Inspection on 20/02/06 for Beech House

This inspection was carried out on 20th February 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Beech House 22/09/07

Beech House 20/12/06

Beech House 01/09/05

Beech House 01/03/05

Beech House 18/06/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Beech House 21 Gravelly Hill North Erdington Birmingham West Midlands B23 6BT Lead Inspector Donna Ahern Unannounced Inspection 20th February 2006 13:20 Beech House DS0000028592.V284416.R01.S.doc Version 5.1 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 DS0000028592.V284416.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 Adults 18-65. 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 DS0000028592.V284416.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Beech House Address 21 Gravelly Hill North Erdington Birmingham West Midlands B23 6BT 0121 428 5000 0121 382 7290 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) Birmingham Focus on Blindness Maxine Kallon Care Home 6 Category(ies) of Learning disability (6), Sensory impairment (6) registration, with number of places Beech House DS0000028592.V284416.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents must be aged under 65 years Date of last inspection 1st September 2005 Brief Description of the Service: Beech House is a large detached house situated in the Erdington area of Birmingham, and is within easy walking distance of the local shopping centre. Star city entertainment village with cinemas, shops, restaurants and bowling alleys is a five-minute drive away. The home offers accommodation to six residents with sight loss and learning disabilities. Each resident has his or her own personalised bedroom with en-suite bathroom. The home has a large car park to the front with attractive flower borders; the rear of the home can be accessed via a conservatory and is mostly laid to lawn with flower borders and attractive garden furniture. Beech House DS0000028592.V284416.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was announced and took place over one afternoon and evening. The inspector met and spoke to all the residents. A partial inspection of the physical standards was undertaken. Residents care plans and risk assessments were inspected. Staff records were examined, and some Health and Safety records were inspected. The inspector had the opportunity to talk to the manager and three care staff. This report should be read in conjunction with the inspection report of the 1st September 2006. What the service does well: What has improved since the last inspection? A new manager and deputy were appointed in November 2005. Medicine management has improved since the last inspection to a safe level. The manager presented as competent. She had started to make progress on previously raised requirements and was open and positive and presented as committed to the development of the home. The reviewing and restructuring of residents care plans had commenced so that so that there is a detailed support plan in place for each resident. Good progress had been made on updating risk assessments and a system for reviewing them had been implemented. The manager had implemented residents meetings. Residents were being asked about the kind of activities they would like to do when they are at home or out in the community. A supervision structure had been implemented so that staff receive the right support and supervision to do their job. Beech House DS0000028592.V284416.R01.S.doc Version 5.1 Page 6 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. Beech House DS0000028592.V284416.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beech House DS0000028592.V284416.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 Information about the home required some minor updating so that prospective residents have the information they need to make an informed choice about the home. EVIDENCE: These standards were assessed in full at the previous inspection. Progress on previously raised requirements was monitored at this inspection. The Statement of Purpose required some minor updating again to reflect the recent management changes. The previous inspection report raised concern regarding the home meeting the assessed needs of a resident who had recently moved into the home. The residents needs fell broadly within the registration of the home. Due to the residents physical disabilities bathing and showering presented difficulties. These issues should have been identified prior to admission. The manager said that an assessment of their bathing needs had taken place and funding for specialist bathing had been submitted to Social Care and Health. The provider was due to review the placement after three months to assess the settling in period and to make a decision about the permanency of the placement. A recent review had taken place and in conjunction with the resident, their advocate and placing authority it had been agreed that the resident will remain at Beech house. The manager said that appropriate bathing equipment had been ordered and should be installed within six weeks. Beech House DS0000028592.V284416.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Further development of residents care plans was required so that an up to date plan of care is in place so that resident’s needs, aspirations and goals are clearly documented and monitored. EVIDENCE: The previous inspection required that care plans were developed. A lot of information in different formats had been added to the care plans and it was difficult to track information. Care plans had not been kept under review. Since the new manager has been in post progress has been made on updating the care plans. It is acknowledged that this will take some time, as both the manager and deputy manager are new in post. They need to get to know the residents and then work with the staff team on developing resident documentation. Considerable work was still required so that there is a detailed support plan in place for each resident. The need for the support plan to cross reference to risk assessments and relevant policies and procedures was discussed. Residents’ finances are managed by their families and advocates. Systems are in place for recoding and receipting small amounts of money that are held for Beech House DS0000028592.V284416.R01.S.doc Version 5.1 Page 10 each person for daily spending. It was advised that the current systems are reviewed so that where appropriate residents have greater control and management of their own money. The manager had made good progress on updating and reviewing risk assessments. A review sheet had been implemented so that there is evidence that they are kept under review. Some further development was required. Risk assessments for the support required from night staff must be implemented. Beech House DS0000028592.V284416.