Inspection on 25/09/06 for Beech House

This inspection was carried out on 25th September 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Beech House 14/08/09

Beech House 03/02/09

Beech House 18/08/08

Beech House 20/02/08

Beech House 20/09/07

Beech House 07/06/07

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 Announced Inspection 25th September 2006 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Beech House DS0000064947.V311626.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.V311626.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 Ash Paddock Homes Limited Care Home 54 Category(ies) of Dementia - over 65 years of age (8), Old age, registration, with number not falling within any other category (46) of places Beech House DS0000064947.V311626.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of Service User`s must not exceed 54 Older People who require Nursing Care. This number may include a maximum of 8 Service User`s who suffer from Dementia. Staffing levels in the home must meet the minimum levels required throughout the 24 hr day, including weekends, for service users who have low to medium dependency nursing needs. Additional staff must be on duty when high dependency service users are accommodated. These minimum levels are for direct nursing and personal care only. They do not include ancillary staff. 08:00-14:00 22:00-08:00 Nursing Beds 1 RN 34-40 3 Care Asst 41-45 2 RN`s 3 Care Asst 46-50 2 RN`s 3 Care Asst 51-56 2 RN`s 4 Care Asst 3 RN`s 9 Care Asst 3 RN`s 8 Care Asst 3 RN`s 8 Care Asst 3 RN`s 7 Care Asst 3 RN`s 6 Care Asst 2 RN`s 7 Care Asst 2 RN`s 5 Care Asst 2 RN`s 7 Care Asst 2 RN`s 4 Care Asst 2 RN`s 6 Care Asst 2 RN`s 5 Care Asst 2 RN`s 6 Care Asst 14:00-17:00 17:00-22:00 Beech House DS0000064947.V311626.R01.S.doc Version 5.2 Page 5 Date of last inspection 10th January 2006 Brief Description of the Service: Beech House is registered to provide nursing and personal care for a total of 54 older people, of whom eight 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 £470 and £540 per week depending on the care, support and accommodation provided. Additional charges to service users are for hairdressing, toiletries, and newspapers. Beech House DS0000064947.V311626.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out the key announced inspection over two separate visits to the home, lasting a total of ten hours. The inspection was carried out by observing activity within the home, inspecting the premises, having an ‘in depth look’ at records for residents and staff, observing, talking and listening to more than 30 of the people living there, as well as eight staff on duty throughout the time of the inspection. A total of six residents and relatives and five staff sent written comments about the home back to CSCI. The inspection was carried out in response to concerns raised by the owners of the home, as a result of an investigation into a complaint made by the family of one of its residents. The inspection was announced in order for the Area Manager for the company, Sarah Kaye to be present. The accurate details the home provided to CSCI (Commission for Social Care Inspection) about the performance of the home before the inspection was most valued and appreciated. The first inspection day coincided with the newly appointed manager commencing work at the home. Everyone, including residents and staff were very welcoming and helpful throughout. A total of 23 out of a possible 38 National Minimum Standards for Older People were assessed on this occasion. A CSCI specialist pharmacist inspector will also be assessing the way medications are managed in the home in the near future as a part of this key inspection process. What the service does well: The home has a core of carers who have shown ongoing commitment and enthusiasm to care and support the residents with their daily lifestyles. The majority of residents comments outlined they were happy to be living at Beech House, felt safe, and were well cared for. Others who were not able to confirm this as a result of their medical conditions expressed feelings of well being when observed during their daily pastimes during both visits. The home has a good activity programme, which shows people have the opportunity of both 1:1 and group activities. Beech House DS0000064947.V311626.R01.S.doc Version 5.2 Page 7 The prompt professional actions taken by the owners Springcare Ltd upon receipt of a complaint have assured CSCI (Commission for Social Care Inspection) that urgent permanent changes will continue to be implemented at the home to make sure any areas of concern put right in as short a time as possible. The Area Manager of Springcare Ltd, Sarah Kaye, conducted very thorough quality audits of many aspects of the service provided at Beech House in July of this year, based on National Minimum Standards for Older People. These included an in depth medication and care plan audit which, as a result, action plans were issued to the manager who was in post at that time to improve the service. What has improved since the last inspection? What they could do better: As a result of this inspection a total of thirteen statutory requirements have been made. This shows there has been a marked deterioration in the quality of service this home provides. Professional management systems that are the responsibility of the nursing staff need to be improved to raise the quality of the care provided in the home. CSCI findings reflect those of the company’s audit, and confirm the majority of professional recordkeeping lacks organisation and detail to demonstrate care is delivered appropriately within the home. Care plans should be written in a way that reflects the wishes of each individual and their diverse