspector
Beverley Hill Unannounced Inspection 13th July 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Beech House DS0000044474.V295670.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 DS0000044474.V295670.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Beech House Address Chapel Lane Barton upon Humber North Lincolnshire DN18 5PJ 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) 01652 635049 beech.house@fshc.co.uk www.fshc.co.uk Tamaris Healthcare (England) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Jennifer Anne Hololob Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Beech House DS0000044474.V295670.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 6th January 2006 Brief Description of the Service: Beech House is situated in the centre of Barton on Humber, close to local shops and amenities. It is registered to provide support and care for up to thirty older people. The home is a mixture of old and new buildings over two floors, serviced by a passenger lift and stairs. There are twenty-two single bedrooms, sixteen of which are en-suite and four double rooms, one of which is en-suite. The upper floor has a further raised level accessed via five stairs. There are two bedrooms and one unassisted bathroom in this area, which is only accessible to more ambulant service users. There are two assisted bathrooms, one of which has a bath lift and the other a parker bath. A walk in shower room with hairdressing sink is provided on the ground floor. A forth bathroom is now used as a storeroom. There are a further five single toilets throughout the home. The home has two lounges, the larger of the two having two dining tables at one end. There is also a separate dining room. Both lounges have patio doors that have access to a paved area with garden furniture. There is a quiet seating area in the entranceway. The enclosed rear garden is well maintained. Car parking space is available at the front and side of the building. According to information received from the home on 02.06.06 their weekly fees are £312 when funded by care management with a £30 top up fee for a single bedroom and £410-£420 for privately funded service users. Items not included in the fee are toiletries, hairdressing and chiropody. Information about the services the home provides is kept in each of the service users bedrooms. Beech House DS0000044474.V295670.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over one day. Throughout the day the inspector spoke to six service users and a relative to gain a picture of what life was like for people who lived at Beech House. The inspector also had discussions with the manager, an administrator, one senior carer, three carers, an activity coordinator, the maintenance person and a student speech and language therapist who was on placement at the home. The inspector looked at assessments of need made before people were admitted to the home, and the home’s care plans to see how those needs were met while they were living there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. The inspector also checked with service users to make sure that privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. The inspector also observed the way staff spoke to service users and supported them, and checked out with them their understanding of how to maintain privacy, dignity and choice. Prior to the visit to the home the inspector had sent out a selection of surveys to service users, some family members, a selection of staff members and professional visitors to the home. Those returned were checked and comments used throughout the report. Out of fourteen returned from service users ten stated they ‘always’ received the care and support they needed whilst the remaining four stated this was ‘usually’ received and all fourteen felt that staff listened to them and acted on this. However only six felt that staff members were ‘always’ available when they needed them, the other replies were ‘usually’ and ‘sometimes’. All three replies from relatives stated that they felt there was, ‘insufficient staff members on duty’ and one commented that, ‘care standards varied depending on which staff was on duty’. Two out of nine staff surveys indicated there were not always sufficient staff members on duty and discussions during the day with staff confirmed this view. One service user also commented that, ’there are outstandingly good staff who compensate for one or two less competent ones’. Staff members indicated they enjoyed their jobs and felt well supported and the reply from the district nurse commented that, ‘service users were happy with their care provision’. They had also ticked the boxes that stated they were satisfied with the overall care, communication was good and there was always a senior to converse with. What the service does well:
Beech House DS0000044474.V295670.R01.S.doc Version 5.2 Page 6 The home made sure that service users had their needs assessed prior to admission to make sure they were able to meet them and the manager was careful that only people whose needs they could meet properly were admitted to the home. An assessment of social needs was also completed and this included preferences, likes and dislikes and a personal history. This was important as staff members need to be fully aware of social needs as well as personal care and health needs so they provide a complete service for people. The home provided a well balanced diet with choices and alternatives. Twelve survey replies indicated that there was a good choice of food; meals were plentiful and well presented and one person described them as, ‘out of this world’, although another stated the evening meals were not as good as the main meal at lunch. Service users spoken to liked the food and one person described it as, ‘excellent’ whilst another said, ‘I wouldn’t want to change anything, you always get two choices at lunchtime and I like ham sandwiches and toasted teacakes for tea’, yes you get enough to eat and drink’. The staff have developed good relationships with relatives and visitors to the home and notice boards in the entrance gives lots of information about what is going on to service users and visitors. The home has a friendly, welcoming atmosphere and on the whole is kept clean and tidy. What has improved since the last inspection?
