Inspection on 20/09/07 for Beech House

This inspection was carried out on 20th September 2007.

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 20/02/08

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 Unannounced Inspection 14:00 9 October 2007 th 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.V351145.R02.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.V351145.R02.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 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.V351145.R02.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 7th June 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.V351145.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors carried out this key unannounced inspection. It was carried out in the form of two separate visits to the home and lasted a total of twelve hours. Beech House was inspected in June 2007. Concerns expressed to us about the service since that time triggered this early return to conduct another “key” inspection. On the first inspection day, a CSCI specialist pharmacy inspector assisted by carrying out an inspection of the medicines management systems at Beech House We observed activity within the home, inspected the premises, had an ‘in depth look’ at records for residents and staff. We also spent time observing, talking and listening to over half of the 40 people living there. Several 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. A total of 3 residents and 10 relatives sent written comments about the home to us. A postal survey was also carried out to get some comments about the home from the staff team, however no replies were received. On the second day of the inspection, two hours were spent observing the care being given in a communal lounge occupied by some people with dementia related medical conditions. The care of five people was looked at in depth, when comparisons with the observations were made with the home’s records and the knowledge of the care staff. Everyone, including residents and staff, was very welcoming and helpful throughout the inspection. In total, we assessed a total of 25 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. Beech House DS0000064947.V351145.R02.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: As a result of this inspection seven additional statutory requirements have been made, totalling eleven in all. In addition, six recommendations to improve practice have been listed for the attention of Beech House management. Although the home has implemented Springcare’s good policies and procedures for staff to follow, practice shows they are not always followed. On occasions this has resulted in the home not being able to evidence that people have Beech House DS0000064947.V351145.R02.S.doc Version 5.2 Page 7 received the care they need and prefer. This means that the well being of people has not been fully safeguarded at all times. The home’s admission procedures need further development to ensure everyone is offered accurate information about what living at Beech House is like, especially with regard to the care and accommodation provided for people with dementia related conditions. Newly introduced procedures for people who are admitted on a regular basis for short term care must be followed to ensure all residents have all their needs identified and addressed whilst living at Beech House. Care records need to be further improved to reflect all of the personal and nursing care planned so that staff have the right guidance and people can be confident that they will receive the care and support they need. There must be appropriate care planning in place for people with dementia related medical conditions so that staff are directed to manage their behaviours safely and effectively. Additional improvements to medication management systems need to be carried out with regard to the staff training, administration, safe storage and disposal of medication. Observation of day-to-day practices in the home show the staff do not always follow the company procedures for disposing of medicines safely. The management needs to improve the way safe systems are monitored. Two Immediate Requirement notices were issued on the second day of the inspection when issues of concern identified on the first inspection day had not been fully rectified. These concerns focused on hot water temperatures and the use of bedrails. The home needs to complete risk assessments for individuals who are assessed as needing bed rails and ensure that staff who are responsible for selecting, fitting and checking bed rails receive appropriate training. Beech House management also need to continue with their recruitment drive to ensure permanent staff are appointed as soon as possible to reduce the use of temporary staff in the home. This appears to be compromising the care of residents and over half the written comments received about the home from relatives and visitors reflected this. The home also needs to continue to ensure all staff have access to the supervision and appraisal process. 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.V351145.R02.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.V351145.R02.