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the 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, 15, 16, 17 The range of activities that residents are supported to access was under review so that facilities available within the home and opportunities in the community meet residents assessed needs. EVIDENCE: All six residents attend a day service on a full time basis. (Monday to Friday) Birmingham Focus runs the “Centre on Blindness” and it is a specialized resource specific to the needs of residents. The manager identified that the range of in house and community activities for residents required development. A residents meeting was held in December 2005. Minutes of the meeting indicated that residents were consulted about the type of activities they would like to do and some board games and tabletop games have been purchased. The manager recognised that this was only the start of the consultation process and further work was required. The manager stated that information about activities, hobbies and interest of individual residents will be updated and recorded on peoples care plans. Beech House DS0000028592.V284416.R01.S.doc Version 5.1 Page 12 Residents said that they do go out occasionally and one resident said they like to go out for a drink at the local pub another resident said they like to listen to music. Sampling of care plans, conversations with residents and staff indicated that resident’s relatives, friends and advocates are actively involved with their care. Many of the residents have very regular contact with their family and some have regular visits to their relative’s home. Some of the residents require a high level of support with their personal care. There is some routine around busy times of the day such as the morning so that residents receive the support they need prior to the transport for the day centre arriving at about 8.45 am. Residents said it was more relaxed at weekends. One of the residents asked if they could have a key to their room. The manager confirmed that this would be actioned immediately. All bedroom doors are lockable but none of the residents had previously requested to have their own key. A four week rotating menu is in place that indicated that residents receive a healthy diet. The manager said that this may be reviewed so that the menu is more flexible. The arrangements for food storage were adequate. A new thermometer was required for the testing of the fridge temperature. A dishwasher has been installed since the previous inspection this was a previous recommendation. Beech House DS0000028592.V284416.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 The systems for medicine management have improved since the last inspection. Clear comprehensive arrangements had been installed to ensure service users medication needs are met. Staff were very keen to improve this further. EVIDENCE: The CSC pharmacy inspector undertook a full audit of the homes medication recording, administration and storage on the 7th February 2006. Her findings were that all audits demonstrated that the medicines had been administered as prescribed. She felt that staff were very receptive and keen to improve practice further. They had a good understanding of the clinical needs of the residents’ and were actively seeking medication reviews with the doctor. The previous report required that the epilepsy management plan in place for one resident required some clarification. One resident’s epilepsy was under review the previous manager stated that a referral to a consultant had been actioned so that the management of their epilepsy could be fully reviewed. Risk assessments in place for residents with epilepsy required further development and must include that staff supervise and remain with residents after a seizure. These requirements remain outstanding. The manager agreed to review the epilepsy guidelines as a matter of urgency and agreed to involve the support of the community nurse. Beech House DS0000028592.V284416.R01.S.doc Version 5.1 Page 14 Health Action plans required further development including details of what action must be taken to support the resident with meeting their health care needs. . Beech House DS0000028592.V284416.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 The home’s procedures protect residents from abuse. The provider must explore how the complaint procedure can be more accessible to residents. EVIDENCE: The complaints procedure had been updated since the previous inspection so that it includes the timescales that complaints will be addressed in. The complaint log indicated that no complaints had been received since the last inspection. The provider must explore how the procedure could be developed so that it is more accessible to residents. Most residents would not be able to verbally raise a concern or a complaint and are reliant on the staff team to promote and protect their well-being. The organisation had an Adult Protection Policy, which was reviewed last year. The Multi- Agency Guidelines were also available. Adult protection training took place in September 2005. Beech House DS0000028592.V284416.