The manager and staff team had worked hard to make sure most of the things the inspector asked them to do at the last inspection had been completed. There were still a few things outstanding. See below in the section, ‘what they could do better’. One thing that had made a difference to service users was the employment of an activity coordinator. They organised more activities for people to participate in and one person stated, ‘the new activity coordinator has made a wonderful contribution, thank you’. Risk assessments had improved and care plans had been updated to a new style, which made it clearer to see the tasks that staff members had to complete to assist people. It is important that staff members are aware of what they need to do to meet peoples’ needs otherwise care may be missed. However in two of the three care plans examined not all the persons needs had been recorded, see below. The manager had successfully completed an application to be registered with the Commission for Social Care Inspection. They were working on management tasks such as staff supervision, training and the monitoring of the quality of the service provided. They had also ensured that documents that need to be kept secure were locked away.
Beech House DS0000044474.V295670.R01.S.doc Version 5.2 Page 7 What they could do better:
Although there had been some improvement in the care plans, they still didn’t always give a full description of people’s needs. For example some people had a need to maintain their independence in certain areas such as eating or shaving independently. This may just need monitoring so that it continues, but it still needs to be written down. If things are not written down staff may complete tasks for people that they are able to do themselves or they may think they are able to do them and not offer assistance. Either way needs may not be met. Generally medication was managed well but there were two things that needed attention. When staff members administer certain medication they need two signatures for safety as is indicated in the homes policy but when checked on four occasions there was only one signature. Also a mistake had been made in documenting the amount of stock the home had for one medication. Care must be taken to follow medication policies and procedures or mistakes will be made and service users could be at risk. Not all staff had completed training in the protection of vulnerable adults from abuse. This was really important, as all staff must know what to do and who to tell if they suspect abuse has occurred. Also not all staff had up to date certificates in other important training and staff supervision had only just started. The manager needs to make sure that all staff members have the necessary skills to be able to do the job of caring for older people or care will be missed. Some people were not sure how to complain even though the complaints procedure was displayed in the home. This may need to be displayed more prominently and brought up in meetings so everyone is fully aware. The home had the correct amount of staff on duty in terms of numbers but returned surveys and discussions with staff and service users showed there were some difficulties especially at weekends and care staff doing some catering staff tasks. This might just be how the rota is managed or what the staff members were actually doing during their shift. It also had something to do with the changing circumstances of some staff members, which the manager was aware of. It needs to be looked at so that people feel there is sufficient staff on duty at all times. When the residents fund was checked it was noted that a mistake had been made and money had been taken out for a staff members transport to a training course. This was refunded to the fund. Although the home had started sending out questionnaires to people about the quality of the service provided, the results had not been checked and a plan had not been made to sort out any problems that had been identified in them. Also questionnaires had not been sent to professionals such as district nurses,
Beech House DS0000044474.V295670.R01.S.doc Version 5.2 Page 8 care management and GP’s. It was important to look at the questionnaires quickly and deal with things and also to get the full range of views. 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 DS0000044474.V295670.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beech House DS0000044474.V295670.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users had assessments of need completed prior to admission and the home obtained copies of assessments completed by care management. This enabled the home to have full information about the service user in order to meet needs. The home offered visits and trial stays so people could assess the services provided by the home. EVIDENCE: The home evidenced that service users were only admitted after an assessment of need had been carried out either by the manager or by care management when funded by them. The home obtained copies of care management assessments. This enabled them to make a decision as to whether the persons’ needs could be met. After the assessment the manager formally wrote to the service user or their representative stating the homes capacity to meet needs. Beech House DS0000044474.V295670.R01.S.doc Version 5.2 Page 11 The home had appropriate moving and handling equipment to meet the needs of the current service users and staff members had developed good working relationships with professionals who visited the home. Staff described how they supported someone during admission to settle in, introducing them to other service users, showing them around and unpacking belongings. Service user guides were in each of the bedrooms. The manager and staff confirmed that the home offered short respite stays or visits for a meal and this enabled people to see what the home was like. The home had two service users currently using the respite service. Surveys indicated that two people, whilst in hospital, were visited by the homes staff to give them information about the home and another mentioned a respite stay prior to a permanent decision being made. Beech House DS0000044474.V295670.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. To ensure service users assessed needs were met and maintained, the home needed a consistent approach to care planning and support. Staff generally supported service users in a way that promoted privacy and dignity. Improvements were required in the management of medication to ensure policies and procedures were followed after administration and service users received the medication prescribed for them. EVIDENCE: There had been some improvement in care plans, as they were now all in the same style, but there was still a tendency to miss certain needs. The care plans focussed on problems and those that were highlighted had clear tasks for staff that reflected the need to maintain privacy and dignity. One of the three care plans examined had missed needs relating to the maintenance of the service users independence skills in areas such as personal care and eating and drinking, and some needs highlighted on assessment such as continence promotion, communication, emotional well being and social stimulation had not