needs e.g. dietary needs, activity/social/emotional support and spiritual and religious views. Beech House DS0000064947.V311626.R01.S.doc Version 5.2 Page 8 The home needs to take urgent remedial action to show what levels of dependency the people living there currently have. At present, the records are not able to confirm what level and category of care they should be receiving. This also means it cannot be established what the appropriate staffing levels are necessary to keep people safe and properly looked after. Staff training is a major issue, which needs further action. The majority of staff are in need of being fully updated in many aspects of mandatory training, as well as training specific to the needs of the people living there, including dementia awareness. Staff awareness of the company’s policies and procedures needs to be raised to ensure the effective smooth running of the home, is in line with necessary legislation. Some individuals were clearly not happy with aspects of life at Beech House, and expressed their concerns verbally and in writing to CSCI. The concerns raised were mainly in connection with their privacy being interrupted whilst in their bedrooms by the wander some behaviour of the people with dementia related illness living in the home. The odour in the lounge used mainly by residents with dementia related illness is not pleasant and needs attention to ensure all people at the home have access to clean hygienic communal areas. Attention to infection control management especially with regard to clinical procedures is in need of action. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Beech House DS0000064947.V311626.R01.S.doc Version 5.2 Page 9 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.V311626.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 &4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Newly introduced systems show the home carries out a comprehensive assessment for prospective service users before they move in, which assures everyone concerned that the home can meet the needs of the individual admitted. EVIDENCE: On the first day of the inspection, when the care records of two residents who had been admitted to the home since the last inspection were looked at, there was not enough information to show these people had been thoroughly assessed to show the home could meet their needs. The area manager had already identified this shortfall, as the home was not following the company Beech House DS0000064947.V311626.R01.S.doc Version 5.2 Page 11 policies for this matter. New systems have been set up by Springcare to make sure this does not happen again. By the second inspection day the new manager was able to show that the newly launched systems to assess people thinking about moving into Beech House were appropriate. A gentleman who had expressed an interest in moving to the home had been assessed face to face by the new manager at a local hospital that morning. The detail and depth of information that had been collated about the person demonstrated that a professional decision could be reached to assure the resident, his relatives and staff that the home could meet his needs. Beech House DS0000064947.V311626.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The care plan recording does not provide staff with the information they need to satisfactorily meet all service users needs to keep them safe at all times. The ‘hands on’ personal support in the home is offered in such a way that promotes and protects service users dignity and independence. EVIDENCE: When the current residents of the home were discussed at the start of the inspection, the area manager confirmed it could not be established what category of care some service users have been assessed to require. The home is registered to accommodate 8 individuals with dementia related illness. It was anticipated that more than this number of people were living at the home with this condition. Work has already started on the reassessment of the current residents at Beech House. Following some retraining for the nursing staff, seven residents were seen to have had new sets of care information formulated to address this Beech House DS0000064947.V311626.R01.S.doc Version 5.2 Page 13 issue. Some of this had not been fully completed. The company recognise this important process needs priority. This was discussed with the area manager and the new manager. It was confirmed that this important task was to be the first main responsibility to be overseen by the new manager, and her deputy, who was also starting work at the home the week of the inspection. Attempts to have an in depth look at 5 residents care records turned out to be a challenging task. As the majority of the 50 people living at the home had ‘old style’ care records, it was very time consuming to locate all of the information before it could be examined. In order to look at the care information relating to one person, paperwork had to be sought from a hygiene file, daily report file, and a care plan folder from the filing cabinet, a ‘professional visits’ book and a dressings folder. This system is not user friendly for residents or staff. Furthermore, evaluation of the content of the care records showed they fail to make sure the home is doing all it can to promote resident safety and well being. For example: Evaluation of the information of a resident seen wandering around the home show that this person has had 17 falls between February and September of this year. The care plans show very scanty details to guide staff and show this person and the family how the home is keeping the individual safe day and night. • Inadequate detail for falls risk management meant there was not clear guidance for staff to avoid situations, which