Inspection on 19/04/06 for Beech House

This inspection was carried out on 19th April 2006.

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 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 14/08/07

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 19th April 2006 07:30 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.V288790.R01.S.doc Version 5.1 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.V288790.R01.S.doc Version 5.1 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 01706 629435 Prylor Properties Ltd Helen Frieda Whalley Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Beech House DS0000025463.V288790.R01.S.doc Version 5.1 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. 1st August 2005 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 house, which has been converted and extended to provide accommodation in 27 single rooms, 1 of which has en suite facilities. A variety of lounges are available including a designated smoking area. 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 5 cars and further car parking is available in the lane to the side of the home. The weekly fee is £323.01 as at 1 April 2006. 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 generally displayed within the home, but on this inspection, it was missing from the folder. Beech House DS0000025463.V288790.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. There have been recent changes in the ownership and management of the home. In November 2005, the limited company Prylor Properties was purchased by Mr R Gupta and in February 2006, a new manager was appointed by the owner and approved by the Commission for Social Care Inspection (CSCI). At the inspection in August 2005, there were many things which needed putting right in order to improve the quality of the service for the residents living at the home. In order to make sure that the home took steps to put matters right, extra visits to the home were made on 29 September 2005 and 4 January 2006. In addition the Pharmacy Inspector (a person who looks at medication in care homes), made a visit on 8 September 2005. All but two of the requirements made at the last inspection had been met. This unannounced inspection took place over one full day with the Inspector arriving at the home at 07.30 to speak with the night staff and leaving at 15.45. The inspector looked around parts of the building, checked the records kept on residents to make sure staff were looking after them properly as well as looking at how the medication was given out. In order to obtain as much information as possible about how well the home looked after the residents, the manager, 8 residents, 3 relatives, 3 staff, a district nurse and cook were spoken with. In addition comment cards were sent out before the inspection to relatives, residents and professional visitors to the home. Of these 6 resident, 4 relative/visitors and 1 care manager questionnaires were returned. Other information, which has been received about the service, over the last few months has also been used as evidence. What the service does well: The home had a group of staff who had worked at the home a long time and residents spoken with liked the present staff team, including the new owner and manager. They felt they cared for them well and words used to describe staff were “lovely”, “caring”, “quite good”, “my carer makes me laugh” and “excellent”. Other comments made were “they look after you well here”, “I’m really satisfied” and “wouldn’t move anywhere else”. 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. Beech House DS0000025463.V288790.R01.S.doc Version 5.1 Page 6 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 were well looked after, that the accommodation was homely and that staff always followed any instructions she gave to them. Whilst there were still areas in the home which still needed attention, the atmosphere was relaxed and the home had a friendly, homely feel about it with staff spending time talking to the residents. What has improved since the last inspection? What they could do better: The statement of purpose and service user guide needed to be updated so that the right information was available for new residents and a copy of the service user guide needed to be given to each resident. As the guide contained a copy of the complaints procedure, this would make sure each resident was clear about how to make a complaint. Whilst residents had a dessert after their main meals, what was given to them was not recorded on the menus. This needed to be done so that residents’ diets could be checked to make sure they were having sufficient daily milk and fruit in their diet. Beech House DS0000025463.V288790.R01.S.doc Version 5.1 Page 7 The owner needed to employ a laundry assistant and week-end cleaner so that the staff could spend time with the residents rather than doing domestic jobs. This was highlighted at the last inspection and had not been addressed. New staff needed more training in how to do their jobs safely and not all those who already worked at the home had done all the necessary health and safety training. Residents’ monies and records were held in the owner’s office, which was kept locked when he was not at the home. This meant the inspector could not check if the records were in order. The owner needed to make arrangements for the residents’ finances to be available to the manager when he was away from the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Beech House DS0000025463.V288790.R01.S.doc Version 5.1 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.V288790.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 Standard 6 does not apply to this home. Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. The Service User Guide and Statement of Purpose need further reviewing to ensure that the information contained is accurate so that any prospective residents and/or their representatives would have the information necessary to make an informed choice about the home. Residents are assessed before coming into the home to ensure their needs can be satisfactorily met. EVIDENCE: Whilst the new owner had reviewed the Statement of Purpose, it had some inaccurate information in it and needed further reviewing. For example it stated that “all our care assistants have achieved or are working towards gaining their level 2 or Level 3 National Vocational Qualification” and this is not the case. The additional charge for staff accompanying residents to hospital appointments was contradictory as on one page it stated the charge was £20 and on other pages it stated the charge was £35. The Service User Guide had not been reviewed and updated since 2004 and this must be addressed as a Beech House DS0000025463.V288790.R01.S.doc Version 5.1 Page 10 priority. Residents interviewed, including the most recently admitted person, did not remember receiving a copy of the Service User Guide. This was also commented upon on a returned resident comment card. The manager stated the newly admitted person had been given one but the other residents had not. This must be addressed. The Service User Guide did not include reference to where the most recent inspection report could be obtained. Whilst an old inspection report was displayed in the entrance hall, it was not the last report and the manager should ensure that the most recent report is available for residents and/or visitors to the home. The file for the most recently admitted resident was checked and seen to contain a full care management assessment as well as one done by the manager. The resident said he could remember being asked questions about his needs before coming into the home. He had settled in well and felt his admission had gone very smoothly. The manager was aware that should a privately funding resident want to come and live at the home, she would need to do an assessment prior to admission. Beech House DS0000025463.V288790.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The individual health and personal care needs of residents were being met They were accorded a standard of care and attention which respected their privacy and dignity, recognised their individuality, fostered independence and enabled them to control decisions in their day to day routines. EVIDENCE: Three people’s files and information relating to them, were checked through. Their care plans were detailed and easily understood and identified their needs and individual choices with regard to daily lifestyles and routines. As a result of a requirement at the last inspection, an additional section had been introduced in relation to mental health needs. The care plans were being reviewed and updated monthly and the manager was planning 6 monthly reviews for the future. The key worker system was working much better and key workers had been sitting with their residents to get more social history information for the care plan. They had also done some research into the medication they were on and recorded the side effects and why people were on it on their files. One resident spoken to was able to recall who her key worker was and said that Beech House DS0000025463.V288790.R01.S.doc Version 5.1 Page 12 she liked her because she made her laugh. Whilst some reference was made to hobbies and interests, this needed further expansion as was noted on the care plan of the most recently admitted resident. Information contained in the service delivery agreement relating to interests was not always being transferred to the care plans. The manager acknowledged this and said she would ensure this was done in the future. Whilst care plans had been written in consultation with residents and/or relatives, they had not been signed to say they were in agreement with them. Risk assessments were in place were risk areas had been identified i.e. smoking, continence, falls, nutrition. Whilst two of the care plans inspected had moving/handling assessments in place, one did not. The manager had already identified a shortfall in moving/handling assessments and was in the process of undertaking them. Health care needs were well recorded and care plans addressed continence, sight/hearing, feet, mobility, oral care, toileting, diet and bathing. Since the last inspection, all residents had been consulted about what day and time of day they wanted a bath or shower and this had been recorded on their care plans. Two of the residents spoken with confirmed that staff were adhering to their wishes. Baths and nail care were now being recorded on care plan files and weight was being done regularly. Due to the frailty of some residents, the manager felt that inaccurate recordings were being taken. She had discussed this with the owner who said he would consider purchasing sitting scales. None of the residents had any pressure sores and this was confirmed by the District Nurse who was spoken to during the inspection. All visits by professional visitors were recorded on individuals files. The manager and two senior care assistants had recently attended a half day seminar on nutrition. Following the training, the new MUST tool (Malnutrition Universal Screening Tool) was being used for new residents and the most recently admitted resident had such an assessment in place. This now needs using for those people assessed at high nutritional risk. Due to the delay in getting appointments for audiology tests, the manager had made arrangements to take all hearing aids to Baillie Street the day after the inspection when they had promised to test them to ensure they were working correctly. The pharmacy inspector had undertaken two inspections to the home over the past 12 months. The home had implemented all but one of the requirements