Beech House DS0000044474.V295670.R01.S.doc Version 5.2 Page 13 been care planned. All the care files had appropriate assessment and general risk assessment information in relation to moving and handling, nutrition and pressure areas and individual risk assessments as required for particular activities such as smoking, self-medication or falls. Care plans were evaluated monthly and there was evidence that changes in need had resulted in a change to the care plan. The inspector observed staff attempting to ensure that a service user maintained their independence whilst eating their main meal but the service user was really struggling to cut their food and required some assistance which was supplied, but too late for the meal to be enjoyed properly. The presence of the inspector may have affected staffs’ behaviour in this instance as the manager assured that the service user was usually offered support. Staff members need to be able to judge the changing or fluctuating needs of service users and when they require assistance. Apart from this one incident, service users spoken to felt that staff members carried out personal care tasks in a way that respected privacy and dignity. One person spoken to told the inspector they had received very good support from the manager during a recent bereavement. Service users spoken to felt their health needs were met and surveys received confirmed this. A survey returned from a visiting health professional stated, ‘the residents I see are happy with their care provision’ and they had ticked the box indicating their satisfaction with the overall care provided. Out of three surveys from relatives two had indicated their satisfaction with care, although one did state it depended on which staff was on duty, and another stated their dissatisfaction and this was followed up. See staffing. Generally medication was managed well but four entries for Temazepam medication had only one signature and a documentation error had been made in calculating the stock of a controlled drug, which meant that the actual stock did not tally with the recorded stock. The medication administration record for one service user had not been adjusted appropriately on their return from hospital. These issues were resolved on the day. Beech House DS0000044474.V295670.R01.S.doc Version 5.2 Page 14 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 good. This judgement has been made using available evidence including a visit to this service. The home provided nutritional meals, flexible routines and enabled service users to make choices about aspects of their lives. EVIDENCE: The inspector witnessed open visiting and service users confirmed their relatives were always made welcome. In discussions they also stated they were satisfied with the food provided and they could make choices about aspects of their lives such as when to get up and retire, activities, meals, the colour scheme of their room and whether they wanted to remain in their bedrooms during the day. Documentation and a check of the premises showed that some people chose to have their own telephone and manage their own finances and medication. The inspector observed staff respecting peoples’ choice of where to sit in the dining room. There were certainly signs of well being in the home especially at lunchtime when service users met and it became a social occasion for most. Menus looked varied, catered for special diets such as diabetics and a vegetarian and the meal sampled was well cooked and presented. One service user stated, ‘ the food is brilliant and there are always two to three vegetables
Beech House DS0000044474.V295670.R01.S.doc Version 5.2 Page 15 at each meal’. Service user surveys were positive about meals although one did indicate that the main meals were better than those at teatime. There were no menus on display in the dining room although staff went around the day before and asked service users for their menu choices. The employment of an activity coordinator had enhanced the quality of life for people in this area and surveys from service users indicated an improvement. One person described how they liked to be, ‘useful’ by folding napkins around cutlery. Two surveys indicated that people preferred not to join in activities whereas three stated that there were sufficient activities ‘sometimes’. This last statement may mean that the home have not got it quite right for everyone, although individual logs were maintained and these showed a range of activities including individual walks around the garden and to the shops as well as group games and visiting entertainers. Beech House DS0000044474.V295670.R01.S.doc Version 5.2 Page 16 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 adequate. This judgement has been made using available evidence including a visit to this service. The uncertainty some service users and relatives expressed about the complaints process could mean that issues were not dealt with straight away and the lack of training in adult protection for all staff could place service users at risk. EVIDENCE: The home had a complaints procedure and forms to complete should anyone make a formal complaint. Although staff stated in discussions that the senior in charge or the manager would be informed should there be any complaints some were unsure of where the complaints forms were. All three relatives survey results indicated they were not fully aware of the complaints process although one stated they would see the manager. Five service user surveys indicated they were unsure of how to complain, although two stated they had never had to, and four felt they were unsure of whom to speak to if they were not happy. Given the results of surveys the complaints procedure needs to be explained to service users and displayed more prominently. Three service users spoken to stated they would complain if they needed to although none had. They would, ‘go to the office’ or they would, ‘see Jenny’ if they had a complaint. Not all staff had received training in the protection of vulnerable adults from abuse and this was confirmed in staff surveys where four indicated little
