Inspection on 14/08/07 for Beech House

This inspection was carried out on 14th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Beech House 19/04/06

Beech House 01/08/05

Beech House 18/02/05

Beech House 14/04/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Beech House 68 Manchester Road Heywood Lancashire OL10 2AP Lead Inspector Jenny Andrew Unannounced Inspection 14th August 2007 08:15 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 DS0000025463.V346832.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 DS0000025463.V346832.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beech House Address 68 Manchester Road Heywood Lancashire OL10 2AP 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) 01706 368710 F/P 01706 368710 beechhousecare@hotmail.co.uk Prylor Properties Ltd Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Beech House DS0000025463.V346832.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered for a maximum of 27 service users to include: up to 27 service users in the category of OP (Older People). The service should employ a suitably qualified and experienced manager who is registered with the CSCI. 31st October 2006 Date of last inspection Brief Description of the Service: Beech House is a care home providing personal care and accommodation for up to 27 older people and is owned by Prylor Properties Limited. No nursing care is provided. The home is situated approximately one mile from Heywood town centre and is on bus routes to and from Rochdale, Middleton and Bury. The M62 motorway network is within easy driving distance of the home. Beech House is a traditional Victorian style building, which has been converted and extended to provide accommodation in 27 single rooms, one of which has en-suite facilities. A variety of lounges is available, including one where smoking is permitted. A garden area is available to the front/side of the home and ramped access is provided to the front door. A car park is provided for approximately five cars and further car parking is available in the lane to the side of the home. The weekly fee is £334.98 as at 1 August 2007. Additional charges are made for private chiropody, hairdressing, newspapers, toiletries and providing an escort for hospital or Doctors appointments. The provider makes information about the service available upon request in the form of a Service User Guide and Statement of Purpose, which is given to new residents. A copy of the most recent Commission for Social Care (CSCI) inspection report is displayed within the home and also contained in the service user guide. Beech House DS0000025463.V346832.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The staff at the home did not know this visit was going to take place. The visit lasted nine hours, with the inspector arriving at 08:00 and leaving at 17:00 hours. The inspector looked around parts of the building, checked the records kept on service users to make sure staff were looking after them properly, as well as looking at how the medication was given out. The files of three members of staff were also checked, to make sure the home was doing all the right checks before they let the staff start work. In order to obtain as much information as possible about how well the home looks after the residents, the provider, manager, seven residents, the activity worker, two care assistants, the cook, domestic and two relatives were spoken to during the visit. Before the inspection, comment cards were sent out to residents and relatives/carers asking what they thought about the care at the home. Eight residents and two relatives filled the cards in and returned them to the Commission for Social Care Inspection (CSCI) and this information has also been used in the report. Before the inspection, we also asked the manager of the home to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what the management of the home feel they do well, and what they need to do better. This helps us to determine if the management of the home see the service they provide the same way that we see the service. Overall, we felt this form was completed honestly but some sections had been duplicated and did not address the relevant standards. A random inspection took place on 31 October 2006 to check whether the requirements made at the last key inspection had been done. There were two requirements outstanding at that time. On this inspection they had been addressed. The Commission for Social Care Inspection has not undertaken any complaint investigations at the home since the last key inspection. Beech House DS0000025463.V346832.R01.S.doc Version 5.2 Page 6 What the service does well: The atmosphere in the home was warm, relaxed and friendly. One relative commented, “Whilst the home has a nice friendly atmosphere, staff have a professional attitude to their work”. Residents had good relationships with the staff and appeared happy and content. Staff were observed being kind, caring and patient when assisting people in daily living tasks. Residents described staff as “excellent”, “very nice”, “really good”, “smashing” and “fine”. Other comments included, “Didn’t think I would settle but I have”, “I have no grumbles at all”, “I’d recommend the home to anyone”, “I’m well looked after” and “I love being here, I feel safe and cared for”. Relatives also felt the care was good, stating that staff were good at letting them know if there were any problems and also felt they were made welcome. One relative commented, “Nothing is too much trouble and staff are always available to speak to you.” The care plans were detailed, easy to read and showed what residents’ preferred routines and likes and dislikes were. This