Inspection on 29/11/05 for Beech House

This inspection was carried out on 29th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 09/07/07

Beech House 01/08/06

Beech House 10/03/05

Beech House 02/09/04

Beech House 23/10/03

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Beech House Beech Close Halesworth Suffolk IP19 8BQ Lead Inspector Jill Clarke Unannounced Inspection 29 November 2005 11:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Beech House DS0000029245.V268867.R01.S.doc Version 5.0 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 DS0000029245.V268867.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Beech House Address Beech Close Halesworth Suffolk IP19 8BQ 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) 01986 872197 01986 874638 The Partnership in Care Limited Post Vacant Care Home 39 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (39) of places Beech House DS0000029245.V268867.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1 The home may also, within the total of 39 service users, accommodate up to 10 older people with dementia - DE(E) 30 June 2005 Date of last inspection Brief Description of the Service: Beech House, owned by The Partnership in Care Limited, provides care for up to 39 people aged 65 years and over. The home can care for up to 10 older people who have a diagnosis of dementia. The purpose built home, is set within a residential area, within walking distance of Halesworth town centre. There is a footpath, which leads straight to the town’s market place, where there is a range of amenities. These include shops, church, banks, post office, eating and drinking establishments. Public transport links include railway and bus services. The home consists of 2 floors, which can be accessed via a lift or stairs. The 38 single bedrooms (located on both floors) all have wash hand basin, and 6 also have an en-suite toilet. A further single bedroom cannot be used until the renovations have been completed. For residents that do not have their own toilet, there are communal bathrooms and toilets located close to the bedrooms and lounges on each floor. The home is separated into 2 areas, 1 part known as the main home, has a large dining room. The second part of the home is the special needs unit, which supports people with dementia, and has it’s own dining room, lounge and enclosed garden. This is a non-smoking home. The home’s Manager is Miss Sonia Sherwood, whose application to become registered manager, is currently being processed by the CSCI. Beech House DS0000029245.V268867.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second of 2 routine regulatory inspections, undertaken between 1 April 2005 and 31 March 2006. The inspection undertaken by the Lead Inspector for the home, took place over 8 hours, on a Tuesday in November. The aim of this inspection was to look at relevant standards, which had not been looked at during the first inspection (30 June 2005). Time was also spent to ensure that requirements and recommendations made, following the last inspection had been addressed. Commission for Social Care Inspection (CSCI) feedback cards were sent to the home before the inspection. This gave an opportunity for relatives, visitors and staff to give feedback on how they thought the service was run. Comments from the completed 15 resident, 10 relative, and 11 staff feedback cards, have been included in this report. During the inspection time was spent talking to 3 residents in private, to hear their views on what it was like living at Beech House. General feedback from residents was also obtained throughout the day. Time spent with 2 relatives and 10 Members of staff, which included the Registered Manager, Senior Carer, Care Assistants and Housekeeper. During the inspection, contact was also made with the Suffolk County Council Fire Safety Office, who attended for part of the inspection. A tour was made of all the communal accommodation, laundry and a sample of 9 bedrooms, to check the standard of cleanliness. Records inspected included care plans, medication record, Fire risk assessment, recruitment paperwork and staff rotas. Discussions during the day with people living at the home, and staff, identified that they preferred to be known as residents, rather than service users. This report respects their wishes. What the service does well: Resident’s asked their views during the inspection commented that they were “looked after well” and they thought the care “couldn’t be better’. One resident said they were “quite happy” at the home, and confirmed that the staff were “very kind”. Another resident, who was asked if they would change anything about the home if they could?, replied “No- I am quite happy here” Beech House DS0000029245.V268867.R01.S.doc Version 5.0 Page 6 Relatives described the staff as ‘cheerful’,’ friendly, and ‘approachable’. Residents spoken to during the inspection felt that the home had a good friendly atmosphere, and they felt free to do as they wished. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Beech House DS0000029245.V268867.R01.S.doc Version 5.0 Page 7 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 DS0000029245.V268867.R01.S.doc Version 5.0 Page 8 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 and 6. People wishing to move into the home, can expect their needs to be fully assessed. This ensures that the home only admits residents within their registration category, whose care needs they can meet. EVIDENCE: During the last inspection (30/6/05) concerns were raised that the home was not always fully assessing residents before admission, to be able to establish if the home could meet the prospective residents needs. Discussions with 2 new residents, and a look at their care records, confirmed that the home had undertaken an assessment, and the residents felt the home could meet their needs. Due to the funding of the home, (as an ex-local authority home, which was sold to The Partnership in Care Group), all new residents also have a local authority assessment and contract. Residents (15) who had completed the CSCI feedback cards had all answered ‘yes’, when asked if they felt ‘well cared for’. This was also reflected in the comments made by residents during the inspection, who felt that they received a good level of care. Beech House DS0000029245.V268867.R01.S.doc Version 5.0 Page 9 Time spent with 1 new resident, who was staying in the ‘transitional’ (residents who are waiting to move into long term residential care) unit, said that staff “treat me very well” and that they would “like to stop” permanently. When asked about the care they received they said that they “couldn’t grumble at all”. They confirmed that they were fully aware of the costs. Relatives (10) who had completed the CSCI feedback card, had all replied ‘yes’ when asked if they were ‘satisfied with the overall care provided?’