Beech House DS0000044474.V295670.R01.S.doc Version 5.2 Page 17 knowledge about it and whistle blowing policies. However some care staff members spoken to during the inspection were clear about the action to be taken should they suspect abuse has taken place. All ancillary staff as well as care staff must receive training in how to recognise abuse has taken place and who to refer this information to. The manager was very clear about their responsibilities in referring to social services. Beech House DS0000044474.V295670.R01.S.doc Version 5.2 Page 18 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 good. This judgement has been made using available evidence including a visit to this service. The home provided a clean and safe environment for people who live and work there and service users were able to personalise their bedrooms. EVIDENCE: The home was clean, fresh smelling and tidy and the domestic staff obviously tried hard to maintain standards. Out of fourteen service user surveys nine felt the home was clean and fresh, ‘always’ and the rest stated, ‘usually’. One person stated, ‘my room is cleaned every day’ and another ‘standards are continuing to improve’. Relatives also stated the home was clean although one did state that insufficient staff did lead to the bedrooms not being cleaned as thoroughly as they would like all the time. Service users spoken to were happy with their rooms and those examined were clean personalised to varying degrees. Bedroom doors had lockable facilities and privacy locks to the doors. Beech House DS0000044474.V295670.R01.S.doc Version 5.2 Page 19 The two lounges looked homely and both had access to a patio area, which had garden furniture and parasols. The garden was well maintained and the activity coordinator pointed out tubs that had been filled by service users during a recent activity. The maintenance person confirmed all bedrooms had been repainted at least once in the last two years and service users had the choice of colours. They completed maintenance tasks as and when they occurred to ensure problems did not escalate and completed daily, weekly and monthly environmental checklists as part of their role. Beech House DS0000044474.V295670.R01.S.doc Version 5.2 Page 20 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 this service. Generally competent and willing staff members supported service users but there were gaps in training and sometimes staff availability and levels of competence, which had affected the care received. The current system of staff recruitment lacked robustness necessary for the protection of service users. EVIDENCE: There was a skill mix of staff and the amount of hours provided appeared to meet the requirements of current service users, however all three relatives surveys and two care staff surveys indicated that there were insufficient staff at times or the care fluctuated depending on who was on duty. When checked out with one relative this related to weekend cover when they thought staff had less direction and ‘authority’ and when, it was perceived, more shortages occurred. There were also changing personal circumstances for some staff and this had affected rota management. The manager was aware of this and was attempting to resolve the situation. One service user survey also indicated that some staff members were more competent than others, but general comments about staff attitude and approach were good. Throughout the day staff were observed chatting to people in a friendly, pleasant way and were appropriately tactile. One person described how they
Beech House DS0000044474.V295670.R01.S.doc Version 5.2 Page 21 liked to make their own bed and on doing so one day, staff had placed a label on their door saying, ‘Super Duper Pensioner’. They were thrilled by this and enjoyed a bantering relationship with staff members, they stated, ‘they give me a cuddle and ask if I’m alright’. The home had a training plan and matrix, which indicated who had current certificates in mandatory and service specific training. There were some gaps in mandatory training, although all had completed fire training and most moving and handling. There were sufficient staff members with first aid certificates to ensure shifts were covered and staff induction met requirements. The manager confirmed that some staff were not fully aware of their key worker role and responsibilities hence key worker logs were not maintained and this was to be addressed in supervision and training sessions. Because of staff turnover not all those administering medication had completed accredited medication training, although the manager had ensured that five staff had been enrolled onto a five-module, distance-learning course. 22 of care staff had completed national vocational training in caring for older people at level 2. Staff recruitment required a review to ensure service users were protected, as two of the three staff files examined evidenced that appropriate references were not always obtained. Beech House DS0000044474.V295670.R01.S.doc Version 5.2 Page 22 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, 32, 33, 35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements had been made in the overall management of the home. However areas such as staff supervision and deployment, service user consultation and the expansion and completion of the quality assurance process needed further attention to be effective for the benefit and safety of service users. EVIDENCE: The manager had recently successfully completed an application to be registered with the Commission for Social Care Inspection and expected to complete her Registered Managers Award in November 2006. She had made improvements in the way the home was managed and service users, staff and relatives spoken to all commented on the difference her management style had produced within the home and to the care received by the service users.
