Inspection on 18/08/08 for Beech House

This inspection was carried out on 18th August 2008.

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

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

Other inspections for this house

Beech House 14/08/09

Beech House 03/02/09

Beech House 20/02/08

Beech House 20/09/07

Beech House 07/06/07

Beech House 25/09/06

Beech House 10/01/06

Beech House 05/07/05

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 23/11/2008.

CARE HOMES FOR OLDER PEOPLE Beech House Wollerton Market Drayton Shropshire TF9 3NB Lead Inspector Janet Adams Key Unannounced Inspection 18th August 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Beech House DS0000064947.V369633.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 DS0000064947.V369633.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beech House Address Wollerton Market Drayton Shropshire TF9 3NB 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) 01630 685813 01630 685014 Ash Paddock Homes Limited Manager post vacant Care Home 54 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (54) of places Beech House DS0000064947.V369633.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care with nursing to service users of both sexes whose primary care needs on admission to the home are within the following categories:old age not falling within any other category, OP, 54; dementia - over 65 years of age, DE (E), 10. The maximum number of service users to be accommodated is 54. 2. Date of last inspection 20th February 2008 Brief Description of the Service: Beech House is registered to provide nursing and personal care for a total of 54 older people, of whom ten may have dementia related illness. The home is owned by Springcare Ltd, (Ash Paddock Homes) the Managing Director being Mr Lee Cox. The home is located in a rural setting within a large extended country house in the village of Wollerton near Market Drayton. It is set in its own grounds, which are well maintained, and all bedrooms have lovely views of the surrounding countryside. Due to its location, there is limited public transport to and from this home. Accommodation is offered in either single or double bedrooms, some of which have en suite facilities. Some bedrooms are provided on the ground floor, and the remainder are accessed by a passenger lift onto the first floor. The home does not have a separate unit for people with dementia related illness. These individuals share their living accommodation and access the communal areas alongside the rest of the residents in the home. Springcare Ltd makes the services of Beech House known to prospective residents in their statement of purpose, and its brochure/service user guide. A copy of the most recent CSCI (The Commission for Social Care Inspection) Inspection report was also seen to be freely available at the entrance of the home for people to look at. The fees charged depend on the care, support and accommodation provided. Additional charges to service users are for hairdressing, toiletries, and newspapers. The reader may wish to obtain more up to date information from the care service about this matter. Beech House DS0000064947.V369633.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor outcomes. Three inspectors carried out this key unannounced inspection. It was carried out in the form of two separate visits to the home and lasted over a total of ten hours. This is the fourth occasion we have inspected Beech House in the last 12 months. We made earlier inspection visits to the home in October 2007, February and June 2008. The main purpose of this inspection was to follow up progress made since the last inspection in June which resulted in us having to issue two statutory notices to make sure they continued to improve the way they provide care and support to the people living there. On the first inspection day, our specialist pharmacy inspector assisted by carrying out an inspection of the medicines management systems in the home. We, the commission, used a range of evidence to make judgements about this service. We asked the service to provide some information before the inspection, which they did. This was very useful and was a good starting point to the inspection work. We observed activity within the home, inspected the premises, and had an ‘in depth look’ at records for residents and staff. We also spent time observing, talking and listening to over half of the 36 people living there. Some of the staff on duty at the time of the inspection shared their views about working at Beech House. Discussions took place in private with people on their own, or in groups in the lounges. Everyone was happy to share their comments, which are included in the main body of the report. As part of the inspection process we circulated questionnaires and stamped addressed envelopes to people living, visiting and working at the home, so their views and opinions could be included in this report. Two people who live at the home, five relatives and three staff members returned written comments. Everyone, including residents and staff, was very welcoming and helpful throughout the inspection. In total, we assessed a total of 22 out of a possible 38 National Minimum Standards for Older People. Discussions with the management team took place throughout and feedback about the conclusions of the inspection was given at the end of both inspection days. What the service does well: Beech House DS0000064947.V369633.R01.S.doc Version 5.2 Page 6 All areas of the home are well presented with the provision of nice quality furnishings and equipment which makes Beech House a welcoming and safe place to live. The company who owns the service has greatly upgraded the surroundings for the people who live there over the past 2 years. The atmosphere within the home is warm and friendly and the staff group communicate well with residents. Anyone who is thinking about moving into Beech House gets a thorough assessment to make sure the home will meet their needs and that the staff team are fully prepared for their admission. The home has systems in place which ensure any concern or complaint is welcomed and acted upon in order to improve the service it provides for its residents. One of the home’s major strengths is the way residents are encouraged to participate in a variety of activities, which suit their tastes, preferences and abilities. 