ensured the staff had the information they needed to meet people’s needs. The home was good at making sure residents’ health was well taken care of by sending for district nurses, and other health care workers whenever they felt they were needed. Residents said they felt happy and cared for. The visiting District Nurse said the residents always looked well cared for and that staff always followed any instructions she gave to them. Staff were making sure they treated people with respect and when assisting them with personal care tasks, were upholding their privacy and dignity. Residents were very pleased with the quality and choice of the food offered to them at each mealtime. They commented as follows: “It’s really good”, “There’s always a choice, “I’m a fussy eater but the food is good”, “Pretty good and you can have different things for supper” and “Lovely home cooked food. The owner had continued to make improvements to the environment so that it would be a more pleasant place in which to live. The building was clean and well maintained. The owner and manager knew how important it was for the staff to get the right kind of training and made sure they attended courses so they would be able to care for the residents safely. More than half of the carers had now done training courses in how to look after the people in their care. These are called NVQ qualifications. The home was being well managed and staff were receiving the right kind of help and support so they could do their jobs well. Beech House DS0000025463.V346832.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Beech House DS0000025463.V346832.R01.S.doc Version 5.2 Page 8 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 DS0000025463.V346832.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents were assessed before admission to the home to ensure their needs could be fully met. Standard 6 was not assessed as the home does not provide intermediate care. EVIDENCE: At the last key inspection, the statement of purpose/service user guide were in need of updating to accurately reflect the services offered to residents. This had now been done and a copy of the contract and complaints procedure had also been included. Each resident had been given a copy of the revised document and these were seen in some of the bedrooms that were visited. A copy of the last inspection report was displayed within the home and included in the statement of purpose/service user guide. Beech House DS0000025463.V346832.R01.S.doc Version 5.2 Page 10 The manager said she visited any new people in their own homes or in hospital to undertake her own assessment of their needs, so she would be clear as to whether they could provide the right level of care. Assessments for four people were checked, one for someone who had lived at the home for over a year, two for people who had been admitted in June 2007 and one for a resident who had only lived at the home for three days. Fully completed inhouse assessments were in place for three people as well as Local Authority Level 3 assessment documents. The person who had only very recently been admitted told the inspector that the manager had visited him in hospital and he said the home was caring for him well. When checking this person’s file however, only a part completed pre-admission form was found. The manager said she had also received assessment documentation from the Local Authority but had misplaced it and, during the inspection, telephoned to ask for replacement information. The manager should ensure that pre-admission documents are fully completed before being placed on file. Some of the residents living at Beech House were mentally frail. In order to ensure the staff fully understood how to meet their needs, training in dementia care had been undertaken by many of the staff. Another in-house course had been booked in September when a further nine staff were due to attend, including the cook and handyman. Beech House DS0000025463.V346832.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. There was a clear consistent care planning system in place, which provided staff with the information they needed to meet the needs of the people for whom they cared. EVIDENCE: At the last key inspection, shortfalls had been identified in respect of lack of moving/handling assessments and inconsistent weighing of residents at high risk of malnutrition. These had now been satisfactorily addressed. On this visit, the care plans of three residents with differing needs were checked. The care plan format had been changed and the plans were easy to read and reflected a full range of needs of each person, together with action required to meet their identified needs. Beech House DS0000025463.V346832.R01.S.doc Version 5.2 Page 12 They detailed people’s preferences in respect of times for rising and retiring, noted people’s individual likes/dislikes and also recorded about the need for staff to ensure their privacy and dignity were upheld when assisting with personal care. The care plans had been drawn up in full consultation with each person and, where possible, the individual had signed to say this. A key worker system was in place and key workers were responsible for drawing up social histories with their residents. These were seen on the plans inspected. When checking assessment documentation, it was noted there was no care plan in place for the most recently admitted resident who had only lived at the home for three days. The manager said this would be done within the next couple of days. A risk area had however, already been identified and an assessment was in place. Key workers were responsible for the reviewing of care plans on a monthly basis. In some