Inspection on 02/10/08 for Beech House

This inspection was carried out on 2nd October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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 06/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Beech House Manchester Road Partington Manchester M31 4DJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Elizabeth Holt     Date: 0 3 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Beech House Manchester Road Partington Manchester M31 4DJ 01617752287 01617751039 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Nuala Mary Bridget Fitzmaurice Type of registration: Number of places registered: Beech House (Partington) Ltd care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N To people of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other categories - Code OP the maximum number of people who can be accommodated is: 23 Date of last inspection Brief description of the care home Beech house is a care home providing personal and nursing care to 23 older people. The home consists of two bulidings within the grounds that are adjacent to each other. Nursing accommodation was provided in a single storey extension that adjoins the original detached house. The other building is a bungalow. Car parking is available at the front of the property. Pleasant garden and patio areas are accessible to all residents. The fees for Beech House range from 435 to 570 pounds per week. Additional charges may be made for hairdressing and other personal requirements. Care Homes for Older People Page 4 of 29 Over 65 23 0 Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use the service experience good quality outcomes. This key unannounced inspection, which included a site visit, took place over two days on Thursday, 2nd October 2008 and Friday 3rd October 2008. This is the first inspection of the service following a change in its registration. The manager was not told beforehand of the inspection visit. All key inspection standards were assessed at the site visit and information was taken from various sources which included observing care practices and talking with people who live at the home, visitors, the manager and other members of the staff team. We sent the manager an Annual Quality Assurance Assessment (AQAA) form before the inspection for her to complete and tell us what Care Homes for Older People Page 6 of 29 they thought they did well and what they need to improve on. Survey forms were left for residents, relatives and staff in order to gain additional views and feedback about the service. The fees for this service were 435 to 570 pounds per week at the time of the visit. This includes the additional cost for nursing placements. The CSCI have not been in receipt of any complaints about this service since the change in registration. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get Care Homes for Older People Page 8 of 29 printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective people and their representatives have the information needed to choose a home, and have their needs assessed before admission. Evidence: A Statement of Purpose and a service user guide is available in the reception areas of the home. Three completed pre admission assessments were looked at, two of these were detailed and informed the staff of the care needs of the individual people. One persons admission detail was minimal. The manager confirmed this person had been on respite care previously, the person had visited the home and chatted to staff and other residents at the time to form their own view of the home. For another person the needs assessment mentioned the person had drop foot and required support for this. This information had not been carried forward into a care plan and there was no evidence of the support given to the person for this. It is good practice for a thorough pre admission assessment to be gathered and recorded before a decision is made as to Care Homes for Older People Page 11 of 29 Evidence: whether the persons needs can be met. Copies of care management assessments were held on file and the information had generally been transferred into the homes admission assessment information where appropriate. One person living at the home who filled in a survey form said the home was recommended to them and they were given written and verbal information during the visits they made before they accepted a room. They felt any questions they had were answered easily. Another person said they had found Beech house to be the most homely home and felt safe that it would meet their needs. A discussion with the manager and information recorded in the homes self assessment showed that people were welcome to have a meal pre admission and were welcome to spend time in the home to try and get a feel for the care home. Some of the residents spoken to said this did happen. Beech House does not offer an intermediate care service. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems and practices in place for monitoring the healthcare needs of residents requires improving to ensure their needs are met. Evidence: Four care plans were looked at and where possible these people were spoken to and their bedrooms looked at with their permission. Each person had an individual plan of care and a separate care plan diary. Two of the care plans looked at did not give enough up to date detailed information to enable the staff to properly monitor the health and personal care needs of the people living at Beech House. The manager had an action plan to address these shortfalls and has plans to introduce a new system for recording the care planning documentation. The staff spoken to understood the care needs of the people who were case tracked and could describe the way they supported the people living at the home. The following issues were identified: Care Homes for Older People Page 13 of 29 Evidence: A number of care plan evaluations had not been reviewed since July 2008, it is of concern that shortfalls in the evaluations of peoples health care needs may lead to their needs not being met in full. For two of the care plans there was no evidence to show how the person was to be supported and cared for on a daily basis to have their needs met. There was no record as to how the person is supported with their personal care needs in line with their assessed needs. A discussion with the manager and the senior care worker showed the need to have a more person centred approach to the care plans. The care plans provided evidence that other health care professionals and services were provided to people living at the home. A visiting GP spoke positively about the staffs monitoring of the residents health care needs and he felt any instructions were carried out appropriately. There were a number of risk assessments in place for individuals but