may put the person at further risk. • Not all accidents experienced by a resident had been logged in the home accident records. • The person had experienced several minor injuries as a result of such falls and the poor chronology and record keeping for the wound care for this person meant that it could not be confirmed what injuries had healed and what injuries still required treatment. • Important incidents were seen to have been recorded into residents daily records without appropriate action to show what the staff are expected to do to prevent similar incidents from happening again. On one occasion in September, it was recorded that during the night the person was encountered on the first floor, in the process of opening a fire exit door. This had not been fully looked into. • It was confirmed that one resident had assaulted another causing a minor injury to one of them. There was a lack of record keeping showing this had been managed appropriately. • It is of further concern that trained nurses recently signed these records as being fully reviewed and evaluated, when the records clearly lack necessary details to reflect appropriate nursing care is being given. In addition to this, there was little evidence of the resident or his or her Beech House DS0000064947.V311626.R01.S.doc Version 5.2 Page 14 representative having their say about the way they agreed to have their care needs met. The above findings reflect similar shortfalls seen in other records. Weight loss management and continence promotion was also seen to be an area of concern. Information detailed did not reflect appropriate nursing intervention was being carried out. In depth scrutiny of records showed that people do receive regular visits from health professionals, however the only person seen to record this information in the designated place was the company physiotherapist. Accounts of GP visits were difficult to locate in the daily report records, and there was little evidence the persons care plan had been updated to account for any changes following this type of health care advice. In addition, the poor handwriting of some entries in daily records were very difficult to read and understand. These findings reflect similar shortfalls the area manager came across when she carried out an audit of the care records on July 18th. It is of note the company has already held professional nurse training to improve this matter. People with very complex care needs were seen during the tour of the home. The care records for the people most at risk and with the most needs should have their information formulated into the new system as a priority at the earliest possible opportunity. On balance of the above information, the staff members on duty were observed working and supporting residents in a polite, caring and respectful manner. Carers appear enthusiastic and committed to their role. Written comments received from staff confirmed they were looking forward to the changes ahead to improve the way people are cared for at Beech House. Six written comments were received from residents at CSCI about the care they receive. Three of these were positive, although one did express concern that although mentally capable of discussing care needs, the person was not involved in this process. A specialist CSCI pharmacist inspector will be carrying out a complete review of the way the home manages its medications. The area manager had already carried out an audit for this issue in mid- July to determine how this system has been managed. The results of this will be helpful to assist the inspector to determine progress made to meet standards since then. Beech House DS0000064947.V311626.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are able to participate in social activity and keep in contact with family and friends. Residents receive a healthy diet, which meets their needs and preferences. EVIDENCE: The home employs a motivated activities organiser who makes sure that there is some level of activity arranged for individuals in keeping with their tastes and preferences.An activity planner seen on a notice board as you enter the home lets people know what is happening on a day to day basis. On the day of inspection residents had the opportunity of having a hand massage as well as joining in crafts. Discussion with the activity organiser confirms that she starts her day by visiting people who prefer to stay in their bedrooms, to have 1:1 time with them. Later in the morning she holds group activities in one of the lounge areas once everyone has had the opportunity to meet up. Observations of the way the carers encourage and support residents to join in demonstrated staff have a good understanding of the service users support and leisure needs. Discussion with staff members confirmed that visitors are made very welcome, and the visitors book showed there had been plenty of Beech House DS0000064947.V311626.R01.S.doc Version 5.2 Page 16 people coming to the home during the week the inspection was held.As Beech House is located within a small close knit community, many local people have moved into the home, with the result that several local villagers visit the home regularly. One visitor who was in the home at the time of the inspection did not wish to discuss any issues with the inspector, although it was commented that a written questionnaire had been completed and sent to CSCI. It was reported that the reading interests of residents are met by the library service which comes to the home the second week of the month. The home also gets 13 newspapers delivered daily for individuals who have requested them. It was confirmed by the administration manger that specific training to ensure more appropriate activities for people with dementia related illness was being explored. 