instances, where it had been noted on the review notes that changes to a person’s needs had taken place, the care plan had not always been updated to reflect this. The manager said she would address this. Risk assessments were in place in respect of moving/handling, nutrition, skin care, falls and any other identified risk area. With the exception of nutrition, which was reviewed monthly, these were updated approximately three monthly. Discussion took place with the manager in respect of reviewing these more frequently if a person’s needs changed before the due date. One resident had a high incidence of falls recorded and the management team were doing their best to try and prevent further falls. The falls had been well documented on accident records, the falls co-ordinator’s advice had been sought, there was a fall risk assessment in place and a pressure mat had been purchased which alerted staff at night when the resident was trying to get out of bed unsupervised. The care plan section on mobility partially addressed the risks but the manager was advised to record more fully the action needed to try and reduce the high risk to the resident. Advice was also given to the manager in respect of keeping a record of times and places of falls so that it can be more easily identified if there is any set pattern to the falls. Health care needs were well recorded and care plans addressed continence, sight/hearing, feet, mobility, oral care, toileting, diet and bathing. Referrals were made for eye and hearing tests as needed and evidence on one care plan showed that since one resident’s admission, arrangements had been made for a sight test and new hearing aid. One returned relative comment card said “the staff always notice medical issues” and both confirmed that they were kept up to date of important issues affecting the person they visited and that they felt the needs of their relatives were always being met. Beech House DS0000025463.V346832.R01.S.doc Version 5.2 Page 13 Following a recommendation made at the last key inspection, sitting scales had been purchased and the frailer residents were now able to be accurately weighed. The MUST tool (Malnutrition Universal Screening Tool) was being used for new residents and for those who were at high nutritional risk and action plans were written and followed. None of the residents had any pressure sores and this was confirmed by the visiting District Nurse who was spoken to during the inspection. She stated that residents always looked well cared for, the staff had a good attitude with the residents, they adhered to any instructisons given and that residents could get up in a morning at whatever time they liked. She further stated that the home had implemented a district nurse communication book which was kept in the ground floor office. She said this was useful for both staff and nurses as if the staff were busy, she could check the book to see if any problems had been identified or to record additional instructions to the staff. Residents spoken to said that if they needed a doctor, the staff always telephoned for a visit. All visits by professional visitors were recorded on individuals’ files, together with the action needed as a result of the visit. Medication storage, administration and recording systems, including controlled drugs, were examined. The systems were up to date and accurate ensuring residents were receiving their medication as prescribed. All the medication was securely stored and the records were maintained in line with good practice guidelines. One area for improvement was identified in respect of recording on the medication administration record any nutritional supplements in order to ensure they are given as prescribed. Residents spoken with all felt their privacy and dignity were respected and that the staff treated them with kindness. The home’s in-house quality assurance feedback questionnaires from residents also indicated their privacy and dignity needs were being upheld. As all rooms were single, residents were able to receive visitors in private or choose to remain in the lounge. Cordless telephones were available so that residents could choose to take personal calls in the privacy of their bedrooms. Observations made during the visit showed residents to be appropriately dressed, hair care, shaving and nail care had been attended to and residents were discreetly asked if they wanted the toilet. Care assistants were able to give examples of how they ensured people’s privacy was protected when they were assisting with personal care tasks. Examples given were: lock bathroom doors so other staff don’t walk in, keep people covered with towels when getting them dressed, undressed, knocking on bedroom or toilet doors before entering and waiting outside toilets if this is the person’s wishes. Beech House DS0000025463.V346832.R01.S.doc Version 5.2 Page 14 Over 50 of the staff had completed their NVQ level 2 training where privacy and dignity is addressed. The home’s policies and procedures and aims/ objectives also addressed this important care issue. When reading an in-house questionnaire completed by one resident, an area for improvement was made, which was to provide separate toilets for male and female residents. This was discussed during the visit and the manager will consider this provision on the ground floor, in view of the number of male residents currently living at the home. Beech House DS0000025463.V346832.