which was in relation to undertaking risk assessments for residents who wished to self administer their own medication. One of the residents spoken to during the inspection was self medicating but only a disclaimer form was contained in his care plan. When the lack of a risk assessment was highlighted to the manager, she spent time with the resident, during the inspection, undertaking an assessment which he was in agreement with. Medication Beech House DS0000025463.V288790.R01.S.doc Version 5.1 Page 13 Administration Record sheets now included a large clear photograph of each resident and staff specimen signatures had been recorded. The aims and objectives of the home reinforce the importance of treating residents with respect and dignity. Residents interviewed were all complimentary about how staff assisted them with personal care tasks and carers interviewed were able to give good examples of how they promoted privacy and dignity in their daily care routines. All assistance with personal care was given in the privacy of service users bedrooms or bathroom. Service users were also able to meet visiting professional visitors and family/friends within the privacy of their own rooms. Evidence of this was seen at the time of inspection when a district nurse visited. Those residents spoken with said that staff treated them with respect and dignity and this was also observed during the inspection. Whilst several male residents were living at Beech House, there were no male carers. Two male residents were interviewed and both said they were happy to be assisted with personal care needs by a female carer. The manager said that whilst they would like to recruit a male, the majority of applicants were female and on the rare occasion males applied, they failed to turn up for interview or the pay was insufficient. A good age range of all white staff were however, employed for the all white client group. Beech House DS0000025463.V288790.R01.S.doc Version 5.1 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Residents were encouraged and supported to exercise choice in their daily routines in relation to lifestyle and activities and to maintain contact with their relatives. The dietery needs of residents were well catered for with a balanced and varied selection of food available at each meal. EVIDENCE: Since the last inspection, activities and stimulation for the residents had greatly improved. Whilst an activity programme was still not in place, an activity book was being used to record both group and individual daily activities. From entries recorded, it was identified that more 1-1 work was being undertaken, including two instances where individuals had gone out to bingo and to the local garden centre and café. An external entertainer “Active Minds” were visiting the home fortnightly and were there on the day of the inspection. A craft co-ordinator visited weekly who was also responsible for holding residents meeting, as an independent person. In addition, one of the carers had expressed an interest in spending some time on activities and she had been given 6 hours a week to do so. More in-house activities were being organised by care staff and during the inspection, individual staff spent time playing cards, dominoes and assisting a resident to do a jigsaw puzzle. Also Beech House DS0000025463.V288790.R01.S.doc Version 5.1 Page 15 staff spent one to one time just sitting talking to individual residents or holding their hand and giving them some comfort. Appropriate music was on the radio and no childrens television programmes were being shown. The home have newspapers delivered and two residents were seen to read these. Bingo, skittles, hoop the loop, catching a soft ball and singsongs were done regularly. Musical entertainers also visited and a guitarist had been booked for the week of the inspection. Residents spoken to said they were satisfied with what was being offered. Monthly visits by the Church of England Vicar were being made and communion was taken in one of the residents bedrooms, with their permission. A Roman Catholic priest also visited occasionally and Jehovahs Witnesses were visiting one resident. At a recent resident meeting, two people had requested they be supported to attend the local church. The manager was arranging staffing for the following Sunday so that this would be possible. Other suggestions at the meeting had been made for trips out but these had not yet been arranged. The manager said this was an area she was seeking to improve and more trips out would be arranged over the Summer. The recording of more social histories was also alerting staff to what other more varied activities they could do. The garden was being attended to and the raised garden to the rear of the home had potential for residents to do some planting when the weather improved. All the residents spoken to felt the staff respected their preferred routines and lifestyles and evidence of this was seen during the inspection. They could get up when they wanted, choose to eat where they were sitting or at the dining tables, had the choice of various lounges, including one for those who smoked and could chose to join in with social activities or not dependent upon how they were feeling. Relatives spoken to said they were made to feel welcome by the staff. They also said they were also notified when their relative was ill or any changes to their condition were identified. One relative who was visiting over the lunch time period was given a meal. As all rooms are single, residents are able to receive visitors in private or choose to remain in the lounge. 