Inspection on 20/02/08 for Beech House

This inspection was carried out on 20th February 2008.

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

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

Other inspections for this house

Beech House 14/08/09

Beech House 03/02/09

Beech House 18/08/08

Beech House 20/09/07

Beech House 07/06/07

Beech House 25/09/06

Beech House 10/01/06

Beech House 05/07/05

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Beech House Wollerton Market Drayton Shropshire TF9 3DB Lead Inspector Janet Adams Key Unannounced Inspection 20th February 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Beech House DS0000064947.V361054.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Beech House DS0000064947.V361054.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beech House Address Wollerton Market Drayton Shropshire TF9 3DB Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01630 685813 01630 685014 pete@birminghamfocus.org.uk Ash Paddock Homes Limited vacant post Care Home 54 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (54) of places Beech House DS0000064947.V361054.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care with nursing to service users of both sexes whose primary care needs on admission to the home are within the following categories:old age not falling within any other category, OP, 54; dementia - over 65 years of age, DE(E), 10. The maximum number of service users to be accommodated is 54. 2. Date of last inspection 9th October 2007. Brief Description of the Service: Beech House is registered to provide nursing and personal care for a total of 54 older people, of whom ten may have dementia related illness. The home is owned by Springcare Ltd, (Ash Paddock Homes) the Managing Director being Mr Lee Cox. The home is located in a rural setting within a large extended country house in the village of Wollerton near Market Drayton. It is set in its own grounds, which are well maintained, and all bedrooms have lovely views of the surrounding countryside. Due to its location, there is limited public transport to and from this home. Accommodation is offered in either single or double bedrooms, some of which have en suite facilities. Some bedrooms are provided on the ground floor, and the remainder are accessed by a passenger lift onto the first floor. Springcare Ltd makes the services of Beech House known to prospective residents in their statement of purpose, and its brochure/service user guide. A copy of the most recent CSCI (The Commission for Social Care Inspection) Inspection report was also seen to be freely available at the entrance of the home for people to look at. The current fees charged vary between £450 and £640 per week depending on the care, support and accommodation provided. Additional charges to service users are for hairdressing, toiletries, and newspapers. This fee information applied at the time of the inspection and the reader may wish to obtain more up to date information from the care service about this matter. Beech House DS0000064947.V361054.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor outcomes. Two inspectors carried out this key unannounced inspection. It was carried out in the form of two separate visits to the home and lasted over ten hours. This is the third occasion we have inspected Beech House in the last 12 months. The main purpose of the inspection was to follow up progress made since the last inspection in October 2007, which resulted in the home having to provide us with a detailed plan of how systems in the home were to improve. On the first inspection day, our specialist pharmacy inspector assisted by carrying out an inspection of the medicines management systems in the home. We observed activity within the home, inspected the premises, and had an ‘in depth look’ at records for residents and staff. We also spent time observing, talking and listening to over half of the 37 people living there. Some of the staff on duty at the time of the inspection shared their views about working at Beech House. Discussions took place in private with people on their own, or in groups in the lounges. Everyone was happy to share their comments, which are included in the main body of the report. As part of the inspection process we circulated questionnaires and stamped addressed envelopes to people living, visiting and working at the home, so their views and opinions could be included in this report. One relative and six staff members sent written comments about the home to us. Everyone, including residents and staff, was very welcoming and helpful throughout the inspection. In total, we assessed a total of 24 out of a possible 38 National Minimum Standards for Older People. Discussions with the management team took place throughout and feedback about the conclusions of the inspection was given at the end of both inspection days. What the service does well: The atmosphere within the home is warm and friendly and the staff group communicate well with residents. The home has systems in place which ensure any concern or complaint is welcomed and acted upon in order to improve the service it provides for its residents. Beech House DS0000064947.V361054.R01.S.doc Version 5.2 Page 6 One of the home’s major strengths is the way residents are encouraged to participate in a variety of activities, which suit their tastes, preferences and abilities. Over 70 of the carers have the minimum expected care qualification. What has improved since the last inspection? What they could do better: Recent attempts at improving written information to tell people what services the home offers still does not give a full picture of Beech House. Although the company that owns the home has provided the information, this was not checked by the home management to confirm that what it contained was correct. Shortfalls in communication appear to be having a negative effect on the people living at the home and it appears that people with more complex care needs are not receiving the care they need promptly. • Delays have occurred in carrying out investigations requested by health professionals. Beech House DS0000064947.V361054.R01.S.doc Version 5.2 Page 7 • • • Medication records do not accurately account for medicine given for people who receive medicine to keep their blood chemistry right. The poor handwriting by some staff residents care records makes them very difficult to read and understand. Records confirm that people do not receive all of the support and attention they need to promote good health. Systems to store staff records have changed and resulted in some information necessary for inspection not being available. Bedrail safety systems need to be further explored to make sure all people have the right information on their paperwork to show staff know what is expected of them to keep people who need this equipment safe. Accident management systems need to be more robust to reflect the actual events and actions that have taken place. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Beech House DS0000064947.V361054.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beech House DS0000064947.V361054.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3.Standard 6 is not applicable. Quality in this outcome area is good. An appropriately qualified person assesses all people considering moving into Beech House before being admitted to make sure the home can meet the person’s needs and wishes. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Springcare, the Registered Providers for the service, produce a corporate styled information folder for prospective residents, which contains the home’s Statement of Purpose and Service User Guide, the information we require them to have by law. This information has been looked at as part of the last two inspections and did not meet legal requirements. Although the information Beech House DS0000064947.V361054.R01.S.doc Version 5.2 Page 10 has been improved some details need further adjustment to clearly reflect the service it provides. • The statement of purpose now reflects information about the people the home accommodates, however this does not match the numbers it is registered for • The service user guide and separate information sheet about the home does not detail how the home supports people with dementia related conditions and their accommodation arrangements. An in depth look at the admission records of two people who moved into the home since the last inspection confirmed that good standards of recordkeeping are kept for this matter. One set of care records was for a person who moved into the home on a permanent basis, the other was for an individual who was admitted for short term care. Both individuals had been fully assessed by the home manager. Findings show the home has improved their systems for readmitting people to the home on a short term basis. Details seen written down confirm as much information as is necessary is collected for the home to decide whether they can meet the person’s personal and health care needs before they move in. This means that staff can fully prepare for people before they move in. Another management improvement for the recordkeeping for people living at the home for a short period of time has resulted in a ‘resident discharge form’ being created for use. This means the home now provide a written recap of a persons condition whilst they have been staying at home, so the person they are being discharged back to is fully aware of the individuals well being at the point of leaving the home. This home does not offer intermediate care. Beech House DS0000064947.V361054.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10. Quality in this outcome area is poor. The support and personal care provided at Beech House does not promote good health for all of the people who live there. Management of residents’ medication has improved, but there are still areas where people have not received medication as prescribed This judgement has been made using available evidence including a visit to this service. EVIDENCE: A requirement we made following the last inspection was that the home must provide up to date information to direct staff so they knew how to promote the health and well being of people living in the home. As a result the home were requested to submit to us an ‘Improvement Plan’ to confirm what actions would be taken to improve the quality of care and support given to people, and how it was accounted for. Beech House DS0000064947.V361054.R01.S.doc Version 5.2 Page 12 Inspection findings confirm that the home team have received a lot of support from ‘Springcare,’ the company who owns the home to improve this part of the service it provides. Since the end of last year the company area managers have been visiting the home on a weekly basis in order to monitor the team progress with the quality of care and support offered to people living at the home. This has resulted in improvements in several care practices. • All comments we received about the care the staff team carries out for its residents were complimentary. • Staff were seen to be attending the needs of residents in a respectful, caring manner. • People appeared well groomed and content. • Paperwork especially for people with dementia related conditions has improved. • People are informed of changes in their relative’s health needs and care planning. One relative commented, ‘They are patient, kind and caring. The staff always seem to be very attentive to the needs of residents.’ However, some people requiring complex care are not getting their health needs fully met. This appears to be caused by a lack of effective communication between staff. Although the records for people checked by the ‘Springcare’ managers were of a good standard, those they had not looked at were not, and show the home team are not sharing information nor learning from the good example led by the company. Improvements Springcare have expected the home team to carry out have not been done. Actions requested by them after three recent visits were not fully carried out. Some staff have been advised their handwriting was not clear to read. Records seen on the inspection day confirmed it was still very difficult to read records to understand what care had been carried out, and more importantly what additional care was needed for people. One person with diabetes and who was on medication to thin her blood saw a doctor because of nursing staff concerns about the deterioration of wounds on her feet. The person was identified for tests to check for infection to be carried out on a specific day. A breakdown in communication led to it not being carried out until three days after the day the manager had expected them to be done. During this time the person’s general health as well as her wounds deteriorated resulting in the person being ill with a high temperature, and bowel problems. In addition, the person also developed a pressure sore that was not monitored as it should have been due to failures in recordkeeping and communication, the manager was not aware of this situation when it was shared with her. Beech House DS0000064947.V361054.R01.S.doc Version 5.2 Page 13 This incident was a specific concern to us as one of the reasons for our last inspection was to explore similar issues being reported to us by relatives. This resulted in a safeguarding adults investigation, which is still in progress. The nursing staff of Beech House confirmed that seven residents who live in the home need to have regular blood tests to make sure they get the right dose of medication to keep them well. By talking to staff it appeared that the day to day practices for managing this important task are not consistent. There was no information written down in peoples care records as guidance how this health need should be managed. A system introduced by the manager since the last inspection was not being followed by all staff, and this meant results of blood tests and other investigations were not recorded properly. Inspection findings last year confirmed that the home was not been able to fully meet the needs of people with complex care needs. The above issues describe similar events, which have occurred in the home since then that have not been handled properly to keep people with such needs safe. The pharmacist inspector visited the home on the 20th February 2008 as part of the key inspection and carried out an inspection of the medicines management systems being practiced within the home. The pharmacy inspection looked at the effectiveness of the home’s arrangements for the receipt, recording, handling, storage, safekeeping, safe administration, and disposal of all medicines received into the home. The inspection comprised of examining the medication storage area, examining the records kept and having discussions with both the care staff and residents. The findings of the pharmacist inspector were then fed back to the manager at the end of the visit. Overall the quality of the recording of the receipt of medication into the home had been maintained. However the administration records had not been maintained to the same standard. Auditing a selection of the residents’ medication found that some medication could not be accounted for and some MAR charts had been signed when the medication had not been administered. At the last inspection concerns were expressed about the handling and administration of Warfarin. The home was advised to write a protocol for the administration of Warfarin for each resident so that the strength of tablets used to meet the prescribed dose remained consistent. The home had obtained a general protocol for the administration of Warfarin, which did not represent what the home was doing nor as we saw did it protect residents from administration errors. We found that a) instructions from the INR clinic for one resident to miss one days dose in order to reduce their INR levels had not been complied with by the home b) one resident had been administered more Warfarin than the prescribed dose c) the nursing staff were still not using the same tablet combinations to reach the prescribed dose and d) there were failings to record quantities of Warfarin present within the home. We also found that the care plans were lacking essential information and these included Beech House DS0000064947.V361054.R01.S.doc Version 5.2 Page 14 the INR results, dosage changes, date of receipt of the changes and the target INRs. The home need to improve their systems for the complexities involved with handling Warfarin. The Controlled Drug records were examined and it appeared that all of the Controlled Drugs could be accounted for and that on the whole the Controlled Drugs were being administered as prescribed. We found, according to the Controlled Drugs register that on two occasions that some medication had not been administered as expected. When the MAR charts were examined to find the reasons for this we found that on one occasion the MAR had been signed indicating that administration of the medication had taken place. On the other occasion a generic abbreviation had been used but had not been defined and therefore the reason for not administering the medication was not evident. We found that some of the nursing staff had undertaken and completed a safe handling of medicines course conducted by Walford College. These nursing staff had also undergone and passed assessments for their competency to handle and administer medication safely. The pharmacist inspector was informed that some members of the nursing staff had still got to undertake the safe handling of medicines course and be assessed for their competency to handle and administer medication safely. We informed the home that it was important that those members of staff who had not completed the training course should be assessed for their competency as soon as possible. There had been further improvements in the storage of the residents’ medication. The fridge temperature records showed that the fridge was being maintained within the correct temperature range. Beech House DS0000064947.V361054.