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents were encouraged and supported to exercise choices in their daily routines in relation to lifestyle, food and activities and to maintain contact with their relatives. EVIDENCE: The choices residents made each day varied, dependent upon their mental frailty, but residents generally chose what time to get up, go to bed, what clothes to wear, where to spend their day, what food to eat and whether or not to participate in activities. Overall, residents considered they were encouraged to do what they could for themselves and make appropriate choices throughout the day. On the morning of the inspection, it was noted that residents came down to breakfast at varying times and irrespective of what time it was, were offered anything at all from the breakfast menu. Care plans included details of people’s religion and any specific cultural needs. Representatives of three different faiths were visiting the home on a regular basis and those people spoken to said they were satisfied with the arrangements in place. Beech House DS0000025463.V346832.R01.S.doc Version 5.2 Page 16 The manager had identified an Advocacy service in Manchester that was prepared to visit any resident who had no-one to act on their behalf. A good supply of leaflets had been displayed within the home about this service. The manager believed that residents should be aware they can have access to any of their records and a notice to this effect was displayed in the home. A monthly activity magazine was being issued to each resident and copies were also available for the relatives. The August copy had been delayed due to the activity worker having been off sick. An activity book was also being used to record both group and individual daily activities. An activity worker was employed to work three afternoons a week for twohourly sessions. The worker was spoken to during the visit. She said the residents had been asked about what they would like organising and, as a result, Tuesdays were usually dominoes or cards and Thursdays were for bingo. Wednesdays were varied, with occasional baking, arts/crafts or outings taking place. From checking the activity book, it was noted that it was usually the same five or six residents who took part in these activities. Discussion took place with the owner and manager about the need to organise other activities to meet the needs of the more mentally frail people currently living at the home. The manager said she would address this need. In addition, on a fornightly basis, an external entertainer, “Active Minds” also visited whom the residents said they enjoyed. The manager and activity worker were trying to organise more trips out into the community and, in July, several residents had enjoyed a trip out on a Saturday evening to a local club. They had also been out on a couple of occasions for lunch and entertainment to a pub and, from photographs seen, it was apparent they had really enjoyed this trip. Resident meetings were held by the activity worker where activities and trips were always discussed. Due to the really poor summer weather, the suggestions made to go to Hollingworth Lake and other places had not been able to be organised. However, the activity worker said another trip to Blackpool Illuminations was being organised, as well as arranging Christmas entertainment. Relatives and friends were encouraged to visit as often as possible and the home operated an open visiting policy. The relatives spoken to on inspection confirmed they were always made welcome and offered refreshments. One relative said he visited the home daily and had his lunch with his wife each day. He really appreciated this. Beech House DS0000025463.V346832.R01.S.doc Version 5.2 Page 17 At the random inspection in October 2006, several of the residents spoken to commented about how much they liked the new dining room furniture. Smaller circular tables had been bought with new dining chairs that had gliders fitted so that chairs could easily be pushed up to the tables. The residents were able to choose whom to sit with at mealtimes, now they had tables, which seated up to four people, rather than the former larger type tables. A dining table had also been provided in one of the conservatories. The people sitting in this room were pleased with this provision, as it gave them more choice of where to sit. Some people still preferred to sit in their lounge chairs with over-chair tables rather than use the main dining room. New carpet had also been fitted in the dining room and new crockery had been purchased. Feedback from residents spoken to and responses on returned comment cards, was very positive about the food. Since the last inspection, a new cook had been employed and both she and the manager had spoken to residents about what they would like to see on the new menus. The cook said the residents’ wishes had been followed and several changes had been made, including roast dinners served on both Saturdays and Sundays. The new cook was clearly enjoying her job and spoke enthusiastically about how she was trying to provide a much more varied range of fresh food, as well as home baking. She had previously been a care assistant and had an NVQ level 2 qualification. She was looking forward to enrolling on a catering NVQ course in the next few weeks. A menu board was displayed in one of the lounges, which showed the meals for the day. The three weekly rotational menus showed a variety of meat and fish; fresh and frozen vegetables were served daily. A choice of two meals were offered at lunch time together with a choice of desserts which included milky puddings, fruit, custards and yoghurts. The desserts were displayed on a trolley so that residents could see the choices on offer. A good choice of teatime meals were offered which included a cooked meal, sandwiches or something on toast. On the day of the inspection, home made steak pie, broccoli, swede