70 of the carers have the minimum expected care qualification. Everyone we asked confirmed the food provided at Beech House has continued to be of a very good standard with plenty of choice and variety. What has improved since the last inspection? Our inspection findings confirm that the ongoing efforts of the care team have resulted in a total of 7 statutory requirements being fully met. Care plan paperwork and practices has continued to improve. The monitoring efforts of the company area managers and the home management team since last year show reflect this. Although there have been some improvements in medication management systems, there are still shortfalls in that some staff are failing to keep accurate records, and so are unable to demonstrate that people have received the medication they require. Successful staff recruitment has resulted in a new home manager and nurse being appointed. The availability of in house staff training has improved; the home team have all recently been fully trained and updated in practices for safeguarding adults. The home have received several compliments from relatives of residents who have been admitted since the beginning of this year. Since we last inspected the home in June, two people wrote to confirm they were very happy with the Beech House DS0000064947.V369633.R01.S.doc Version 5.2 Page 7 care and support offered at Beech House. One family member wrote to express their heartfelt appreciation for the care their father was receiving they stated, ‘Whatever time we visit he is always clean warm comfortable and well fed. Communication is good and we are informed of any changes immediately.’ 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 DS0000064947.V369633.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 DS0000064947.V369633.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.Standard 6 is not applicable. Quality in this outcome area is good. An appropriately qualified person assesses all people considering moving into Beech House before being admitted to make sure the home can meet the person’s needs and wishes. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Springcare, the Registered Providers for the service, produce a corporate styled information folder for prospective residents, which contains the home’s Statement of Purpose and Service User Guide, the information we require them to have by law. Copies of this information was requested and examined after our inspection visit. Although the information has been improved and the statement of purpose now reflects the numbers the home is registered for, it is still considered that more information should be included to make it very clear to potential residents/representatives that people with dementia cared for at Beech House DS0000064947.V369633.R01.S.doc Version 5.2 Page 10 the home are not accommodated in a separate unit, but share the same living and communal accommodation with the rest of the people living there. This has caused some confusion with people in the past. We found good admission records for two people who moved into the home since the last inspection. Both sets of care records were for people who moved into the home on a permanent basis, including an individual with a dementia related illness. As the home has been without a manager lately, both individuals had been fully assessed by the company assistant area manager. The information the home provided us with before the inspection included the following complimentary comments from a relative of a person who was admitted to the home for short term respite care, ‘“Please convey to your staff, my thanks for enabling me to take some respite ……….I have been very pleased with the care he has received”. This home does not offer intermediate care. Beech House DS0000064947.V369633.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 poor. Systems to record the support and personal care provided at Beech House have improved though some of the paperwork does not reflect the way the home promotes good health for the people who live there. Management of residents’ medication has improved, records still need to be improved in order to demonstrate that people have received the medication prescribed for them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been improvements in care practices as well as record keeping since the last inspection. Staff were seen to be attending the needs of residents in a respectful, caring manner. Everyone we saw appeared well groomed and content. Observations of care practices reflected the positive comments we received from residents and their visitors. People wrote, Beech House DS0000064947.V369633.R01.S.doc Version 5.2 Page 12 ‘On the whole the standard of care is very good.’ ‘They look after the residents very well’ The care records of four people who have a variety of care and support needs were examined. They were easy to read and understand as staff have made an effort to write clearly and legibly. The home team have continued to receive a lot of support from ‘Springcare’, the company who owns Beech House to improve care provision. Since the end of last year the company area managers have been visiting the home on at least a weekly basis in order to monitor the team progress with the quality of care and support offered to people living at the home. Records are now being kept up to date and in line with company policy. Records for people with complex care needs have improved and they give a good ‘pen picture’ of the way people get the care they need. In particular, the recordkeeping for wound care was seen to have improved in all records looked at for this matter. The records of a person recently transferred to hospital showed the staff had written a good account of the persons needs on a form especially designed by the company for this situation. As a result of our last inspection we had serious concerns about this aspect of the service provided by the home, and as a result a Statutory Requirement Notice was issued to ensure there would be permanent improvements established. Our findings confirmed a lot of effort has been made to demonstrate this has been carried out. However, not all care records were of the same standard. • We were concerned that one care plan did not describe the changes in a person’s care needs when a person sustained a fractured wrist. • We also looked at a set of records of an individual with dementia related illness who is known to wander at night. The person lives on the first floor and has a special alarm attached to the bedroom door which is set at night to alert staff so they can manage this behaviour. On the home tour we observed this was out of order. This equipment failure had not been accounted for to make sure people were aware of this issue and informed of what care changes were necessary to keep the person safe. In addition, it could not be established how long the equipment had been out of order as there was no evidence it had been reported to the home management team to be repaired. Three days before our inspection the person’s records had been audited by one of the company area managers, and she was not aware of this equipment not working. • We also noticed denture cleansing tablets in the en suite of the same person’s room. Although the care records accounted for an earlier incident when the individual had bitten into some soap, this issue had not triggered staff actions to make sure a safety assessment was in place to keep the individual’s bedroom safe. Beech House DS0000064947.V369633.R01.S.doc Version 5.2 Page 13 These issues show the home records need further regular monitoring to ensure any alteration in a person’s circumstances trigger changes to care and safety records which in turn should guide staff to minimise any hazards with the potential to cause a person harm. When this information was shared with both of the company area managers they were aware of the majority of issues described above, as a result of the auditing they had carried out the week before our inspection. It was reassuring that action was already in progress with nursing staff to improve these standards. The pharmacist inspector visited the home on the 14th August 2008 as part of the key inspection to establish what progress had been made in meeting the requirements set out in the statutory requirements notice. We found that the home had failed to record the receipt of some of the medication and had also failed to carry forward some of the quantities from the previous month into the current month. The auditing of a selection of the residents medication found that some medication could not be accounted for. There was particular concern about the home ordering additional medication on top of the current supply because they had run short during the previous month and had had borrowed some from the current months supply. Examination of the previous month’s MAR charts gave no reason why the home would have run short of this medication. As a consequence of these failings it was determined that the following requirement had not been fulfilled: Medicines must be administered at the correct time and dose, as prescribed by the clinician and records must accurately reflect practice. We found that the area managers were also carrying out audits on the receipt, administration and disposal of medication and were still finding anomalies within the records. We found no evidence that these anomalies were being investigated and addressed with the appropriate staff members. We also found that none of the nursing staff had undergone any competency assessments to ensure they were handling and administering the residents’ medication safely. As a consequence it was determined that the following requirement had not been fulfilled: A quality assurance system must be implemented to assess staff competence in their handling of medications. Appropriate action must be taken when discrepancies are found, to ensure that all medicines are administered as prescribed and this can be demonstrated. We found on the day of the inspection that the practice of removing the MAR charts from the MAR chart folders for the visiting general practitioners (GP) had ceased. We found that the nursing staff were taking the whole folder on the GP’s medical round, which meant that important information like any known allergies were available to the GP when prescribing medication. We also found that following the discovery of one of the residents receiving a dose of medication that she was allergic to, at the last inspection, the home had been Beech House DS0000064947.V369633.R01.S.doc Version 5.2 Page 14 in contact with the resident’s doctor. The doctor had instructed the home to ensure that only one particular antibiotic was administered and the home had attached clear direction to the divider card that was situated in front of the residents MAR charts. As a consequence it was determined that the following requirement had been fulfilled: Service users medical history must be made known to clinicians when new medications are prescribed to prevent adverse effects from allergies from occurring. Beech House DS0000064947.V369633.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. The daily life and social activities arranged for people living at Beech House takes into account the differing expectations, preferences, lifestyle and abilities of each individual. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Findings during this inspection were of a similar good standard to those seen at our last four inspections. Visitors continue to be welcomed in a professional manner and obviously have a good relationship with the staff on duty. The home’s strong links with the nearby community continues. Residents’ records show the local clergy visits regularly to offer Holy Communion. In the information the home sent us before the inspection they confirmed they continue to provide information to people so how they can obtain external assistance in matters such as advocacy. The home continues to receive a bi-monthly company newsletter, which keeps Beech House DS0000064947.V369633.R01.S.doc Version 5.2 Page 16 people up-to-date with events across the group, and people who use the service send their contributions to be included. As several people in the home are not able to share their opinions about their lifestyle at Beech House due to their medical conditions, they were observed for some time in two separate lounge areas during the inspection. All individuals observed appeared to demonstrate evidence of wellbeing. People were observed to have a good rapport with the home activities coordinator as she spent time with them on an individual basis. The activity photo album she was using was seen to be most useful to get people stimulated for a chat. It had just been revamped with the latest snapshots of recent social events, which their responses confirmed they had enjoyed. Activities advertised on the notice board in the corridor included plans for three outings for August, confirming the home mini-bus, which is suitable for wheelchair use, continues to be well used. A range of ‘in house’ activities for those residents who prefer to stay at the home offered people the opportunity to join in gardening, a barbecue and mini-olympics. An invitation to have lunch with residents in the dining room was accepted. The meal was tasty and portions were generous; choices were available and people’s preferences observed. The dining room continues to have its tables set to restaurant standards. Likewise meals seen being served on trays to people in their rooms were attractively presented to hotel standards, making mealtimes at the home an enjoyable event. Discussion with the cook confirmed the meals are planned and presented in line with the home 4 weekly menus. The home catering staff continue to use their “Safer food, better business” paperwork recommended by the local environmental health officer. This means they have a good permanent record that all food hygiene practices continue to be followed. Beech House DS0000064947.V369633.R01.S.doc Version 5.2 Page 17 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. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure, are protected from abuse, and have their rights protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Quality in this outcome area is good. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure, are protected from abuse, and have their rights protected. All comments received from people living, visiting and working at the home were unanimous in that people knew what to do if they had to make a complaint. Springcare, the company who owns Beech House actively welcomes comments in order to improve the service they provide. The home complaints procedure on display in the entrance area to the home clearly describes what people have to do if they are not happy with the service at Beech House. This information is also contained in the Springcare resident information folder issued to everyone as they move into the home. Beech House DS0000064947.V369633.R01.S.doc Version 5.2 Page 18 The home has fully implemented the company monitoring systems for this matter and a company area manager checks these at least monthly. Information the home sent us before the inspection told us, ‘ Staff are encouraged to document every complaint no matter how small it may be and to record the response to the complainant and any action taken.’ We have not received any complaints about this service this year. Management improvements have continued to make sure people feel comfortable to raise any concerns they are unhappy about. The home also wrote to us and informed us, ‘All staff are trained in the protection of vulnerable adults and work to these regulations.’ Information seen in the office confirmed 15 staff members including new starters had attended training for this matter in July and the beginning of August. This confirms the home’s commitment to raise ongoing awareness of this sensitive issue. The home have also confirmed their responsibilities with the introduction of new Mental Capacity Act legislation and will be improving their service in the coming year to reflect this. Beech House DS0000064947.V369633.R01.S.doc Version 5.2 Page 19 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. The physical design and layout of the home enables people who use the service to live in a safe, well-maintained and comfortable environment, which encourages independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All individuals who made comments to us about the home were in agreement that the home always smelled fresh and had a welcoming, clean and tidy appearance. One person who wrote to us commented, ‘Beech House provides a warm, safe and secure home.’ A tour of the home was carried out with the deputy manager, and all bedrooms of the people whose care records we examined were seen. All were personalised, furnished and equipped to meet residents’ needs. Beech House DS0000064947.V369633.R01.S.doc Version 5.2 Page 20 One individual who shares a bedroom with another person expressed her satisfaction in the accommodation she had. Good systems were seen to be working to keep both people’s belongings separate as well as promoting good infection control. Communal areas both inside and outside the home offer people a variety of locations to socialise and enjoy the surrounding countryside views. The home informed us that a ‘Dignity in Care’ grant enabled investment in new garden furniture to enable more people to enjoy the beautiful gardens. This has also provided funding for replacement carpets in communal areas and the refurbishment of several bedrooms, new bedding and curtains as well as some sensory equipment for people with dementia related illness. Staff comments were generally positive about the home environment although they did express that sometimes the bathing and showering facilities have not been fully operational, and this resulted in people having to be moved from one part of the home to the other to have their hygiene needs met. Standards seen and observed during the home tour confirmed there is a good working knowledge of infection control management within the staff team. The home told us that almost half of the staff team had received training in infection control recently, and discussions with staff confirmed this. The home has not been inspected by the Environmental Health Department lately. Beech House DS0000064947.V369633.R01.S.doc Version 5.2 Page 21 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. Staff in the home are being trained and are in sufficient numbers to fill the aims of the home and meet the changing needs of residents. People living at the home are supported and protected by the home’s recruitment policy and practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Favourable comments received from people living at the home confirmed that they receive the care and support they require. One person commented, ‘The staff are always on hand to talk to you and guide you if you need any help’. On the day of the inspection the assistant manager confirmed that a total of 3 nurses and 6 carers were on duty to care and support for the 37 people living at the home. Information provided for us by the home management confirmed the home has been satisfactorily staffed in recent months. Recent use of agency staff has continued to be been minimal and has not had an adverse effect on the care and support people have received. Beech House DS0000064947.V369633.R01.S.doc Version 5.2 Page 22 The home has recently had a successful recruitment drive and new starters include the newly appointed home manager and a Registered Mental Health Nurse. Examination of the files for two other new recruits to the home showed that improvements seen at our inspection in June continue to make this process robust. Inclusion of the trainee’s work sheets with the skills certificate is an example of good training and management practice. However, one set of records did show that a reference accepted for one individual was sought from a “unit manager” rather than the registered provider or manager of the service and this was discussed with both company area managers during our feedback. Staff comments sent to us indicated that they are clear regarding their role and what is expected of them. Team morale has started to improve and a new starter wrote to us to say, ‘Support is always there. I have not been at Beech House very long, but it is a very warm and happy environment to work, and I feel people are very well looked after. This is one of the best places I have worked.’ Many aspects of staff training have continued to improve in recent months, and almost 70 of the carers have the minimum expected care qualification. Good ‘tracker systems’ have been set up by the management so they have an ‘at a glance’ picture of the training staff have had and what they need. This information told us that 18 staff were in need of moving and handling training updates and this was already in the pipeline. Likewise, it was seen that staff had not received chemical safety updates since October 2006. This was also in the process of being arranged. The management are aware that not all staff are working to expected standards at present. Although there has been no formal nursing staff training to improve their care plan recordkeeping it was confirmed that specific record keeping issues were being acted upon as a result of weekly auditing and staff supervision sessions. Discussion with the deputy manager confirmed that she was to cascade training to staff about using the company forms for assessing the behaviours of people with dementia related illness. Systems are also in the process of being improved to make sure the training they have had is put into day to day practice for medication management systems. Beech House DS0000064947.V369633.R01.S.doc Version 5.2 Page 23 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. The management team is committed to improving the quality of the service. Improved systems for the health, safety and welfare for residents, staff and visitors make sure that they are kept up to date, to fully meet all people’s changing needs and safeguard their well being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As the home has been without a Registered Manager for some time it was positive to be informed that there has been a successful recruitment of a person suited for this role at Beech House. The individual, who has been in post for 3 weeks, was not on duty at the time of our inspection. The Beech House DS0000064947.V369633.R01.S.doc Version 5.2 Page 24 administration Manager and Assistant Manager of the home have been carrying out these responsibilities with the support of the company area managers. As recorded earlier, the home management team have had the additional support of weekly visits from the area managers, and between them they have devised a system to monitor the effectiveness of the ‘Improvement Plan’ they produced for us following our last inspection. This information alongside the AQAA (Annual Quality Assurance Assessment) they sent us in July contains good information which lets us know about changes they have made and where they still need to make improvements. It shows clearly how they are going to do this. As a result, with the support of both company area managers, the majority of management systems at Beech House have become well established. Detailed