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. The home believes that residents should be aware they can have access to any of their records and a notice to this effect is displayed in the home. Feedback from residents spoken to and responses on returned comment cards, was generally positive about the food. Three weekly rotational menus were in place which showed a variety of meat, fish, fresh and frozen vegetables were served daily. A choice of two meals were offered at lunch time. Puddings Beech House DS0000025463.V288790.R01.S.doc Version 5.1 Page 16 were not however, recorded on the menus but the Cook said she made milk and sponge puddings and other alternatives were available such as fruit, yoghurts and jellies. In order to ensure that residents’ nutritional needs are being met, the menus must include a choice of desserts, which should include, milky puddings, custard, fruit etc. and these must be recorded on the menus. Since the last inspection, a board was now displayed in one of the lounges, which showed the meals for the day. A choice of 3 meals at teatime were offered: a cooked meal, sandwiches or something on toast. On the day of the inspection, meat and potato pie or tuna salad were the lunch choices followed by bakewell tart and custard. The Inspector sampled the meal and found it to be tasty and well cooked. For tea it was potato hash/salmon sandwiches or egg/beans on toast. One resident had asked for a soft boiled egg and this was not a problem. One resident changed her mind about what she wanted but this was not an issue with the cook who changed her request. The main cook finished work at 13.00 and the teatime cook came on at 14.00 and left at 16.30. Sufficient drinks were served throughout the day and staff were seen during the inspection, prompting residents to finish their drinks. Juice was supplied in the main lounge and residents all said they got plenty of drinks. Cooked breakfasts were enjoyed by two or three people and a good selection of supper foods were offered, such as crumpets, maltloaf, cakes/biscuits. One resident, returning home from a hospital appointment at 11.15, was immediately offered a cup of milky coffee which she gratefully accepted. Residents can choose when and where to eat and this was seen during the inspection. The special dietary needs of the residents were being met. Whilst there were no residents who needed assistance with feeding, one or two people were seen to be prompted and encouraged gently by the staff. Beech House DS0000025463.V288790.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. An effective complaints system was in place which residents were familiar with. Adult protection training had improved since the last inspection and there was clear evidence that residents were being protected from abuse. EVIDENCE: A clear, easily understandable complaints procedure is in place which is displayed in the home. The home ensures that all complaints are logged in a complaints book. Since the last inspection, 16 complaints/grumbles had been recorded and all had been appropriately actioned. Residents spoken with all felt they could speak to any staff about problems and that they would be listened to. One returned resident comment card indicated the person was unaware of the procedure. The manager should check with all residents that they are clear about the procedure and give them a copy of the procedure to keep in their room. Positive comments were also received about the new owner and manager whom were said to spend time chatting with them. Staff knew the procedure and would report anything untoward to the manager or senior on duty. The Commission for Social Care Inspection (CSCI) had not undertaken any complaint investigations at the home over the last 12 months. Two Protection of Vulnerable Adult (POVA) investigations had taken place over recent months and the correct procedures had been followed. One had resulted in a POVA referral with Police involvement and the staff member being Beech House DS0000025463.V288790.R01.S.doc Version 5.1 Page 18 dismissed. New staff files showed that Criminal Record Bureau and POVA checks had been done before any new staff started work so as to ensure that the staff were suitable to work with vulnerable people. Many staff had now undertaken POVA training and this was seen on staff training files. One of the staff interviewed commented upon how useful she had found the course. The manager had recently liaised with a Manchester based advocacy service who had agreed they would visit the home should the home identify this was needed. Beech House DS0000025463.V288790.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. The standard of decor and cleanliness throughout the home had improved and it was evident the new owner was committed to improving the environment for the residents. EVIDENCE: Since the new owner had taken over in November 2005, it was evident he had prioritised work on the building and a refurbishment programme was underway. A written maintenance and renewal programme had not however, yet been done and this is an outstanding recommendation from the last inspection. A maintenance book was however being used to identify any jobs which needed doing. A new sign had been erected outside the home and the gardens and rear of the home had been tidied. Improvements were identified as follows: new boiler and tank installed so that there is sufficient hot water; several areas of re-decoration work including Beech House DS0000025463.V288790.R01.S.doc Version 5.1 Page 20 residents bedrooms; external maintenance work carried out; new carpet tiles to be fitted in 7 bedrooms; new television and walk-about phone so that residents could take calls in the privacy of their bedrooms; some new curtains and light fittings. Several positive comments were made by residents and relatives about the improvements being made. The residents and staff interviewed confirmed that the hot water problem had now been satisfactorily resolved. The manager acknowledged there was still work to be done but she was confident the provider would continue to