and creamed potatoes or cold meat salad was served for lunch followed by melon, chocolate mousse or ice-cream. Teatime choices were cauliflower cheese, hot beef and onion muffin or sandwiches, followed by home baked cakes. The inspector sampled the lunch time meal and found it to be tasty and well cooked. The main cook finished work at 13.00 and the teatime cook came on at 14.00 and left at 16.30. Following a requirement made at the last inspection, a tea time person was now on the rota at weekends in order to give the care staff more time to meet the personal care needs of the residents. Beech House DS0000025463.V346832.R01.S.doc Version 5.2 Page 18 Sufficient drinks were served throughout the day. Juice was supplied in the main lounge and residents all said they got plenty of drinks. Cooked breakfasts were enjoyed by several residents and a good selection of supper foods were offered, such as crumpets, maltloaf, cakes/biscuits. The special dietary needs of the residents were being well met. The daily choice sheets had been amended to highlight the individual dietary needs of residents so that the cooks could easily identify which residents may need advice to follow their diets. Some of the completed sheets were seen for those people on low fat, diabetic and soft diets. Those people on soft diets had their food liquidised in individual portions so that it looked appetising. Several residents needed assistance at meal times and this was done on an individual basis with staff allowing people to take their time to eat their meals. Beech House DS0000025463.V346832.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. An effective complaints system was in place which residents and relatives were familiar with and staff training and good recruitment practices ensured that, as far as possible, residents were protected from abuse. EVIDENCE: The complaints procedure was included in the service user guide/statement of purpose, which each resident had been given a copy of. Feedback from the residents interviewed and the returned comment cards indicated they were clear about how to make a complaint. Those people spoken with said they would feel able to talk to any of the staff if they had a problem or concern and that it would be sorted out for them. The home had a complaints book but no complaints had been entered in the book since the last visit. Discussion took place about entering what staff may consider to be “grumbles” rather than complaints together with the action taken to resolve them. The Commission for Social Care Inspection had not received any complaints about the home since the last key inspection. The staff interviewed were clear that any complaints or allegations would be immediately reported to the manager or the senior on duty. Beech House DS0000025463.V346832.R01.S.doc Version 5.2 Page 20 There had been no protection investigations over the last 12 months and appropriate policies/procedures were in place. New staff files showed that Criminal Record Bureau and Pova First checks had been done before any new staff started working at the home to try and make sure that staff employed were suitable to work with vulnerable people. Many of the staff had already undertaken protection of vulnerable adult training. Another training session, undertaken by an external trainer, was being held at the home on the day of the visit. The cooks and handyman were included in any relevant training courses including protection. Beech House DS0000025463.V346832.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The environment was clean, comfortable and well maintained, providing a safe environment for the residents. EVIDENCE: The owner had continued to make improvements to the home so that the residents would have a nicer environment in which to live. A part-time handyman was employed and, from checking his maintenance book, it was noted that all reported problems had been addressed. Beech House DS0000025463.V346832.R01.S.doc Version 5.2 Page 22 The maintenance/refurbishment programme, since the key inspection in April 2006, had included the following: New fire and call bell system fitted; two new boilers and digital thermostats; new carpets in all the communal areas of the home; a further eight bedrooms had new carpets fitted; new dining room tables, dining chairs and 27 new lounge chairs had been bought; new kitchen units installed; new fridge and freezer; three new beds and new furniture in two bedrooms; four new televisions purchased; new curtains in the conservatory; roof repaired and new aerials fitted; gardens landscaped and new fencing erected; exterior censor lights fitted, new moving/handling equipment. The owner said his next improvement was to have a new conservatory built and he was already in the process of obtaining quotes for the work. The manager was also hopeful that a walk-in shower room might also be provided to give residents more bathing options. At the last inspection a requirement had been made about providing additional heating in one of the bedrooms. This had been done and the resident concerned was satisfied with this provision. One of the conservatories was designated a smoking area and an extractor fan and smoke detector were fitted. It was noted however, that the door to the smoking area was permanently opened which meant smoke could spread to the adjoining lounge and was contravening the recent smoking legislation. The manager and provider said they would discuss this and look at what would be best for all service users. At the last Greater Manchester fire inspection, undertaken on 15 November 2006, several requirements and recommendations had been made. A letter from the provider to the fire