recordkeeping in quality audit files confirms there is close monitoring of important issues such as complaints. The audits carried out by the area managers as part of their visits show that care plans and medication systems are especially being looked at closely. Since our last inspection visit we were informed by the company area managers that all of the care records for people living in the home had been fully audited and as a result any shortfalls are being addressed with individuals concerned. The home management are keen to let ‘everyone have their say’ how the service can be improved. Information the home told us before the inspection told us a recent survey they had carried out confirmed the home was performing well. These were not at hand to examine on the inspection day. It was also positive to be informed that plans for the coming year were, ‘To hold regular meetings to enable service users to make their views known.’ Improvements to the safe working systems in the home have continued to ensure good management of monies and valuables kept in safekeeping for residents. Review of one person’s records confirms this system to be as robust as when it was looked at during our inspection in February this year. Many service and maintenance records for essential equipment used in the home were seen to be up to date and complied with necessary health and safety legislation, the administration manager confirmed the 6 monthly checks due for the home hoisting equipment in July were booked and were due to be carried out. Good recordkeeping confirms weekly maintenance checks are carried out for equipment such as wheelchairs, hot water supply, and fire safety. Bedrail safety checks are carried out daily to ensure they are installed properly at all times. The home has effective recordkeeping systems for accidents, which meets all health and safety and data protection legislation. As part of the ‘in house’ monitoring the staff also complete a monthly audit for accidents to make sure they are followed up properly, and any care paperwork is reviewed as part of this process. However, upon checking the records of the Beech House DS0000064947.V369633.R01.S.doc Version 5.2 Page 25 person who had sustained a wrist injury, the information written down was not accurate. It identified the care information had been updated whereas our checks confirmed it had not been done. This was discussed with the company area managers. Review of the home fire risk assessment with a management team member confirmed this was in need of update to include emergency arrangements about recently installed stair gates. Although the home have not been inspected by the fire service since November 2006, they have a good working relationship with the Fire Service, as the home is used for fire officer training. Beech House DS0000064947.V369633.R01.S.doc Version 5.2 Page 26 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 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 4 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Beech House DS0000064947.V369633.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement Staff who administer medication must be trained and competent and their practice must follow current written policies and procedures to ensure that residents receive their medication safely and correctly. (Previous timescale of 19/04/08 and 20/6/08 not met) Medicines must be administered at the correct time and dose, as prescribed by the clinician and records must accurately reflect practice. Timescale for action 30/09/08 2 OP9 13(2) The records of the administration 30/09/08 of medicines for the people who use the service must be robust and accurate to demonstrate that all medication is administered as prescribed. (Previous timescale of 19/04/08 and 20/06/08 not met.) A quality assurance system must be implemented to assess staff competence in their handling of medications. Appropriate action must be taken when discrepancies are found, to ensure that all medicines are DS0000064947.V369633.R01.S.doc Version 5.2 Page 28 Beech House administered as prescribed and this can be demonstrated. 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 OP1 Good Practice Recommendations The Statement of Purpose and Service User Guide should contain information about the service as per Schedule 1 to the Regulations including accommodation arrangements for individuals with Dementia related illness. People thinking about moving into Beech House must be provided with all the necessary information they need to help them to decide whether the home is right for them. It is recommended that until care plans are a consistently good standard for all people living in the home, they are kept under regular review by the home management team. This will make sure any alterations in people’s circumstances will be addressed and staff will be working to care plans that reflect the changes in the care that they need to keep them safe and well. Any alteration in a person’s circumstances should trigger a care plan review and /or risk assessment of the individual. The service must make proper provision for the health and welfare of people who live at Beech House to ensure that they receive the nursing care and monitoring that their conditions require until it is apparent they are of a consistently good standard. It is recommended the home continues to evaluate their staff training plan against the needs of people living in the home. This will ensure staff are trained and competent to ensure that residents receive their care and support safely and correctly. It is recommended the home fire safety risk assessment is reviewed and updated to include the team responsibilities for the safe use of stair gates in an emergency situation. 2 OP7 3 OP8 4 OP30 5 OP38 Beech House DS0000064947.V369633.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 DS0000064947.V369633.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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