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 not applicable. The home does not provide intermediate care. Quality in this outcome area is adequate. People are not provided with all of the information they need to make an informed choice about whether the home can meet their needs. The assessment process for people returning to the home for short term care does not ensure that the home team has adequate information to ensure people’s needs can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Springcare, the Registered Providers for the service, have introduced a new corporate styled information pack for prospective residents, which contains the home’s Statement of Purpose and Service User Guide. It is presented in an eye catching, easy to read and understand folder. A copy of this information was looked at in June as well as on the occasion of this inspection. Although it has Beech House DS0000064947.V351145.R02.S.doc Version 5.2 Page 10 been updated to comply with recent changes of The Care Homes Regulations of September 2006 concerning fees, important information was lacking. • The information pack still lacks details of when the contents were put together. • It did not describe the specialist service and support the home offers for up to 10 people with dementia related conditions. • There was no reference to the very important role of the care manager who supports the administration manager in her role, as she has recently submitted an application into CSCI to be the Registered Manager for the service. The admission records of six people were examined. All six people have been admitted to the home since the last inspection in June 2007. Records showed;• Two of the individuals returned to the home for a short stay, having been admitted to the home for short term care on previous occasions. • Two sets of records belonged to people staying at the home for short term respite for the first time, one of these individuals had been an emergency admission. • The other two sets of records checked were for people who had moved into the home on a permanent basis. Findings confirmed that the home has good procedures and record keeping for admitting people for the first time to the home. This was not been the case when were re-admitted to Beech House for additional short term stays. Their assessment information had not been fully updated to reflect any changes that may have occurred in a person’s health and wellbeing since their last stay at the home. This issue is currently being explored as part of a safe guarding adults investigation. In response to this investigation and in recognition of the above findings Springcare have already taken steps to improve this aspect of the service. They have made changes to the home’s admission policies for people admitted for respite care to make sure all paperwork is fully updated with the full involvement of the person admitted and any other significant person directly involved in their care. At the last inspection it was confirmed the home is implementing an assessment tool especially designed to make sure the needs of people with dementia related conditions can be fully met. This was seen in the records of a person admitted to the home at the end of August. A total of 90 of people who sent written comments to CSCI confirmed they received enough information about the home before they moved in. However, one relative who specifically asked to speak to us did say that their relative was upset by having to live alongside people with dementia related conditions. The family were not aware of this until after the person’s admission. As recorded above - this information is not included in the home information pack. Beech House DS0000064947.V351145.R02.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. Care plans are improving but are not yet sufficiently detailed to ensure that all residents’ needs are met. Staff are sensitive to the individual needs of each service user and meet the majority of these in a professional manner. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Some of the comments received about the care the staff team carries out for its residents were complimentary. All residents we spoke to in private offered praise about the care team. One person we spoke to commented that she would recommend the home to any visitors if she were asked. Another commented ‘I wouldn’t be afraid to leave anyone here - they are so kind.’ Beech House DS0000064947.V351145.R02.S.doc Version 5.2 Page 12 40 of relatives who wrote to the home all made positive comments about the staff such as ‘I feel that the staff are very kind and the home has a nice caring atmosphere’. 60 of relatives had mixed opinions and in particular commented that communication between residents and carers was a problem, and there were times people had to wait some time for their call bells to be answered. One of the reasons for carrying out this inspection was to explore the concerns raised by different people including relatives, health professionals and a social worker. Concerns were expressed that the home had not looked after people properly to meet both nursing and personal care needs. As a result of receiving this information, we referred the home to the local authority lead ‘Safeguarding Adults’ procedure for investigation. This investigation is still in progress. Due to their medical conditions, several people living in the home are not able to communicate their opinions. The two hours spent observing people in a communal lounge the second day of the inspection day was helpful in confirming findings of the inspection process. Care practices observed were generally satisfactory and the majority of permanent staff were seen to be attending the needs of residents in a respectful, caring manner and were very knowledgeable about the individual needs and preferences of the people they were caring