department, dated 20 December 2006, was seen, which confirmed that all the requirements had been implemented. In order to provide more light in one of the corridors, a solid door had been replaced with one with fire safety glass. The home was adequately equipped with aids and adaptations to enable residents to remain as independent as possible. When walking around the home it was noted that, in one of the bathrooms, the Scandia frame around the toilet was badly flaking and in need of replacement. One of the mobile hoists, kept in a first floor bathroom and currently not in use, had not been serviced. Discussion took place around the need to either have the hoist serviced regularly or have it removed. The manager said she would arrange to have it serviced. Beech House DS0000025463.V346832.R01.S.doc Version 5.2 Page 23 Infection control policies/procedures were in place and the staff were observing these. At mealtimes staff changed into blue disposable aprons and wore white aprons when providing personal care to residents. New lidded bins had been provided and soiled linen was put into red disposable bags, which went straight into the washer. Whilst liquid soap and paper towels were supplied in bathrooms and toilets, they were not provided in the bedrooms of residents who required assistance with personal care tasks. The manager should consider this provision to cut down on the risk of spreading of infections. All but the recently employed staff had undertaken infection control training. Adequate laundry facilities were in place and individual baskets were supplied for each resident’s clothes. Feedback from residents indicated that missing clothing was not a problem. One resident said she had experienced missing clothes but they had been found. The home was clean throughout and the domestic confirmed that she had a good supply of gloves, aprons and cleaning equipment. Beech House DS0000025463.V346832.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Sufficient trained staff were on duty throughout the day and night to ensure the needs of the residents were able to be met. EVIDENCE: From checking the staff rotas and speaking to care staff and residents, it was clear that sufficient staff were working on each shift. Since the last key inspection, when it was identified staff were finding it problematic at weekends to cover both laundry and teatime duties, the manager had met with the staff to try and resolve the problems. It had been agreed that hours would be allocated at teatime so that the care staff had more time to spend with the residents. The staff spoken to said this was now working well. There was only one vacancy, which was for a domestic, who was leaving in September. Many of the current residents living at Beech House were male but there were no male care assistants. The men who were spoken to did not, however, identify this as a problem. The manager said they did not seem to get any male applicants when advertising care assistant jobs. Discussion took place about introducing staff gender at the pre-admission stage in order that any potential new residents would be aware of the gender of the staff who would be caring for them. Beech House DS0000025463.V346832.R01.S.doc Version 5.2 Page 25 The ethnic makeup of the team was predominantly white British, which reflected the current all white resident group and the age range of the staff was varied. Information provided on the Annual Quality Assurance Assessment (AQAA) form showed that staff turnover over the past 12 months was reasonable with five staff having left. Several of the staff had worked at the home for many years, which meant that the residents had built up strong trusting relationships with them. According to information provided on the AQAA, policies and procedures were in place for the recruitment and selection of staff and these were being implemented. Three staff files were checked, two of which were for recently recruited care staff. The files were in order and staff were not starting work until the necessary references and Criminal Record Bureau/Pova First checks had been done. A recommendation made at the last key inspection, for the home’s job application form to be reviewed to include full employment history, had been met. As part of the induction process, new staff were given a copy of the General Social Care Council’s “Code of Practice”, but these were kept in their personnel files. The employees should hold these booklets so they can be referred to. Of the 17 care staff employed, nine had already completed an NVQ level 2 qualification, equating to a ratio of 53 trained staff. Three of these had also done their NVQ level 3 training. Four carers were currently undertaking NVQ level 2 training and one of the newer staff was waiting to enrol. It was clear the manager and provider were committed to ensuring the staff received the right training to equip them to do their jobs well. All new staff were undertaking the Skills for Care induction training, which the manager was overseeing. The two files for the most recently recruited staff were seen. One contained completed Skills for Care training records and this person had also started her NVQ level 2 training. Certificates in her file showed she had done all the required mandatory training. The other file showed only the first two units of the Skills for Care training had been completed. However, as this person had only commenced work in June, the 12 week timescale for the completion of this training had not yet expired. The manager said she would ensure the training was completed within the timescale. The training matrix showed that the majority of the staff had undertaken all the mandatory training courses, e.g., first aid, moving/handling, fire, infection control and food hygiene and certificates were in place in the files that were checked. The manager was in the process of arranging for the newer staff to undertake the necessary training and places were already being booked. Beech House DS0000025463.V346832.