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 29, 30 Residents live in a homely, comfortable and safe environment. EVIDENCE: The home meets the required minimum standards in respect of the physical environment. Since the previous inspection painting of communal areas has taken place and new carpets had been fitted in the dining room and lounge. The home is furnished and decorated to a satisfactory standard. The sofa in the lounge is very worn and the manager said that this will be replaced in forthcoming months. As raised in previous reports the layout of the kitchen is disappointing. There is minimum work surface space for food preparation and a single drainer sink. It is advised again that the kitchen is refurbished. A specialist bath must be installed to meet residents assessed needs as stated under standard 3. Beech House DS0000028592.V284416.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 35, 36 Staffing levels were adequate to meet resident’s needs. Staff training must be actioned so that staff have the required knowledge and skills to support residents. EVIDENCE: The home has gone through a very unsettled period again with staff and management changes. The manager has invoked the organisations disciplinary procedures in respect of some staff members. Whilst this can be unsettling for residents and the staff team it is positive that the organisation is being proactive in dealing with inappropriate practice and or conduct matters. The new manager demonstrated a good understanding of the importance of having an effective staff team in place and how this could be achieved and the need for staff to receive the relevant training and support to do their job. Three full time vacant posts for support workers were in the process of being appointed to. The rota indicated that there are six support workers on in the morning until all residents have gone out to the day centre. In the afternoon/evening there are four staff on duty. At the weekend there are four staff on duty, which is increased, to five in the evening if residents are going out. At night there is one waking night staff and one sleeping in on call. The manager recognised the Beech House DS0000028592.V284416.R01.S.doc Version 5.1 Page 18 need to continue to monitor staffing levels to ensure that they are appropriate to meet resident’s needs. Many of the staff required refresher training in mandatory areas. Including Food Hygiene, Fire safety, Infection Control, Disability Awareness, Basic First Aid. Training specific to the needs of residents is also required in Management of Behaviour, Epilepsy and Mental Health/dual diagnosis so that staff have the required knowledge and skills to support residents. Staff training records must be improved so that there are details of training received, duration of the training, and the training provider. Supervision records were assessed and it was pleasing to see that since the new manager and deputy had been in post significant improvements in the frequency of supervision had been made so that staff receive the required support to do their job. Beech House DS0000028592.V284416.R01.S.doc Version 5.1 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 The health, safety and welfare of residents was well managed. EVIDENCE: The previous manager resigned from her position in September 2005. Temporary management arrangements were in place, which included support from a manager from another registered service and support from a senior staff member who works within the organisations day services. A new manager and deputy were appointed in November 2005. The manager was previously a registered manager for another organisation. CSCI require an application to register the manager for Beech House. The manager presented as competent. She had started to make progress on previously raised requirements and was open and positive and presented as committed to the development of the home. The fire records, risk assessments for the environment and water checks were examined and all found to be in good order. Beech House DS0000028592.V284416.R01.S.doc Version 5.1 Page 20 The manager had implemented residents meetings and was keen to seek the views of residents and their relatives about the running of the home. Beech House DS0000028592.V284416.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 2 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 X 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X 2 X X X X 3 X Beech House DS0000028592.V284416.R01.S.doc Version 5.1 Page 22 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. 2. 3. 4 Standard YA1 YA6 YA9 YA13 Regulation 4(1)(c) Sch1 Requirement Timescale for action 31/03/06 31/05/06 30/04/06 30/04/06 5. 6. YA18 YA19 7. YA19 8. 9 10 YA19 YA22 YA29 The Statement of Purpose required some updating. (Previous requirement 31/10/05) 15(1)(2) Care plans required further development. 13(4)(a-c) Risk assessment required further development. 16 (m) The provider must consult with residents about the programme of activities arranged by or on behalf of the home. 13(1)(b) Care plans must be updated following input and advice from other professionals. 13(4)(a-c) Risk assessments for residents with epilepsy required some development. (Previous requirement 30/09/05) 12(1)(a,b) Clarification was required regarding the management of one resident’s epilepsy. (Previous requirement 30/09/05) 12(1)(2) Health Action Plans required further development. (Previous requirement 30/11/05) 22(2) The complaint procedure must be accessible to residents. 14(1) The appropriate bathing facilities 23(n) must be provided to meet residents assessed needs. DS0000028592.V284416.R01.S.doc 31/03/06 31/03/06 01/03/06 31/05/06 31/05/06 30/04/06 Beech House Version 5.1 Page 23 11 12 YA35 YA35 18(1)(c) 18(1)(c) 13 YA37 8(1)(a)(b) (i) 31/05/06 Training updates were required in mandatory areas. To meet residents assessed 31/07/06 needs training was required in Epilepsy, managing behaviour, and dual diagnosis/Mental Health. Training records must include. Date of training, duration, training provider, date refresher required. CSCI require an application to 31/03/06 register a manager for the home. 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 Refer to Standard YA24 YA7 Good Practice Recommendations It is advised that the kitchen is refurbished. To review how residents are supported to manage their own finances. Beech House DS0000028592.V284416.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 DS0000028592.V284416.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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