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14, &15. Quality in this outcome area is good. The daily life and social activities arranged for people living at Beech House takes into account the differing expectations, preferences, lifestyle and abilities of each individual. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Findings on both inspection days were of a similar good standard to those seen at the inspections in June and October last year. Visitors are welcomed in a professional manner and obviously have a good relationship with the staff on duty. The home’s strong links with the nearby community continues. Residents’ records show the local clergy visits regularly to offer Holy Communion. As several people in the home are not able to share their opinions about their lifestyle at Beech House due to their medical conditions, they were observed for some time in two separate lounge areas during the inspection. Beech House DS0000064947.V361054.R01.S.doc Version 5.2 Page 16 Although there was very little activity going on during the morning, an afternoon baking session which included several relatives as well as residents, proved to be enjoyable for all involved. People not only enjoyed the practical side of making cakes, they shared an enthusiastic discussion of baking cakes in ‘days gone by.’ The home’s minibus is used regularly, and some residents had used this transport to visit a candle making factory the day before the inspection. Since the last inspection, the home have introduced an activity diary which the staff use to refer to while planning their work to make sure people are supported at the right times to get the opportunity to join in the activities they have chosen to do. An invite to have lunch with residents was accepted and the meal of poached salmon was tasty and appetising. It was served in the dining room, which had tables set to restaurant standards. Likewise meals seen being served on trays to people in their rooms were attractively presented to hotel standards, making mealtimes at the home an enjoyable event. Discussion with the cook confirmed the meals are planned and presented in line with their menus. She told us one resident who used to be a cook has regularly sent notes of thanks to the catering team to remark about the nice quality food served. Observations and discussions with staff on duty confirmed they were knowledgeable about people’s dietary needs, and the best way to serve their residents’ food so they can dine independently. Beech House DS0000064947.V361054.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 &18. Quality in this outcome area is good. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure, are protected from abuse, and have their rights protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All comments received from people living, visiting and working at the home were unanimous in that people knew what to do if they had to make a complaint. Springcare, the company who owns Beech House actively welcomes comments in order to improve the service they provide. The home complaints procedure on display in the entrance area to the home clearly describes what people have to do if they are not happy with the service at Beech House. This information is also contained in the Springcare resident information folder mentioned earlier in the report. The home has fully implemented the company monitoring systems for this matter and a company area manager checks these at least monthly. We have not received any complaints about this service since the last inspection in October 2007. Beech House DS0000064947.V361054.R01.S.doc Version 5.2 Page 18 Management improvements have continued to make sure people feel comfortable to raise any concerns they are unhappy about. Up to date policies and procedures for safeguarding adults are freely available at the nurses’ station in Beech House for all staff to refer to. Examination of staff records also confirmed that all new recruits to the staff team have received safeguarding adults training as part of their introduction to working at the home. A ‘Safeguarding Adults’ investigation is currently being carried out about Beech House. This has given the management team the opportunity to demonstrate their professionalism in cooperating with external agencies to make sure all issues are being acted upon to the satisfaction of all parties involved. However, the wellbeing of residents cannot be fully safeguarded until all staff are following the procedures and policies of ‘Springcare’ as part of their day to day working. Although the home has significantly improved during the past 18 months, further work is needed so that all people who live at the home receive a consistent, satisfactory service, which shows the home meets National Minimum Care Standards for Older People. Beech House DS0000064947.V361054.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25, &26 Quality in this outcome area is good. The physical design and layout of the home enables people who use the service to live in a safe, well-maintained and comfortable environment, which encourages independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All individuals who made comments to us about the home were in agreement that the home always smelled fresh and had a welcoming, clean and tidy appearance. One person wrote, ‘I could not think of any negative comment to make regarding Beech House. The home is always spotlessly clean, welcoming and bright.’ Beech House DS0000064947.V361054.R01.S.doc Version 5.2 Page 20 A tour of the home was carried out with the manager, and over a dozen bedrooms were seen. All were personalised, furnished and equipped to meet residents’ needs. Completion of the upgrade of communal areas in the home means the home offers a variety of welcoming well furnished areas for its residents to congregate for activities and meetings or just to relax in peace. Communal bathrooms have also improved. Not only are systems more robust to make sure the hot water is at safe temperatures, the residents and staff have been involved in giving them a more homely appearance by using wall art and bathroom accessories. The home are also in the process of installing fly screens to windows in readiness for the changing weather to keep make sure flies from the neighbouring fields don’t bother residents like they did last year. Fly repellent machines are also being provided, as one bought on a trial basis has been effective. A new call bell system has also been installed and has additional sensors to cater for the needs of residents with dementia related conditions. The home have taken this opportunity to reorganise its bedroom numbers to make it easier for people to find their way round Beech House, and have fully involved the fire service in this task. The home has recently been inspected by the environmental health department, and are in the process of carrying out actions which were recommended. Beech House DS0000064947.V361054.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29, & 30 Quality in this outcome area is adequate. Staff in the home are being trained and are in sufficient numbers to fill the aims of the home and meet the changing needs of residents. People living at the home are not always supported and protected by the homes recruitment policy and practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Copies of ‘past, present and future’ team rotas were examined and confirmed the home has been satisfactorily staffed in recent months. The home has recently had a successful recruitment drive and most vacancies for the care team have been filled. Recent use of agency staff has been minimal. Staff comments sent to us confirmed that team morale has started to improve. All staff are clear regarding their role and what is expected of them. One person commented, ‘I have worked at Beech house for a very long time. I am very happy here.’ Beech House DS0000064947.V361054.R01.S.doc Version 5.2 Page 22 The organisation has clear expectations and procedures relating to recruitment and selection. It was found that these are not being implemented consistently within the home with some shortfalls identified in staff records e.g. only one reference for one individual and lack of photos on some staff files. Some elements were not fully documented e.g. lack of evidence of supervision of a person started without full criminal records disclosure, and lack of written information to show that a questionable reference had been followed up to confirm the person’s suitability. Induction workbooks were not available on file for new starters but it was stated that these would be with the individuals concerned. A copy of the new CSCI guidance was provided. Many aspects of staff training have continued to improve in recent months, and over 70 of the carers have the minimum expected care qualification. Good ‘tracker systems’ have been set up by the management so they have an ‘at a glance’ picture of the training staff have had and what they need. On the tour of the home some staff were seen in a lounge receiving training in safe handling of residents. Recent training has meant that several staff members are now competent to take blood samples from residents. This has been a positive move to improve the service the home offers. The management are aware not all staff are working to expected standards at present. Systems are also in the process of being improved to make sure the training they have had is put into day to day practice. This will ensure management can be confident staff are working as their company policies expect them to, and everyone gets the care they require. Beech House DS0000064947.V361054.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35, 36 &38. Quality in this outcome area is adequate. The management team is committed to improving the quality of the service. Systems for the health, safety and welfare for residents, staff and visitors need to be improved and adjusted to make sure that they are kept up to date, to fully meet all people’s changing needs and safeguard their well being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Changes in the organisation of the day to day management of the home have resulted in Pauline Probert the clinical care manager being nominated to apply Beech House DS0000064947.V361054.R01.S.doc Version 5.2 Page 24 to us to be considered for registration as the home manager. She will continue to have the support of the home administration manager to assist with the day to day running of the home. With the support of both company area managers, the majority of management systems at Beech House have become well established. Detailed recordkeeping in quality audit files confirms there is close monitoring of important issues such as complaints. The audits carried out by the area managers as part of their visits show that care plans and medication systems are especially being looked at closely. However, this auditing system needs to be further developed to make sure all actions recommended by the area managers in their reports are actually carried out at the home within a reasonable timescale. This issue was first raised as a result of the June 2007 inspection. The home management are keen to let ‘everyone have their say’ how the service can be improved. Although the home manager reported the results of the satisfaction survey carried out around the time of the October 2007 inspection have not been circulated by Springcare yet, actions taken since then shows the home aims to being run for the best interests of the people who live there. However, the quality the service the home provides will only improved when staff fully respond to monitoring and supervision of their working practices. Improvements to the safe working systems in the home have continued to ensure good management of monies and valuables kept in safekeeping for residents. All service and maintenance records for essential equipment used in the home were seen to be up to date and complied with necessary health and safety legislation. As recorded earlier, the home management team have had the additional support of weekly visits from the area managers, and between them they have devised a system to monitor the effectiveness of the ‘Improvement Plan’ they produced for