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home was well managed which was reflected in the good outcomes for residents with regard to the quality of care they were receiving. EVIDENCE: Since the last key inspection, the manager had successfully completed the required units of the Registered Manager’s Award and a copy certificate confirming this was seen. She was aware of the need to keep up to date with contemporary practice and on the morning of the inspection, attended refresher adult protection training. She utilised the Commission for Social Care Inspection’s website so that she was aware of any changes but this had to be done at her own home as there was no internet facility provided at the home. The provider should give serious consideration to providing broadband Internet Beech House DS0000025463.V346832.R01.S.doc Version 5.2 Page 27 access at the home. Feedback from staff indicated she provided clear leadership and guidance and was approachable and fair to the staff. Since her appointment in February 2006, she had continued to work in partnership with the provider in an effort to improve the quality of care provided to the residents. She was having regular one to one supervision with the staff, had undertaken staff appraisals, continued to source relevant staff training courses, reviewed and updated the necessary policies/procedures, highlighted staff’s future training needs, held regular staff meetings and encouraged and supported the activity worker to organise more outings for the residents. The home had a quality assurance award, Investors in People Award, which had been reviewed and re-awarded in May 2006. Since the last key inspection, a quality assurance policy had been written and implemented. Residents’ meetings were being held monthly, although one or two had been missed due to sickness or other problems. Satisfaction questionnaires were being circulated to residents and their relatives/advocates on a six monthly basis. The most recently completed questionnaires were seen during the visit and the manager said she was trying to implement any suggestions made. Difficulties had, however, been experienced in implementing some of the outings suggested due to the poor summer weather. The manager said she had circulated questionnaires to doctors but they had not been returned. In addition, the manager said she liked to walk around the building to ensure there were no health and safety hazards and also checked medication. She did not currently record such audits but said she would consider this as part of the quality assurance system. Residents spoken to were satisfied with the arrangements in place in respect of their personal monies. The majority said they left this side of it to their relatives to organise. Where the home had involvement with residents’ finances, appropriate records and receipts were held. The finances of three residents were checked and found to be in order. At the last inspection, finances could not be checked due to only the provider having access to finance records. This had now been changed so the manager could access all relevant records. The returned AQAA form showed that all maintenance records were in order and up to date. Random sampling was undertaken of the accident records, water temperatures, public liability certificate, portable electrical appliances and passenger lifts/hoists. As stated in the staffing section above, all mandatory training was up to date except for the most recently recruited staff and arrangements were already in place for them to receive the required training. Beech House DS0000025463.V346832.R01.S.doc Version 5.2 Page 28 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 3 x 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 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 DS0000025463.V346832.R01.S.doc Version 5.2 Page 29 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 OP19 Regulation 13(5) Requirement The hoist stored in the first floor bathroom must either be serviced or removed in order to ensure the safety of residents. Timescale for action 31/10/07 Beech House DS0000025463.V346832.R01.S.doc Version 5.2 Page 30 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 OP7 Good Practice Recommendations Where residents have been assessed as at high risk of falling, a very detailed plan of care should be in place so that all staff will be aware of what to do to try and prevent further falls. Where nutritional supplements are prescribed by the GP, these should be recorded on the medication administration records to ensure the person is receiving them regularly. The rusty Scandia frame around the toilet should be replaced. In order to try and prevent the spread of infection, liquid soap and papers towels should be supplied in all bedrooms where staff assist residents with personal care. Internet access should be provided within the home in order to enable the manager to continue to keep updated of new practices and procedures. 2 3 4 5 OP9 OP19 OP26 OP33 Beech House DS0000025463.V346832.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Manchester Local Office 11th Floor, West Point 501 Chester Road Old Trafford Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 DS0000025463.V346832.R01.S.doc Version 5.2 Page 32 - 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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