for. However, findings did confirm there was some inconsistent care practices and more attention needs to given to ensure people’s privacy, dignity and comfort is maintained. • Observation of people being hoisted in view of others in the lounge areas showed that on two out of three occasions people were transferred from armchairs with their underwear exposed. • On the second day of the inspection the home was experiencing a problem with flies from neighbouring fields. At least 5 people without the ability to swat them away were observed to be bothered by them. One person had 5 flies on her at one same time. The home must take effective remedial action to ensure it is prepared to manage such events in the future. • Peoples belongings in a shared bedroom were not kept separate. In order to see what progress the home have made to improve their recordkeeping, a total of nine sets of care records were looked at. Although some care records confirmed that the majority of health needs are accounted for, all of them showed that there was a lack of detail and recordkeeping to account for how the home fully meets each person’s needs. Several care plans lacked detail to keep individuals safe. • The daily hygiene records do not reflect the actual hygiene needs being carried out, and there were gaps in recordkeeping for all sets of records examined. It could not be identified from records when the basic but Beech House DS0000064947.V351145.R02.S.doc Version 5.2 Page 13 • important care of when people had been bathed or had their hair washed. Poor records for oral hygiene were kept about a very dependant person who has to be fed through a stomach tube. The person cannot speak and relies on the care team to carry out all day-to-day needs including assisting with drinks. The person was observed to be dribbling a lot and their tongue had a thick coating of debris. The person’s records identified mouth care had to be carried out every two hours but there was no instructions for staff to follow to cleanse the tongue. On the second day of the inspection this person was observed to have a fly on her mouth on several occasions. When her care charts were checked they did not identify oral care had been carried out that day. One of the residents we spent time in the lounge with was observed to have a dressing on the side of her face. When this was discussed with the care manager she confirmed it was to protect a rodent ulcer on the person’s face. This was not accounted for in her records. • An in depth look at the records of two individuals admitted to the home for regular short term care confirmed that there had been a deterioration in the way the home manages the care of these people. Omissions of important nursing care details meant the home could not provide evidence to show the two people had been looked after properly. For instance, records lacked details of care of feeding tubes and catheter care. As a result Springcare, the company who owns the home, have already made changes to their policies and procedures to ensure such incidents do not happen again. Slow progress has been made to develop care plans for residents with dementia to show the home is doing all they can to keep these people safe and ensure all their behavioural needs are being met. This was also an issue of concern identified at the June inspection. Assessments of mental health needs have been carried out, however care plans have yet to be formulated to account for their findings and offer guidance to staff to keep people safe. • During the home tour on the second day, we met a person with a dementia related condition who had climbed the stairs, and was not aware of this risk to her safety. The care manager immediately escorted the person to the safety of the ground floor. One lady recently admitted to a bedroom on the first floor of the home was assessed to have wandering behaviour and to be at risk of falls at night. There was no care plan or risk assessment to minimise the risk of her falling, and she has already experienced a fall, which was not witnessed. • The above issue is of a particular concern. During a safeguarding adults investigation at the end of 2006, concerns were raised about the safety of Beech House DS0000064947.V351145.R02.S.doc Version 5.2 Page 14 people with dementia related conditions who choose to wander about the home. It had been agreed that people with this type of health challenge would not be admitted to first floor bedrooms at Beech House. The above findings show this has not been the case. Assessment of the home medication management systems showed they have continued to get better. Our pharmacist inspector visited the home on the first day of the inspection and carried out an ‘in depth’ look at the medicines management systems being practiced within the home. The recording of the receipt, administration and disposal of medicines had significantly improved compared to the last inspection, although the following issues identify some extra work needs to be done to ensure the well being of residents living at Beech House is fully safeguarded when the home manage their medicines. • The home was advised to write a detailed protocol for the administration of tablets prescribed for each resident who receive medicine to prevent blood clots. This will confirm the strength of tablets used to meet the prescribed dose remained consistent. Residents’ liquid medication showed that the quantities administered did not tally with the records. It was suggested to the home that they should