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. The way the dining tables are organised makes sure people who need assistance or may be embarrassed about feeding themselves get the privacy they need to enjoy their meals. All residents who made comments about the meal provision were in agreement that the food was very good. Beech House DS0000064947.V311626.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The quality outcome in this area is poor. This judgement has been made using available evidence including a visit to this service. Beech House now has a satisfactory complaints management system in place. Management procedures at Beech House need further action to fully demonstrate resident’s well being is safeguarded at all times. EVIDENCE: CSCI have not received any complaints about this home since the last inspection, although an issue of concern was raised about the cleanliness of the crockery used in the home. This was reported to have been dealt with appropriately. It could not be established how the home had dealt with some complaints it had received since the last inspection. However, the actions undertaken by the area manager following an audit of the way the complaints procedure in the home had being managed have resulted in a more robust complaints process being implemented.A new complaints recording system has been set up, and the new manager showed a good working knowledge of this process, as it is the same procedure set up in the home she has just transferred from. This means that in future, that the home will have the recordkeeping to be able to show that residents’ and any of their representative’s views will be acted upon. A complaint, which was received at the end of August, was seen to have been acknowledged, and the investigation for this matter was still in progress. Beech House DS0000064947.V311626.R01.S.doc Version 5.2 Page 18 Although the home does have the necessary policies and procedures in relation to the protection of vulnerable adults, not all appropriate information is available to show the home is doing all it can to safeguard its residents. More evidence of adult protection training in staff records and improvements to recordkeeping in residents’ assessments and care plans needs to be established before this standard can be met.This will then demonstrate Beech House makes sure the safety and well being of everyone living at the home is fully promoted. CSCI were made aware of a current complaint by the provider, Springcare Ltd. It was the reason this inspection this inspection was carried out sooner than planned. It has resulted in a formal adult protection investigation which is currently in progress. All residents and their representatives have been informed of the matter. The professionalism demonstrated by Springcare Ltd in handling with this matter gives CSCI full confidence appropriate actions are being taken.The outcome of the full investigation of the adult protection issue will be included in the next key inspection report. Beech House DS0000064947.V311626.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19.20.24, & 26 The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. The good standard of living accommodation provided within this home provides service users with an attractive, well-equipped homely place to live. EVIDENCE: An extensive guided tour of the home confirmed that the home offers a good standard of personal and communal living facilities for many of the residents it is registered to have living there. The home offers pleasant countryside views from all of its windows. Externally, there are attractive patio and courtyard areas accessible for residents to sit outside. One person was wheeled out in her special armchair by her relative to enjoy the autumn sunshine during the first inspection day. All communal areas were seen to be clean and cosily furnished with the exception of the lounge area used for residents with dementia related illness. An unpleasant odour was present in this room. This was discussed with the administration manager during the tour of the home. Beech House DS0000064947.V311626.R01.S.doc Version 5.2 Page 20 Staff feedback confirmed that the new furniture in the dining room had improved the appearance of this area.It was positive to be informed that the ground floor communal areas are going to be reorganised so that residents have more space in the parts of the home they prefer to congregate at present. An office is to be made into another quiet lounge area, and the ‘library’ at the front of the home, which residents don’t often frequent, will be a new office.This shows the home is recognising the needs of the people currently living there. Hot water temperatures were tested at random in the communal bathrooms and shower rooms and showed they were maintained to keep their temperature within safe limits. A variety of over 15 bedrooms were seen in all parts of the home, including single and double bedrooms. All were appropriately furnished to meet resident’s needs. A married couple have made their room a bed sitting type area, as they prefer their own company in their own private space. One bedroom is specifically allocated for residents to use for short-term respite care. This was reported to be an asset to the local community and it has good year round bookings. The home does not have separate facilities for the individuals who have dementia related illness, and some residents expressed dissatisfaction about the invasion to privacy this has caused.Individuals have been known to wander into other peoples bedrooms uninvited.This issue has been discussed with management and is in the process of being addressed. In the laundry foodstuffs and a fridge containing milk were seen.This practice challenges infection control procedures.It was not possible to assess the progress the home have made with the recommendations made by the Health Protection Agency infection control audit.Some inspection findings show that some areas in particular for clinical procedures for residents needs to be addressed – especially for people with feeding equipment and wound care. The new manager has expertise in this area and is going to carry out her own audit of the homes infection control standards as one of her main priorities. Beech House DS0000064947.V311626.