Inspection on 15/10/08 for Beech House

This inspection was carried out on 15th October 2008.

CSCI found this care home to be providing an Good service.

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 06/12/07

Beech House 07/08/07

Beech House 30/10/06

Beech House 30/01/06

Beech House 22/06/05

Beech House 27/09/04

Beech House 02/08/04

Extracts from inspection reports are licensed from CQC, this page was updated on 16/12/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Beech House 29 Great Bowden Road Market Harborough Leicestershire LE16 7DE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Keith Charlton     Date: 1 5 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Beech House 29 Great Bowden Road Market Harborough Leicestershire LE16 7DE 01858464289 Telephone number: Fax number: Email address: Provider web address: beech_house@harborough.uk.com Name of registered provider(s): Name of registered manager (if applicable) Mrs Lesley Burrows Type of registration: Number of places registered: Mr Keith Burrows,Mrs Lesley Burrows care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: Service User Numbers. No-one falling within categories DE and MD(E) may be admitted into the home when there are 5 persons of categories/combined categories DE and MD(E) already accommodated within the home. Date of last inspection Brief description of the care home Beech House is a residential home, which is registered to accommodate up to thirteen older people, including five within the category of mental disorder and dementia. Beech House is situated in a residential area, close to the Market Harborough town centre. The home is accessible by car or public transport. Parking is available to the front of the home. The home provides a large lounge to the front of the property and a Care Homes for Older People Page 4 of 27 Over 65 0 5 13 5 0 0 Brief description of the care home dining room to the rear. There is a patio area to the rear of the home, which is accessible to residents using wheelchairs and walking aids. Bedrooms are located on the ground and first floor that is accessible by the stair lift or the passenger lift. Bath and toilet facilities are located close to the bedrooms. The weekly fees range from #400 to #420 - the Registered Provider provided this information on the day of the inspection. There are additional costs for individual expenditure such as hairdressing, dentist, optician and private chiropody. The home provides information to residents and prospective residents in the form of a Statement of Purpose that describes the services it offers, and a copy of the summary of the last Inspection Report. These are displayed in the hallway. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means that the people who use this service experience good quality outcomes. This was a key inspection that included a visit to the home and inspection planning. Prior to the visit (throughout the report the use of we indicated the Commission for Social Care Inspection), spent half a day reviewing information relating to the home. The manager sent us an AQAA - an Annual Quality Assurance document that described how residents received the homes services and other relevant information - e.g. about staffing numbers and health and safety issues. During the course of the inspection, which lasted five hours, we checked the key Care Homes for Older People Page 6 of 27 standards, as identified in the National Minimum Standards. This was achieved through a method called case tracking. Case tracking means we looked at the care provided to three residents living at the home by meeting them, talking with the staff who support them, checking records relating to their health and welfare and viewing their accommodation as well as communal living areas. Other issues relating to the home including health and safety and management issues were looked at. We also talked to six residents, two relatives, the Care Manager and two care workers. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 27 Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are assessed prior to admission to ensure the home is suitable for them. Evidence: A relative said that he was told he could have visited the home prior to admission to see if his partner wanted to live there but there was not much time to decide what to do as he was not satisfied with the care in the home she was in. Two surveys said that they did not get enough information about the homes services at the time they were deceiding to whether they wanted to move into the home. This needs to be considered by the management of the home. The Manager said in the AQAA document that people considering coming to Beech House can visit if they choose and they all receive an assessment of their needs. Information is sought from health and social care professionals appropriate. This Care Homes for Older People Page 11 of 27 Evidence: process helps to ensure the home is suitable for those who are considering living there. The admission form details areas of need to help staff plan to meet the care of the new resident. Other residents said that they had been made welcome when they had arrived to live in the home. I am glad staff were friendly because I didnt know what to expect, one resident said. The home does not admit people for intermediate care. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home meet residents health and personal care needs. Medication is secure and residents receive it at prescribed times. Evidence: Residents said that they were well looked after: Its good here. Staff are friendly. The staff and owners are really nice. You dont get rushed. Care plans are well organised and set out in detail how to meet the needs of individual residents. For example for a new resident there was instruction to provide this person with lots of reassurance as she was in a state of anxiety. A staff member said she had not been asked to read care plans. There are also assessments in place to keep residents safe from any identified risk, for example from falling. Residents receive appropriate healthcare services and any health problems were seen Care Homes for Older People Page 13 of 27 Evidence: to be attended to by GPs, District Nurses, and other healthcare professionals. The Manager said she was trying to find a better optical service as she found that the previous one appeared to prescribe new glasses for residents that were not different from their current ones. Accident records showed that medical services had been called if residents had fallen and received a potentially serious injury. Medication is securely kept. Residents can self medicate if they are assessed to be able to do so. A staff member was observed to be issuing medication. She had a number of unlabeled pots of medication to give to a number of residents, which could have been a problem if there had been an interruption to the medication round. Staff said only Senior staff issue medication and they are trained to do so. Records confirmed this. Medication records were found to be complete and up to date. Staff said that there is no controlled medication currently being used. The Manager needs to check that there is an appropriate metaled cupboard that meets the specifications of the 2007 Amendment to The Misuse of Drugs Act 1973 to keep special drugs, when this is the case. We observed that staff were friendly and respectful to residents. Residents and visitors said that staff were very friendly and caring. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Daily life and social activities at The Beeches meets residents social and recreational interests and needs. Evidence: Residents said that they enjoyed the activities that were held on weekday afternoons but there were comments they would like more such as children and pets visiting and having more crafts. Two surveys said that there were usually activities residents could take part in. There was a comment that residents should have outings and being taken out for walks by staff. The Manager in the AQAA stated that she is looking into providing more activities for residents with dementia. One resident said I can go out if I like, and another resident said I like the afternoon activities. Its a bit of interest for us. Residents have the opportunity to take part in a programme including: Crafts, bingo, sing songs, games. There was no evidence that residents are asked what activities they like doing in Care Homes for Older People Page 15 of 27 Evidence: Residents Meetings as no Meetings are currently held. One Care plan looked at said that the resident was religious but there was no evidence that she would like to go to church. Relatives said they were always welcomed into the home by staff and staff said visitors were welcome at all times. One visitor said that he was provided with a meal at lunch so that he could eat with his partner, at no charge, and he was very appreciative of this. Residents said that there were no rules and they could rise and go to bed when they liked. One resident said that he stayed up to watch football on the TV sometimes when he felt like it. Residents said the food was good. There were some comments that there is not always a choice available. Lunch served during the inspection had only one choice of main meal though there were two choices of dessert. Residents said they enjoyed the food. There were three fresh vegetables served, which shows a commitment to taste and healthy eating. Staff helped residents to eat where they had difficulty doing so. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents feel able to talk to staff about any concerns they might have and staff are trained to safeguard adults. Evidence: Residents said that they had not needed to make a complaint but they were sure that if they did then it would be properly followed up by the Manager. A resident said: There is never anything to complain about. A relative said: If you speak to Mrs. Burrows about anything she quickly sees to it. The home complaints procedure was seen in the homes information. This does not give the complainant the choice to complain to the lead Agency (the local Social Services Department) at the initial stage, and does not give the contact detail of the lead Agency, if they felt they wanted to have an independent body to look into it. There have been no formal complaints since the last inspection. The Manager has previously said that if general issues were brought to her attention they would be quickly acted upon. This gives residents and relatives confidence that any concerns they bring forward, however minor, will be taken seriously and addressed. The Manager in the AQAA stated that staff have been trained in the protection of vulnerable adults and when a staff member was spoken with regarding this she named Care Homes for Older People Page 17 of 27 Evidence: the appropriate Agencies to refer to and knew the in house procedure to report it to management. There were proper checks on file to indicate that staff did not constitute a risk to residents. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a home that is homely and cleaned to a very good standard. Evidence: The Beeches is a large semi detached house situated on the edge of Market Harborough. It has a back garden which is enclosed. The home is on two floors with a stair lift and passenger lift for access. Residents said they liked their rooms: I could bring my things in here to make my bedroom the way I wanted. Its kept very clean. The premises are homely, comfortable and spacious and all areas are accessible to residents with limited mobility. The Manager stated in the AQAA that there are plans to redecorate ground floor bedrooms and the front corridor. This was an unannounced inspection and all areas we inspected were clean and fresh. The only problem noted was that a first floor bathroom toilet was very difficult to flush and not being able to do this may embarrass the resident using it. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Friendly and professional staff communicate well with residents. Staffing levels could mean that all residents needs are not met. Evidence: All residents and comments made by residents and relatives in surveys praised the staff. Residents said that staff were friendly an respectful towards them: Staff are very nice. They are always patient. You get good service here, which is not always what I have found in homes, were some of the comments made. During the inspection relationships between staff and residents were seen to be warm and professional. The staff team is established and a number of the carers have been in post for a number of years. There were some comments made regarding the shortage of staff in the afternoon/ evening periods when there are two care staff plus the Management on call/duty. As the majority of residents have confusion and need to have a staff presence to ensure they and other residents are safe, a number of residents need two carers to help them with personal care and some residents are taken to the toilet as per their continence Care Homes for Older People Page 20 of 27 Evidence: plan, so there is pressure on staff to meet their needs. Records showed that all staff have two references and a satisfactory CRB disclosure before starting work. They undergo a detailed induction through the Manager. This helps to safeguard residents and ensure staff know how to meet their needs. This is followed up with further training including NVQs (National Vocational Qualifications) in Care. In addition there is essential core training in issues such as Moving and Handling, Health and Safety, Infection Control, Dementia, Fire, Food Hygiene etc. Staff said that the Manager emphasises training and encourages staff to attend. These training opportunities help to ensure staff have the skills and knowledge necessary to meet residents needs. The Manager said in the AQAA that she would add training on residents conditions, e.g. Stroke, Diabetes, Parkinsons Disease etc to the Training Matrix, so that staff have a fuller knowledge of these conditions. A staff member said: I feel supported in doing this work. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a home that is safe and well managed. Evidence: Residents said that the Manager was efficient and caring in the manner that she ran the home- Mrs. Burrows will put things right that need doing, one relative said. The Manager is very experienced and has been in post for a considerable time. She is responsible for the day to day running of the Home and is also one of the Registered Providers - the other being Mr. Keith Burrows, who also works in the home. During the inspection the Manager was said to have good relationships with all involved in the home - residents, relatives and staff. There was evidence of regular staff meetings which were well recorded and contained discussions relevant to the running of the home to a quality standard, though Meetings appeared to be confined to the Manager and only one other staff member. Care Homes for Older People Page 22 of 27 Evidence: Annual quality assurance surveys are provided to residents and their relatives. They were seen to have been completed this year. The Manager said she does not looks after the monies of residents. Health and Safety records were found to be kept in that there were risk assessments regarding safe working practices and fire practices - holding of fire drills and testing of alarms and emergency lighting systems in place, though fire drills were not held frequently - only one drill since August 2008. The other events noted on fire records were going through the drill with staff. There was no fire risk assessment for the home that staff were able to locate. A staff member was asked about the fire procedure though was not able to relate all aspects of the procedure in order. The hot water was tested and found to be within the safe limit so protected residents from scalding. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 3 7 10 12 Staff need to read care plans so that they follow the correct practice to meet residents needs. Staff need to give medication to residents on an individual basis to reduce the possibility of mistakes being made. The Activities Calender needs to be reviewed and added to to include activities residents like - outings, walks, children and pets visiting etc. There needs to be a choice of food for residents at the main meal to allow for greater residents choice. There needs to be a clear up to date complaints procedure that gives complainants the opportunity to go to the Lead Agency at the initial stage so as to give greater confidence that any complaint can be independantly handled. A review of staffing levels is needed to ensure that all the needs of residents are met. Training staff in residents conditions would ensure that staff possess appropriate skills to meet all identified needs. To provide more information to residents and relatives the Manager needs to analysis the Quality Assurance information, produce an action plan to act on comments made and include this in the homes information. 4 5 15 16 6 7 8 27 30 33 Care Homes for Older People Page 25 of 27 9 38 More frequent drills are needed to ensure staff follow the full fire procedure and a Fire Risk assessment needs to be in place and available to staff, to fully protect residents. Care Homes for Older People Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). 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