investigate ways of ensuring that the liquid medication is accurately measured out. The inspector was shown one resident who was receiving her medication that was being mixed with food. There needs to be informed written consent before putting medication in a person’s food or drink. This action needs reviewing in the light of the Mental Capacity Act with agreements properly recorded from all those involved in this person’s care that the medication and method of administration is in this person’s best interests. Medication administration rounds were observed during the day and some failings were identified. These included the handling of medicines, the administration of medication that had dropped on the floor, the nurse involved in the administration being constantly interrupted by care staff, the morning medication finishing at 11am and not allowing for a four hour gap before the lunchtime administration round began, the medication administration records (MAR) being signed before administration had taken place and the insecure transport of medication around the home. The fridge temperature records for medicines requiring cold storage conditions showed that the fridge was not being maintained within the • • • • Beech House DS0000064947.V351145.R02.S.doc Version 5.2 Page 15 expected temperature range and as a consequence insulin found in the fridge had to be removed for destruction. • In addition, on the second visit to the home, observation of the way two staff members handled the disposal of tablets discarded by a resident on a lounge carpet demonstrated practices for this part of the home medications procedure is not robust. The Controlled Drug records were examined and it appeared that all of the Controlled Drugs could be accounted for and that the Controlled Drugs were being administered as prescribed. Beech House DS0000064947.V351145.R02.S.doc Version 5.2 Page 16 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 capacities 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 inspection in June. Discussions with people visiting four different residents confirmed they are made to feel very welcome. They all agreed to take part in our survey and provided written comments to us about the lifestyle at Beech House shortly after the inspection. 90 of relatives stated the home always helped their relatives and friends to keep in touch with them. Beech House DS0000064947.V351145.R02.S.doc Version 5.2 Page 17 An activity planner seen on a notice board upon entering the home lets people know what is happening on a day-to-day basis. A folder also located in this area was crammed full of photographs and posters of entertainment and outings experienced by the people living in the home in recent months. One of the carers who assists in coordinating the activities in the home commented the folder was a very valuable reminiscence tool and it was used daily to prompt people to talk about their pastimes and interests. The latest Springcare news letter also featured an article and photographs the home’s summer fete, garden teas and barbeques. One person wrote ‘a lot of effort is made to provide occupational therapy and entertainment to include all residents.’ Observation of activities carried out with people who have dementia related conditions confirmed staff were knowledgeable about people’s interests and behaviours and made sure the way an activity was carried out would appeal to the people involved. This was seen when residents had one to one attention to touch, feel and guess items placed in a bag. All care plans looked at also showed improvements in recordkeeping for social activities. All residents who made comments about the meal provision were in agreement that the food at Beech House was good. One said, ‘The food is not bad at all’ Discussion with the cook confirmed she gets regular verbal and written comments about the quality of the meals, and she always incorporates any suggestions when the seasonal menus are prepared. Comments from about meals from relatives were varied. One person wrote,’The meals always look and smell appetising and look very tempting.’ Other people made comments about the timing and service of the meals, stating for example, ‘Mum is put off by the portion size’;‘Sometimes people wait ages for their meals to be served’ Over 30 of written comments received reflected that the impact of people living alongside individuals with dementia related conditions was not always a positive experience, and when this was further explored, people said it included meal times. One individual with this condition was observed to be placed in front of a dining table on her own 20 minutes before being served a meal. Whilst waiting during this time the person started banging the table noisily. This was reported to be a frequent occurrence. The home is about to embark on a satisfaction survey with its residents. One section of the form specifically asks for people’s opinions about meals and will give the home management team the opportunity to listen and act upon what people say to improve everyone’s dining experience in the home. Beech House DS0000064947.V351145.R02.S.doc Version 5.2 Page 18 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 adequate. 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: Springcare, the company who owns Beech House actively welcomes comments in order to improve the service they provide. All written comments received from residents and relatives were unanimous that they knew what to do if they had to make a complaint. One person commented, ‘Anything I have had concerns over has always been dealt with as best they can’. 