upgrade the building. Three residents bedrooms were seen. One person had chosen to buy new furniture for her room and was clearly delighted with the result. Both other residents were satisfied with their rooms and decoration except that one resident said his bedroom was sometimes quite cool. The manager said the radiator in the room was working but that the radiator cover may be restricting some of the heat and that this would be addressed. The hot water was tested in all 3 rooms and the bathroom and found to be of a satisfactory temperature. Environmental Health had made two visits on the 24 February 2006 and 28 March 2006. Several requirements were made which had been completed on their second visit. A Safer Food folder had been issued which contained risk assessment documentation and the home had already started to complete it. Infection control policies/procedures were in place. The premises were clean and liquid soap and paper towels were supplied in toilets and bathrooms. Adequate laundry facilities were in place and individual baskets were supplied for each residents clothes. Feedback from residents indicated that missing clothing was not as big as problem as at the last inspection, but some items were still going missing. At lunch time, whilst staff were seen to change their protective white aprons when serving food, they did not put on blue ones as they were out of stock. The manager said she had re-ordered but that they had not yet arrived. Beech House DS0000025463.V288790.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. Staffing levels were meeting the needs of the resident group and the team had a good balance of staff in relation to age and experience. More staff needed to undertake NVQ training to expand their knowledge in order to provide a higher standard of care for the residents. EVIDENCE: The home was full with 27 people in residence. There were sufficient care staff on the rota to ensure the residents’ health and personal care needs could be met. Feedback from the residents and from comment cards indicated they felt they were well cared for. Relatives spoken to also felt that staffing levels were better and that staff were spending more time with the residents. One comment card stated that there were times when they felt there were not enough staff on duty. A requirement was made at the last inspection for a part-time laundry assistant and week-end domestic to be employed. This had not been addressed and the care staff were continuing to undertake this work. Given there is only 1 domestic employed, it is essential another person is employed who can stand in for the cleaner when she is off sick or on holiday. Of the 20 carers employed, 5 had completed NVQ level 2/3 training and 2 were in the process of doing so. The manager had liaised with the college who had Beech House DS0000025463.V288790.R01.S.doc Version 5.1 Page 22 agreed to provide in-house training for a further 5 carers. No start date had yet been agreed. When these staff have completed the training, the home will have achieved at least 50 staff with a qualification. Policies and procedures were in place for the recruitment and selection of staff. Three staff files were checked, two of which were for recently recruited care staff. The files were in order except that full employment histories were not always being obtained. This should be addressed. Staff interviewed confirmed they had received a copy of the General Social Care Council “Code of Practice” and copies of the document were seen in the staff personnel files. The homes in-house induction training was continuing, but records showed that staff who had been working at the home for several weeks had not yet completed this training. The manager had now identified a 1 day TOPSS training course which 8 staff had completed and 3 of the newer staff were waiting to go on it. The manager must ensure that all staff undertake Skills for Care training within 12 weeks of employment which should include all the mandatory training. Opportunities for staff to undertake training had greatly improved. The staff interviewed all felt they had benefited from the training they had been on. All staff were attending fire training the day following the inspection. From speaking to staff and checking training records 13 had done moving and handling, 12 dementia care training, 9 had done Health and safety, 8 food hygiene, 13 protection of vulnerable adults and 3 had undertaken risk assessment training. All the seniors, who were responsible for the administration of medication had undertaken the Boots medication course. In addition, the manager and 2 staff had undertaken nutritional training so the home could implement the MUST tool (malnutrition universal screening tool) and from this, 7 staff had received in-house training on the use of the tool. Whilst there were some training gaps for the more recently recruited staff, all the longer term staff had done at least 3 days training pro rata to their hours. Staff felt teamwork was good and that practice had improved because of the new managers input. Residents were all complimentary about the staff. Throughout the inspection, staff were observed spending quality time with the residents either chatting, sitting quietly with them or playing cards/dominoes. Beech House DS0000025463.V288790.