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29, &30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Lack of knowledge about resident dependency levels means adequate and safe staffing requirements cannot determined, with the potential to put service users at risk of harm. The standards of vetting and recruitment practices are satisfactory with appropriate checks being carried out. This ensures that suitable staff are employed to care for service users. Recent lack of training provision, monitoring and supervision of staff does not ensure that service users are in safe hands. This does not demonstrate good employment practice, and does not protect vulnerable service users in the home. EVIDENCE: As recorded earlier in the report, due to the lack of recordkeeping including up to date assessments of the 50 people living in the home, it could not be ascertained what the actual care needs of the residents were. These findings combined with the concerns raised by the owners themselves and an ongoing adult protection investigation, make it necessary to assume Beech House DS0000064947.V311626.R01.S.doc Version 5.2 Page 22 that all of the people accommodated at Beech House currently require nursing care. Until the home can satisfy CSCI what actual care needs and categories for all the people living there, the home must be staffed in accordance with the home’s current CSCI Certificate of registration. Rotas seen for several weeks leading up to the inspection and the inspection week itself show that the staffing levels need to be adjusted and additional trained staff deployed. This will also provide a better opportunity for the important recordkeeping to be updated with the involvement of the service user and their representatives. Some staff records were not available on the first inspection day, so it was arranged they would be available for day two. The files of two new recruits were seen and showed that robust recruitment practices are carried out. It was positive to see that both individuals were receiving appropriate induction with a senior carer who with an NVQ level 3 qualification. These individuals have benefited from the new systems set up by the area manager. It was also positive to be informed that 19 of the 32 carers are a minimum NVQ level 2 qualified– making 60 in total. When the mandatory and specialist training undertaken by the team members was looked into, this was seen to be lacking. According to the records and information available, only one person in the home had undertaken dementia training, and the last time any adult protection training has been carried out was in 2003 when three staff members attended. The homeowners have put in systems to address training issues in place once they established similar findings when the staff records were audited in July. This will assist in putting things right in as short a period of time for the benefit of both residents and the staff team. The carers are very enthusiastic about the proposed changes in the home. The area manager commented that the response she got from the team was one of the best ever she has had when holding a staff meeting. Written comments from carers received at CSCI confirmed this. Excellent 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. It will be used to target staff to make sure all of the training is taken up by the staff who need it. Beech House DS0000064947.V311626.R01.S.doc Version 5.2 Page 23 Day to day working systems in the home have been reorganised to ensure the nursing personnel are actively involved with the care delivery for the residents and the care staff get the ‘hands on’ support they need. The nursing staff have already received training for professional recordkeeping, and 24 out of a total of 49 staff have been updated in manual handling training within a month of Springcare Ltd identifying this need. The company have recently employed a trainer for its homes and priority has been given to this individual to focus on the training needs of the Beech House team. Beech House DS0000064947.V311626.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32, 33,35 & 38 Quality in this outcome area is now adequate. This judgement has been made using available evidence including a visit to this service. The new management have not yet had the opportunity to demonstrate how it will benefit service user care. Record keeping in the home is variable in quality so that service user’s rights and best interests are not safeguarded. EVIDENCE: The home has not had a registered manager for over 12 months. This and other management changes within the company have not helped the challenges it currently faces. The previous manager for the home was reported to be on long-term sick leave and therefore unable to apply to CSCI for approval for registration as manager. Beech House DS0000064947.V311626.R01.S.doc Version 5.2 Page 25 It is positive that the current safe working systems in the home has continued to ensure good management of monies and valuables kept in safekeeping for residents, as well as bedrail safety.However, as recorded in this report, there has been a failure to evidence that the company’s employment