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 the company have recently introduced. The company complaints recording system continues to be managed effectively by the new management team at the home and show Beech House now has Beech House DS0000064947.V351145.R02.S.doc Version 5.2 Page 19 established recordkeeping to show that residents’ and any of their representatives’ views are acted upon and managed appropriately. We have recently received two formal complaints about this home, and as reported earlier, investigation of recent concerns raised about Beech House was part of the reason for this inspection being carried out. Management improvements have started to create an environment so that staff, people living at Beech house and their families feel able to raise concerns complaints or allegations of abuse. The policies and procedures for safeguarding adults are freely available at the nurses’ station in Beech House for all staff to access. There is clear specific guidance for anyone who needs to use this information. The clinical manager for the home has recently been approved by a local professional care home organisation to be a trainer for staff with regard to safeguarding adults. The wellbeing of residents cannot be fully safeguarded until all staff are fully trained and operating within Springcare policies. Although the home has significantly improved during the past 12 months further work is needed so that people receive a consistent, satisfactory service and the home meets National Minimum Care Standards for Older People. Beech House DS0000064947.V351145.R02.S.doc Version 5.2 Page 20 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, 20, 25, & 26. Quality in this outcome area is adequate. The physical design and layout of the home enables the majority of the people who use the service to live in a 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 CSCI about the home were unanimous to confirm the home always smelled fresh and had a welcoming, clean and tidy appearance. One person wrote, ‘The place is kept very clean and comfortable – I think one would be very hard pressed to find one which could be said to look better.’ Beech House DS0000064947.V351145.R02.S.doc Version 5.2 Page 21 Recently the home has been the subject of a lot of redecoration and refurbishment. Many of the plans to improve the communal areas in the home have already been carried out, and the home now offers a variety of areas for its residents to congregate for activities and meetings or just to relax in peace. The new décor in communal areas and residents bedrooms has been complimented by new carpets, curtains and bedding. A tour of the home was carried out on both inspection days, and over a dozen bedrooms were seen. All were personalised, furnished and equipped to meet residents’ needs. Some of the bedrooms seen were showing signs of wear and tear, and one bedroom in particular on the first floor was seen to be unsafe, as the single glazed sash window did not have a restrictor in place. This meant it could be fully opened. When this was shown to the care manager it was seen that the window frame had deteriorated to the extent that a loose piece of wood had fallen off. The care manager had not been made aware of this. On the first inspection day we raised concerns about hot water in a communal bathroom and a ‘sit in’ in shower room, which had excessive hot water temperatures. At this time we were assured immediate remedial action would be taken to put this right. Upon checking these bathrooms on day 2 of the inspection, the ‘sit in’ shower facility was confirmed to have a hot water temperature in excess of 54° Centrigade. This demonstrated the remedial action taken by the home had not been effective. As a result we issued an Immediate Requirement notice to assure us action would be taken for improved management and monitoring of this matter within a 48-hour timescale. Findings confirmed the home has access to a good infection control policy provided by Springcare. The care manager reported that this practice in the home is being further improved as the team are in the process being updated with a newly published Department of Health information training pack entitled ‘Essential Steps to Safe Clean Care.’ However, any good infection control measures will remain compromised until solutions are found to reduce any further fly problems. Beech House DS0000064947.V351145.R02.S.doc Version 5.2 Page 22 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 poor. 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: The home continues to rely on agency staff to cover team vacancies and absence in order to achieve adequate staffing levels. This was confirmed following examination of staff rotas for the periods covering inspection visits as well as two other periods of time since the June inspection. The rotas did not clearly show that the home has been adequately staffed at all times. Some rotas were illegible, and others were difficult to audit due to lack of staff surnames and clarity of whether they were agency or permanent employees. At the time when a concern about care had been made it appeared one nurse, the care manager, was on duty for a six hour period, and the same night an agency nurse was left in charge of the home. This indicates the home was not adequately staffed. This situation is starting to have a negative impact on the morale and well being of the people living at the home. Beech House DS0000064947.V351145.R02.S.doc Version 5.2 Page 23 40 of people stated they thought staff usually had the right skills and experience to support people’s needs. Their comments included, ‘Excellent very kind care team’, ‘They care very well very kind and considerate’ However, other written comments received were not so positive. People’s main concerns were about the quality and numbers of staff on duty. For example, people wrote, ‘Staff do not have time to attend to non essential matters which are important to residents.’ ‘If the correct staff are on duty and full numbers present – the home is adequately staffed, but as a family we would like to see more staff to spend time to chat with residents,’ ‘At times there seems to be very few staff available’, ‘Some carers need to learn how to communicate (even English ones)’. We also organised a survey of staff from Beech House to get their opinions of working at the home. No one replied. Beech House management are still in the process of recruiting appropriate permanent staff, including a Registered Mental Nurse (RMN). In the meantime Springcare have seconded an RMN from another home to work one 12 hour shift a week at Beech House to offer some guidance and supervision to staff caring for the residents with dementia related medical conditions. The files of two new recruits were looked at. They confirmed robust vetting systems for one brand new employee, but the records of an employee who left the home earlier in the year and recommenced employment over six months later did not have any evidence of a return to work interview or paperwork relating to re-employment at the home. Many aspects of staff training have improved in recent months, and over 70 of the carers have the minimum expected care qualification. A wealth of training certificates were seen in the office to be filed in staff records, for topics such as fire safety, and dementia. As recorded earlier, staff practices need to be developed to ensure the training they have had is put into day to day practice. Inspection findings also show there to be the need for further team training for issues such as medicine management. • The home has not developed an assessment programme to measure each of the nurse’s competency in the safe handling and administration of medication. • Poor practices regarding medicines management observed during both inspections show staff require additional support and training for this matter, to ensure they follow the home medication policies at all times. Beech House DS0000064947.V351145.R02.S.doc Version 5.2 Page 24 Beech House DS0000064947.V351145.R02.S.doc Version 5.2 Page 25 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. Some 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 meet people’s changing needs and safeguard their well being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The administration manager for the home is awaiting process of her application with us to be the Registered Manager for the service. She has the continued Beech House DS0000064947.V351145.R02.S.doc Version 5.2 Page 26 support of the home’s care manager who gets actively involved with the nursing and care personnel to ensure they get the ‘hands on’ support they need. With the support of both company area managers, the management systems at Beech House continue to progress. Detailed recordkeeping in quality audit files confirms there is close monitoring of many issues such as accidents, pressure sores and complaints. The audits carried out by the area managers as part of their monthly unannounced visits show that care plans and medication systems are currently being looked at closely. The home management are keen to let ‘everyone have their say’ how the service can be improved. As recorded earlier the home is in the process of carrying out a satisfaction survey to ensure the home is 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 receive appropriate monitoring and supervision of their working practices. This appears to be in hand but progress has been slow. Staff meetings continue to be held regularly. The safe working systems in the home has continued to ensure good management of monies and valuables kept in safekeeping for residents. This was reflected during this inspection when the hairdresser showed us her system to manage peoples monies charged for her services. Although several aspects of Health and Safety management have improved, and evidence of this is shown in the care plan details used to guide staff how to safely move and handle people, some other safe working systems are lacking. • Inspection findings described in this report highlight lack of monitoring to make sure all residents bedrooms and equipment in daily use is kept in safe working order. • The paperwork seen in the office to monitor accidents showed accurate systems for recording these events. However, it is a concern a recent accident a resident experienced when she was found under her bed did not trigger a more in depth investigation. If so, this may have identified concerns we identified about bedrail safety in the home. On the first inspection day a number of bedrails were found fitted incorrectly, including those seen on the bed of the person described in the above accident. At least four sets of bedrails were fitted in an unsafe manner, and several others were fitted to beds with pressure relieving overlay mattresses in place on top of a mattress. This means that the person’s safety is compromised as the bed rail is not