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. The manager is experienced and has a clear vision of where further improvements are needed which will benefit the residents. Whilst quality assurance systems were in place, these needed to be incorporated into a quality assurance and monitoring policy so that all staff were clear about their responsibilities in this area. EVIDENCE: The manager had only been in the post since February 2006 and had already made a significant impact in improving the delivery of care. She had increased staffing levels to enable staff to be able to spend more time with residents, had reviewed and improved care plans, was continually encouraging staff to do more activities and spend 1-1 time with residents, had contacted a college to arrange NVQ training and had just started to do staff appraisals. Beech House DS0000025463.V288790.R01.S.doc Version 5.1 Page 24 Improvements in the care plans and the key worker system were also noted. Her other outstanding priorities were : regular supervision, (job chats), to organise more outings for residents during the summer and to continue to get the building upgraded. Whilst she had completed NVQ Level 4 training, she still had 2 units to complete of the Registered Managers Award. She was due to start these in September 2006. She demonstrated her commitment to undertake periodic training to keep abreast of current care practice and had recently attended a nutritional half day seminar. In addition she had undertake protection of vulnerable adult training, moving and handling, first aid and care of medicines. There was no quality assurance policy in place and this was an outstanding recommendation from the previous inspection. Some quality assurance practices were however, in place. The previous manager had sent out questionnaires in Jan 2006 to relatives/friends and service users and 13 relatives and 5 residents had returned them. Regular resident meetings are held by the craft co-ordinator (as an independent person). It was noted from the residents meeting minutes that several of the suggestions put forward had not been implemented although the manager was aware of this and was addressing it. Discussion took place about the need to collate the feedback and incorporate it into the Service User Guide. Whilst there was an old inspection report displayed in the entrance hall, it was not the last report. The manager should ensure that the current report is available to residents and visitors at all times. Residents finances were unable to be checked due to them being kept in the provider’s office of which the manager did not have a key. This standard was not therefore assessed. The manager and provider must make suitable arrangements for residents’ finances to be accessed in the absence of the provider. As stated above, whilst staff appraisals had been commenced, supervision had not and this is an area that now needs addressing. The pre-inspection questionnaire showed that all maintenance records were in order and up to date. Random sampling was undertaken of the accident book, water temperatures, public liability certificate and the Environmental Health Officer’s report. From checking the staff training matrix, it was noted that whilst the majority of staff had undertaken all the mandatory training a minority had not. The manager was aware of the shortfalls and was in the process of addressing them. Beech House DS0000025463.V288790.R01.S.doc Version 5.1 Page 25 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 X 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 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 1 2 X 2 Beech House DS0000025463.V288790.R01.S.doc Version 5.1 Page 26 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4, 5 Requirement The statement of purpose and service user guide must be reviewed and updated to include accurate and relevant information. All residents must receive a copy of the updated statement of purpose. Moving and handling assessments must be undertaken for all residents. The 3 weekly rotational menus must record the daily desserts offered . All residents must be given a copy of the complaints procedure or a copy be kept in each bedroom. The provider must ensure that the heating in bedroom number 7 is kept at a temperature, which suits the resident. A part-time laundry assistant and week-end cleaner must be employed or additional care staff hours allocated for these tasks. (Requirements not met from the last inspection in August 2005). At least 50 of staff must have DS0000025463.V288790.R01.S.doc Timescale for action 31/05/06 2. 3. 4. OP8 OP15 OP16 13 16 22 31/05/06 31/05/06 31/05/06 5. OP19 23 31/05/06 6. OP27 18 31/05/06 7. OP28 18 31/10/06 Page 27 Beech House Version 5.1 8. OP30 18 achieved NVQ Level 2 training All new staff must undertake induction training to the TOPSS specification. (This requirement was outstanding from the last inspection). 31/10/06 9. OP38 18 10. OP35 17 11. OP36 18 All staff must receive all 31/10/06 mandatory training i.e. moving/handling, infection control, first aid, food hygiene. Arrangements must be made for 31/05/06 residents’ finance records to be available at any time, for inspection. All staff must receive regular 31/05/06 structured supervision to address the areas in standard 36.3 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. 2. 3. 4. 5. 6. 7. Refer to Standard OP1 OP7 OP7 OP8 OP12 OP19 OP29 Good Practice Recommendations The most recent inspection report should be made available within the home. Information about residents’ hobbies and interests should be transferred from the Service Delivery Agreement to the care plans. Care plans should be done in consultation with residents/relatives and be signed to show their agreement to the plan. The home should purchase sitting scales so that residents can be weighed safely. An activity programme should be formulated in consultation with the residents. A quality assurance and monitoring policy/procedure should be in written and implemented. Job application forms should contain a full employment history for the potential applicant. Beech House DS0000025463.V288790.R01.S.doc Version 5.1 Page 28 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Beech House DS0000025463.V288790.R01.S.doc Version 5.1 Page 29 - 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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