policies and procedures, induction, training and supervision arrangements have been put into practice. This does not enable staff to develop and be aware of good practice. Some records required by regulation for the protection of service users and for the effective and efficient running of the home were not in good order. It is therefore positive to be informed that a very experienced nurse manager has been appointed to this position. The company have promoted Pauline Probert, who was employed as Deputy Manager in one of Springcare’s other homes. The administration manager will assist Pauline in her role, and the area manager Sarah Kaye will support both in their responsibilities. A deputy manager has also been appointed to strengthen the day-to-day management of the home. She also commenced employment at Beech House during the week the inspection was held. A total of five care staff confirmed in writing they were in support of the new management strategy and were looking forward to the changes ahead. The quality audit systems, which were already in place, have been further enhanced by additional audits and monitoring which the area manager will continue to carry out until issues settle down at the home. All solutions to current issues have been resolved with appropriate sound evidence based decision making which assures CSCI practices will continue to improve in the home. The owners are to be commended for being so open, honest and thorough in the remedial actions proposed and for some issues, already carried out. Most of the necessary service and maintenance records requested were seen to be up to date and complied with necessary health and safety legislation although recordkeeping for water temperatures has not been carried out as regularly as it should be. Improvements to accident monitoring systems by day two of the inspection meant that appropriate auditing and follow up of all accidents and incidents in the home would be carried out to include raising staff awareness and appropriate care plan review which will keep people as safe as possible. All accidents, which had occurred in September, were investigated and appropriate actions taken in line with this new system. Beech House DS0000064947.V311626.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 X X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 X X X 2 X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 X 3 X X 2 Beech House DS0000064947.V311626.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 14 (2), 15(1)(2) Requirement Timescale for action 31/10/06 2 OP7 14 (2), 15(1)(2) 3 OP8 12(1)(b) 15(1 4 OP18 13 (6) All care records must be reviewed and developed from an in depth needs assessment which has involved the service users or his/her representatives, which includes:• all assessments of risk to safety, • including falls risk, • and the safe use of stairs. The registered person must 31/10/06 ensure a competent appropriate individual assesses the service users with possible dementia related illness. Care plans must show details 31/10/06 that all resident’s health care needs are met as they should be, following any health care professional advice at the time it is given, and peoples needs change. The registered manager must 31/10/06 ensure all necessary evidence is recorded in staff and service user records to maximise resident safety and well-being. This includes • Staff training for DS0000064947.V311626.R01.S.doc Version 5.2 Beech House Page 28 • 5 OP19 23(1)(a) (b) vulnerable adults Resident assessment and care recordkeeping. 31/10/06 6 OP24 23(1) (2)(a) 16 (2)(k) 13 (3) 7 8 OP26 OP26 The home layout and strategy must meet all the individual and collective needs of the people residing there to maximise their safety and well being, including caring for residents with wander some behaviour. The registered persons must ensure all residents are provided with bedrooms, which provide comfort and safety and privacy. All parts of the home must be kept clean and free from offensive odours. The home must devise and carry out an action plan to meet the recommendations of the Infection control audit by the Health Protection Agency Food and drink must not be stored, prepared or consumed in the laundry. The home must be fully staffed in accordance with the CSCI staffing notice with the assumption that all residents in the home are in need of nursing care until professional assessments can offer CSCI other evidence. Staff must receive all necessary mandatory and specialist training necessary to care for the people it is registered to care for, including :• refresher moving and handling /hoist training, • dementia, and • risk assessment to make sure residents are safeguarded at all times. The home must submit an application to CSCI for a DS0000064947.V311626.R01.S.doc 30/11/06 31/10/06 30/11/06 9 10 OP26 OP27 13 (4)(a) (b)(c) 18(1)(a) 31/10/06 21/10/06 11 OP30 18(1)(a) (c), (2) 31/12/06 12 OP31 8(1)(a) (b)(1) 30/11/06 Page 29 Beech House Version 5.2 (111) 13 OP32 10(1) 12(1)(5) 14 OP38 13, 4(a)(b)(c) , (8) registered manager (Previous timescales of 10/01/06 not met.) The registered person must provide evidence the staff are competent to carry out their roles and responsibilities in line with Care Homes and Health and Safety legislation as well as the company’s own policies and procedures. The registered person shall ensure that environmental and individual risk assessments are carried out to ensure safe working practices, especially with regard to moving and handling, falls risk and the safe use of equipment in the home. 31/12/06 29/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Beech House DS0000064947.V311626.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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