of a necessary height. We also confirmed that two staff had signed to check the bedrails as being safe on a daily basis. The home management assured us immediate action would be taken to make the bedrails safe and Springcare as a company had started taking action to get Beech House DS0000064947.V351145.R02.S.doc Version 5.2 Page 27 people trained about this matter on the day of the inspection. Two weeks later during the second part of the inspection it was confirmed that: • Nine staff had attended bedrail safety training • Springcare had produced new bedrail checklists and paperwork for people’s care records. After requesting to see the bedrooms of the people we had spent time with in the lounge it was a concern to see the bedrails of one frail person were not fitted securely, despite having a new bedrail check form completed. This meant that although the home had taken some remedial action to improve bedrail safety, it was not robust enough as at least one person remained at risk. As a result an ‘Immediate Requirement’ notice was issued for this matter for urgent action to be taken to put this matter right within forty-eight hours. This issue was discussed in depth at the time of the inspection with both home managers, and the home maintenance man was contacted immediately to take urgent remedial action. Beech House DS0000064947.V351145.R02.S.doc Version 5.2 Page 28 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X 2 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 2 X 1 Beech House DS0000064947.V351145.R02.S.doc Version 5.2 Page 29 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 OP1 Regulation 4,5, & 6 Requirement The Statement of Purpose and Service User Guide must 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. An appropriately qualified or trained individual must be involved with the ongoing assessment and review of the people living at the home with dementia related conditions (Previous Timescales of 18/08/07 not met.) Care plans must kept under review so that up to date information is available to direct staff how to promote residents’ health and wellbeing Timescale for action 30/12/07 2 OP7 14(2) 30/12/07 3 OP8 15 30/12/07 4 OP9 13(2) Medication must be stored within the temperature range recommended by the DS0000064947.V351145.R02.S.doc 30/12/07 Beech House Version 5.2 Page 30 5 OP9 6 OP18 7 OP25 manufacturer to ensure that medication does not lose potency or become contaminated. 13(2) The disposal of all medication 09/10/07 must be completed in accordance with the home’s procedures. (Previous Timescales of 31/07/07 not met.) 13(4)(c) & Management systems must be in 30/12/07 (6) place to identify and minimise unnecessary risks to the health or safety of service users posed by poor staff 13 (4), All bathroom facilities accessible 11/10/07 (6) to residents must have control measures in place to keep hot water temperatures no higher than around 43°C, unless a risk assessment concludes that this is not necessary. This is to ensure unnecessary risks to the safety of people living at Beech house are eliminated as far as possible. Immediate Requirement 09/10/07. 8 OP27 18 (1)(a) 9 OP29 19(1) 10 OP30 13(2) The Registered provider must 09/10/07 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 not met.) Staff must not be employed until 10/12/07 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 not met.) Staff who administer medication 30/12/07 must be trained and competent DS0000064947.V351145.R02.S.doc Version 5.2 Page 31 Beech House 11 OP38 23 (2) (j) and their practice must follow current written policies and procedures to ensure that residents receive their medication 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 11/10/07 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 OP7 Good Practice Recommendations The nursing care plans of residents with dementia related illness must show evidence of guidance in managing such needs by an appropriately trained and experienced nurse. Plans relating to medication should be reviewed and updated to make sure that they reflect what choices people who live in the home are given about how their medicines are administered and their consent to the way in which staff administer their medicines. Where medication is administered with food and consent is not possible because of lacking capacity, records must be made of the agreement that the way in which medicines are administered is in the best interests of that particular individual Protocols should be 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. Care practices should reviewed to ensure people’s privacy and dignity is maximised, especially when they are being moved with a hoist in communal areas, or share bedrooms DS0000064947.V351145.R02.S.doc Version 5.2 Page 32 2 OP9 3 OP9 4 OP10 Beech House 5 OP26 6 OP27 with other people. Solutions should be explored to reduce any further problems caused by excessive flies seen experienced by the very frail residents in the communal areas of the home. Rotas should clearly identify the names roles and responsibilities of all team members on duty at all times. Beech House DS0000064947.V351145.R02.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Shrewsbury Local Office Commission for Social Care Inspection 1st Floor, Chapter House South, Abbey Lawn, Abbey Foregate, Shrewsbury SY2 5DE 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.V351145.R02.S.doc Version 5.2 Page 34 - 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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