Beech House DS0000044474.V295670.R01.S.doc Version 5.2 Page 23 Surveys indicated that staff felt supported and had direction and two service users spoken to commented on the managers caring nature during their particular difficult situations. Improvements had been noted in systems such as staff supervision and records confirmed that care staff had all received at least one supervision session since the last inspection, although they need to receive six sessions a year so a more focussed approach was required. A variety of staff meetings were held but there appeared to be limited service user consultation through meetings, as only relatives seemed to attend these. The inspector suggested smaller group meetings or 1-1’s with service users if larger meetings were not proving an effective way of obtaining service users views about how the home was managed. The home did obtain views via their quality assurance questionnaires but the ones completed in January 2006, along with staffs’ views had not been analysed and actioned yet. The quality assurance system needs expanding to obtain the views of visiting professionals such as GP’s, district nurses and care management staff to give a range of views. Other sections of quality monitoring were completed with regular audits and checks. Service users personal allowance was well managed via a computerised system and those who were able to managed their own and had lockable facilities in their bedrooms. Individual logs were maintained and receipts tallied with expenditure. The inspector noted that an amount was deducted from the residents fund to pay for a staff members travel expenses for a training course. This was discussed with the manager who stated this was an error and the amount was refunded. General health and safety was maintained via adherence to policies and procedures, staff training and the maintenance of equipment. However it was observed that in a morning care staff completed domestic duties in the kitchen, which detracted them from caring, was unnecessary as catering staff were present and created infection control hazards by excessive movement in and out of a kitchen area. The manager was aware of this situation and must address it. Beech House DS0000044474.V295670.R01.S.doc Version 5.2 Page 24 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 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 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 2 17 X 18 2 3 X X X X 3 X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 2 2 X 2 Beech House DS0000044474.V295670.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP18 Regulation 13(6) Requirement The registered person must evidence that all staff have completed or are planned to complete adult protection training (previous timescale of 31/03/06 not met) The registered person must ensure that all staff members have plans to complete mandatory training with updates as required (previous timescale of 31/03/06 not met) The registered person must ensure that care plans reflect all the assessed needs and refer to the assistance required to maintain service users independent skills and fluctuating needs. The registered person must ensure that Temazepam medication is signed for appropriately on administration, care is taken when documenting new stock into the home and the home develops a self audit
DS0000044474.V295670.R01.S.doc Timescale for action 31/10/06 2. OP30 18(1)(a) 31/10/06 3. OP7 15 31/08/06 4. OP9 13(2) 11/08/06 Beech House Version 5.2 Page 26 5. OP27 18 6. OP29 19 7. OP30 18 8. OP33 24 9. OP36 18(2) 10. OP38 12(1)(a) & 16(j) system for medication. The registered person must ensure that the rota is reviewed to reflect the changing circumstances of some staff members and the affect this has on care provision, and examine the weekend cover to ensure competent senior staff cover. The registered person must ensure that the recruitment process includes appropriate references for staff. The registered person must ensure that senior care staff have the required skills and knowledge to manage shifts in the absence of the manager especially at weekends. The registered person must ensure that service user consultation about how the home is managed is improved, and the quality assurance process is completed by analysing survey results and actioning shortfalls. The quality assurance system must be expanded to include the views of other stakeholders and the results of surveys must be made available to service users and visitors and a copy forwarded to the CSCI. The registered person must ensure that all care staff members are on track to receive a minimum of six formal supervision sessions per year. The registered person must ensure minimum amount of traffic in and out of the kitchen area to improve health and safety and infection control measures. 11/08/06 11/08/06 31/08/06 31/10/06 31/10/06 11/08/06 Beech House DS0000044474.V295670.R01.S.doc Version 5.2 Page 27 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 OP16 Good Practice Recommendations The manager should ensure that all service users, visitors and staff are aware of the complaints process and documentation, given the comments received in some surveys. The home should continue to work towards 50 of care staff trained to NVQ Level 2. The manager should ensure that all care staff are aware of their roles as key workers and how to complete the appropriate documentation. The manager should continue to work towards completion of her Registered Managers Award. The manager should obtain guidance regarding the deduction of monies for staff training expenses from the residents fund. 2. 3. 4. 5. OP28 OP30 OP31 OP35 Beech House DS0000044474.V295670.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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