us. The manager showed three different forms, which have been introduced. They showed some remedial action in progress to make sure the home team was carrying out all the jobs necessary to get the standard of the service on an even keel. However, it seems some improvements the home stated they would carry out were inaccurate and some they said they had already put right have not actually been carried out: • Bedrail safety has been an issue of concern for some time in this home. During the last inspection in October 2007, we issued an ‘Immediate Requirement Notice’ for the home to devise a system to make sure all bedrails are safely installed, and to provide appropriate paperwork to confirm that Beech House DS0000064947.V361054.R01.S.doc Version 5.2 Page 25 residents are protected from avoidable risks to their health and safety. The home management told us ‘New documents are in place to record the required checks of bed-rails. Staff have received training in safe use of bedrails.’ In response to the immediate requirement notice, Springcare also wrote to us to confirm, ‘All bedrails now conform to recommended guidelines, and new forms have been implemented to record the daily checks for these rails’. In order to make sure this was going to be effective they stated the information would be recorded on a specific form to make nursing staff accountable for their actions. Spot checks of 4 sets of residents’ records for this matter showed paperwork was not satisfactory for 2 people. • Daily report records written by a qualified nurse accounted how a visitor had found that his relative had rolled off her pillows face down into her padded bedrails. Although this incident was fully documented in the accident book, and it had been audited by the management team, the information did not give an accurate account of the events of the incident. Moreover, when the safety paperwork in the persons records was updated a week later, it did not account for the incident, and did not identify the necessary remedial action staff needed to take to minimise the risk of this type of event happening again. • The bedrail safety records for another person had not been kept up to date. The last time the paperwork was reviewed was four months before the Immediate Requirement notice was issued. Although the form clearly stated it required monthly evaluation, records could not account for it being carried out. These findings demonstrates the home does not have a robust systems in place to maximise the safety of people living in the home, and that the home have failed to act appropriately in response to urgent actions we identified. Beech House DS0000064947.V361054.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 2 3 X X X X X 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 1 Beech House DS0000064947.V361054.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement Care plans must be kept under review in order to monitor alterations in people’s circumstances and effect changes in the care that they receive to keep them safe and well. The service must make proper provision for the health and welfare of people who live at Beech House to ensure that they receive the nursing care and monitoring that their conditions require. The records of the administration of medicines for the people who use the service must be robust and accurate to demonstrate that all medication is administered as prescribed. Staff who administer medication must be trained and competent and their practice must follow current written policies and procedures to ensure that residents receive their medication safely and correctly. Previous timescale not met. Management systems must be in DS0000064947.V361054.R01.S.doc Timescale for action 28/03/08 2. OP8 12 28/03/08 3 OP9 13(2) 19/04/08 4. OP9 13(2) 19/04/08 5. OP18 13(4)(c) 28/03/08 Page 28 Beech House Version 5.2 &(6) place to identify and minimise unnecessary risks to the health or safety of service users. (Previous Timescales of 30/12/07 not met.) The Registered provider must employ a permanent member of nursing staff with appropriate qualifications and experience to meet the specific needs of people with dementia related illnesses (Previous Timescales of 20/08/07, & 9/10/07 not met.) 28/03/08 6. OP27 18 (1)(a) 7. OP29 19(1) Staff must not be employed until 28/03/08 all evidence has been gathered to confirm their suitability to work in care services. This will ensure that people are supported and protected by the home’s recruitment policy and practice. (Previous Timescales of 20/07/07 and 10/12/07 not met not met.) Staff must be trained and competent and their practice must follow current written policies and procedures to ensure that residents receive their care and support safely and correctly. Bed rails must be safely fitted where used in accordance with the relevant Medical Hazard Reporting Agency and Health and Safety Executive Guidance for this equipment, so that residents are not put at risk of entrapment or falls Immediate Requirement 09/10/07 not met (Previous Timescales of 11/10/07.) DS0000064947.V361054.R01.S.doc 8 OP30 18 (1) 10/05/08 9. OP38 23 (2) (j) 20/02/08 Beech House Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations The Statement of Purpose and Service User Guide should contain information about the service as per Schedule 1 to the Regulations. People thinking about moving into Beech House must be provided with all the necessary information they need to help them to decide whether the home is right for them. Protocols are written for the administration of Warfarin so that the strengths of tablets used to meet the required dose remain consistent across all of the nursing staff. All information relating to the administration and monitoring of the Warfarin should be recorded in the care plan of the person who uses the service. 2 OP9 Beech House DS0000064947.V361054.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Beech House DS0000064947.V361054.R01.S.doc Version 5.2 Page 31 - 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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