from the care plans looked at, not all the risk assessments had been completed. For one person a risk assessment in relation to smoking was in place but risk assessments for moving and handling, pressure care monitoring, nutrition or falls had not been filled in. The shortfall in risk assessments has the potential to lead to shortfalls in the health, safety and well being of the individuals. From observations of the staff and a discussion with the resident the staff were seen to support her as needed. A number of residents and relatives made poistive comments about the staff team, one of the residents said, The girls are smashing. I am very happy here. Other comments from people living at the home were, I feel well cared for the staff are kind to me. From the nine residents surveys that were responded to asking about their views on the care home, six were responded to by relatives. All who responded felt the staff listened and acted upon what they said. One relative said they worked well with the resident and the family, they took time to listen to the family and answer any queries. We saw records for the receipt of medication into the home and records for the disposal of medication which were kept up to date. There were some examples where medicines had not been given correctly particualrly in the bungalow. Two residents had clearly missed doses of medication, for one resident over two days the doses were signed as administered and then these entries were crossed out and a code used to show the tablets were not available. This included medication in relation to diabetes. For another resident the code showing medication had not been given had been used but the reason for not giving the medication had not been recorded. The care worker in charge said they had run out of these tablets. Staff must make sure they communicate any shortfalls to the manager and the records need to improve to show Care Homes for Older People Page 14 of 29 Evidence: clearly that medicines are given as prescribed. A regualr thorough audit is needed of the medication system to assess and improve the quality of the service currently being provided. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some opportunities exist for people to join in activities and the residents found that the lifestyle in the home generally met their expectations. Evidence: Since May 2008 one of the care workers also takes responsibility for activities within the home. On the days of these visits there was some evidence of the staff encouraging the residents to take part in activities on a one to one basis or in a small group and a programme of planned activities was in place in the lounge and in each residents bedroom. A discussion with the activities organiser and the manager and comments made in the homes self assessment showed that they hoped to introduce more activities, trips out and social events in the care home. It was evident some of the staff tried to create a stimulating environment for the residents by listening to music, encouraging singing, reading magazines and talking on a one to one basis. An open visiting policy remains in place by the home and on the day of these visits a number of friends and family members spent time in the home visiting relatives. Some of the surveys were returned to the CSCI at the time of the appointment of the lead care worker for activities who is still developing this role. One of the residents wrote in the survey that, More activities would be welcome but the ones we do get are very Care Homes for Older People Page 16 of 29 Evidence: good. A review of the care plans showed that some information was provided to show how the residents liked to spend their day. One relative said, They always look after me here too. I am always given a drink and I join my wife for lunch. A choice of main course was offered at each meal time and the lunch served looked appealing and wholesome. Residents and relatives who expressed a view said the food was tasty and there was always plenty to eat. A number of residents were seen to wear overalls to protect their clothes during the mealtimes and staff were reminded of the need to make sure residents did not mind this and that it did not become custom and practice. The dining tables were pleasantly laid and the mealtime was seen as a sociable occasion for the residents. One resident said, I always like sitting next to my friend at mealtimes, we have a chat together. Information is kept about residents spiritual needs and representatives from local churches visit the home to offer communion. One resident said she would like to attend church more often and she said the staff had said they would try and support her to do this. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The policies, procedures and staff practices were in place to allow residents to raise their concerns and to feel confident they will be treated seriously. Staff would be confident to refer on potential abuse in order to protect resdients. Evidence: A complaints procedure is available in the service user guide and residents are made aware of how to make a complaint when they are offered a place at Beech House. Information provided in the AQAA stated that they believe each person has a right to complain and they would provide the information needed for a resident or relative to make a complaint. A record of complaints made directly to the home was available, this did not show a record of the actions taken or a record of the outcome of the concern. Following a requirement made at the last inspection a number of staff have now received training in Abuse Awareness and safeguarding vulnerable adults. Nine residents and or their representatives returned surveys and of these all nine said that they knew how to make a complaint and their concerns were responded to appropriately. Some staff spoken to said they had recieved some in house safeguarding training as part of their induction at the home. Two staff members confirmed they had read the new Traffords Safeguarding Policy and procedure and the manager had a sheet for the staff to sign they had read this document. Two staff members were clearly aware of Care Homes for Older People Page 18 of 29 Evidence: the course of action they would take in the event of an allegation of abuse in line with the local procedures and they were aware of the whistle blowing policy. The Commission have not received any concerns regarding this service. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a clean, homely and comfortable home. Evidence: A partial tour of the home and the bungalow was carried out which shows the home is well furnished and well maintained and is suitable for the residents living there. The residents bedrooms and the lounges and dining rooms were homely and pleasantly decorated. The previous inspection stated that areas of the hallway were looking tired and the paintwork around the skirting boards and door frames were damaged from wheelchair use. A discussion with the homeowner highlighted this will be addressed following building work which he hopes to start soon. Since the last inspection of the home a number of the rooms have been decorated and some have been refurbished. Residents bedrooms had been personalized with photographs, items of furniture and ornaments. All nine residents and or their representatives who returned surveys said the home was always or usually fresh and clean. One relative expressed satisfaction with the environment saying, There is a homely atmosphere for the residents and another relative wrote, The home and gardens are kept very clean and when suitable residents are taken outside. The Care Homes for Older People Page 20 of 29 Evidence: gardens included patio areas which had recently been extended and were well maintained and accessible to residents. Residents were seen spending time on the patio during the vist and one resident said, The staff are very kind in supporting me to sit outside for a smoke when I want one. The building was well equipped with aids and adaptations, new handrails and safety rails had been added to the ramps leading to patio areas to enable residents to do as much as they can for themselves. Equipment was available in the home to make sure the physical needs of the residents could be met in an appropriate way. A cleaning programme is in place and the home was clean and free from odour. Policies and procedures are in place for infection control. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The number, deployment and training of staff appeared sufficient to meet the needs of residents. Procedures for staff recruitment were in place to protect residents. Evidence: At the time of the inspection visit the numbers and skill mix of the staff was sufficient to meet the needs for the residents accommodated. Comments from a relative in the service user survey showed they were satisfied with the care and attention recieved by the staff saying, The staff treat those in their care with the utmost sympathy and consideration. The home employed 16 care staff, 9 of which had achieved National Vocational Qualification level 2 or above in care and 1 member of staff was currently undertaking NVQ level 2 or 3. This meant that the home had 56 per cent of staff trained to NVQ level which is commended. The care staff spoken to confirmed that they were encouraged and supported to undertake NVQ training. The nursing and care staff were supported by domestic, laundry, catering and administrative staff. The staff files for three staff were looked at and were all found to contain a written application form, written references, evidence of Criminal Records Bureau checks or POVA (protection of vulnerable adults) checks. The records available showed that most Care Homes for Older People Page 22 of 29 Evidence: staff had received training in fire safety, moving and handling, medication, infection control and safeguarding adults. Staff said how they had received some in house training sessions which had included diabetes and continence management and that training was encouraged and they were supported to attend training. The manager confirmed that all new staff employed attend an induction training course which is in line with the Skills for Care induction programme. Responses from four staff surveys returned showed there are enough staff to meet the individual needs of the all the people who use the service. One other staff member felt the nursing unit comes first in terms of staff and they worked mainly in the personal care only unit. From the shortfalls identified in the care plans in the bungalow and this comment, the manager should review how this unit is currently being staffed and managed to make sure the needs of the residents accommodated here are being met. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some of the systems and procedures need further monitoring to safeguard the interests and well being of the residents. Evidence: The residents benefit from a manager who creates an open, positive and inclusive atmosphere. She is a Registered Nurse who is committed to the care of older people and keeps her knowledge and skills updated. The manager and some of the staff spoken to recognised they had been through a difficult period of time since the last inspection due to adjusting to changes in the ownership of the home and felt aware of the shortfalls noted in this report. The manager and the staff team recognised the areas they needed to address particularly in relation to the care plans, risk assessments, medication. The fire records were looked at and the required checks had been made. The fire risk assessment had not been reviewed for this year however the manager advised this Care Homes for Older People Page 24 of 29 Evidence: was on her action plan. A number of windows were without window restrictors on the ground floor, a recommendation was made for a risk assessment to be carried out as to whether restrictors require fitting. Any accidents or incidents were recorded appropriately and there was evidence of action taken if necessary. The policies and procedures were in place to ensure the financial interests of the residents are safeguarded. Staff said there was sufficient equipment within the home to enable them to carry out their jobs safely and effectively. Staff were seen to use the equipment in a safe manner. The home had a quality review service in place and this had been sent out in the last twelve months. The manager stated these responses had not yet been reviewed due to the demands on her time. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 The manager must ensure 31/12/2008 that detailed care plans and risk assessments which are up to date and include the needs of residents are in place. This includes risk assessments for moving and handling, pressure area care, nutrition and falls. To make sure that the health, safety and well being of the residents needs are monitored and met. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 Pre admission assessments should be undertaken and the outcomes be clearly recorded to ensure the service can clearly meet the needs of the prospective resident. A system to audit medication and to assess the quality of medciation handling should be established and maintained by the manager, to ensure that the quality of medication handling is assured and residents health are not at risk. A risk assessment should be carried out as to whether Page 27 of 29 2 9 3 38 Care Homes for Older People window restrictors should be fitted to bedrooms on the ground floor for the safety of the residents accommodated. Care Homes for Older People Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!