. One relative had written ‘I am completely satisfied with everything’. Another relative wrote that their next of kin ‘is very content and happy’, saying that they had ‘settled in completely’. The care records for 1 resident, showed the individual support being given to retain their skill and independence, in case the person decided, at the end of the stay that they could manage at home. Beech House DS0000029245.V268867.R01.S.doc Version 5.0 Page 10 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): 7, 9, and 10. People using the service can expect staff to treat them with respect. Staff will monitor the level of care/support required, and take appropriate action to contact relevant Medical and Social care professionals as required. Staff must record all medication coming into the home. This is to ensure the home can monitor that the right amount of medication is being received, on behalf of the residents. EVIDENCE: Core standard 8, was assessed as met during the last inspection (30/06/05) From the 15 residents asked (CSCI comment cards) if they felt staff ensured their privacy was maintained, and treated them with respect, 14 had said ‘yes’ and 1 had replied only ‘sometimes’. There was no further information to indicate why they felt this. During the inspection 2 residents were asked the same questions, both felt staff were polite, and respectful. One resident said that they had “no qualms”, about staff carrying out personal care, as staff did it sensitively. The resident went on to say that they had “never heard staff swearing or using bad language”. Beech House DS0000029245.V268867.R01.S.doc Version 5.0 Page 11 When talking to residents in their bedrooms, staff knocked and waited for a reply before entering. Time spent with 1 resident identified that they would like to see a doctor; this was fed back to staff, who arranged for the resident to be visited. Care records (2) looked at, and discussions with both residents and staff, confirmed that residents were referred (when required) to specialist health professionals (for example Urologist, Psychiatric consultant) to support them with their physical, and mental health needs. Care plans were reviewed monthly, and required changes made. Discussions with 1 resident and their relative identified that it was left to the relative to cut the resident’s toenails, as staff were not allowed to. They said that the home offered to arrange for a private Chiropodist to visist, but they felt £10 was a lot of money to “pay to have your toe nails cut”. The manager said some staff were not happy to cut residents toenails. This led to discussions about looking at training to support staff, to give them the confidence to undertake this (only for residents who did not have a identified need to see a Chiropodist, for example Diabetic. Due to the inspector not observing the staff giving out medication during the inspection, information was sought from residents. Two residents were asked if staff brought their medication around on time - replied ‘yes’. One of the resident’s asked, also said that they were “never kept waiting”, that when staff gave out the pills, they always “checked” the medication. The resident said that you “know they are taking their time” and felt that this would reduce the chance of any mistakes being made. Time was also spent looking at the homes storage of medication and record keeping. Medication was held securely in a lockable trolley, which when not in use, was stored in a locked room. Key access was restricted to the Manager/senior carer on duty, who was responsible for giving out the medication. The records for 2 residents, who were on controlled medication was checked against records held, and found to be correct. Records showed that the home had policies in place for the safe handling of controlled medication, which included, a member of staff signing to confirm they had witnessed the resident being given the right medication, at the required time. The majority of the residents’ medication is supplied by a Pharmacist in individual sealed ‘dossett’ boxes, which are sent to the home once a week. Medication, medicines, creams, ointment and liquids, not supplied in the dossett boxes, are sent in separate individual containers. Records showed that all medication not received in dossett boxes, are recorded in a book. The home said that they had another book, which they wrote any returns in, which was currently held at the dispensing Pharmacy, and would be sent back to the home when checked. Beech House DS0000029245.V268867.R01.S.doc Version 5.0 Page 12 The home was asked how they recorded the medication received into the home, which was held in dossett boxes. Staff showed the individual Medication Administration Records (MAR) sheet, which was attached to the front of the dossett box. The current procedure at the home, is for a delegated member of staff to check the tablets held in the sealed dossett box, against the prescription information given on the back of the container. They would then sign, and date, the top of the MAR sheet to confirm that the amount of tablets received was correct. If it did not agree, or there had been any changes in a resident’s prescription, staff confirmed that they did not alter the boxes themselves – but sent them back to the dispensing Pharmacist. The printed information on the MAR sheet (attached to the front of the dossett box) from the Pharmacist did not always agree to the amount received. This was pointed out to staff, which led to discussions that the home could use the designated areas on the MAR sheet to record the exact amounts received and returned each week. The home was asked how they monitored and ordered repeat prescriptions. They said they received the repeat prescription from the residents General Practitioner (GP), and marked which ones they needed reordering. The repeat prescription would then be returned to the resident’s GP, who would issue the required prescriptions, and pass them onto to the dispensing Pharmacist. This led to discussions, where creams and ointment, which were not required for that month, were not listed as ‘not required or none ordered this month’ on the MAR chart. This led to further discussions over the homes responsibility in checking repeat prescriptions, on behalf of residents, and having a system in place to ensure they receive only the items requested. The inspector, tried to undertake a sample audit - of 2 resident’s medication, which was not held in the dossett boxes. Due to missing information on the MAR sheet (confirmation of quantity received, brought forward totals) and staff unable to locate at the time, 1 resident’s previous MAR sheet, the audit was not undertaken. This was because the inspector felt that it would have taken too much time out of the inspection day, to be able to undertake a check. The home’s system of recording medication will checked at a future inspection, when staff have instigated a clear method of ensuring all medication held, is recorded on the MAR sheet. Beech House DS0000029245.V268867.R01.S.doc Version 5.0 Page 13 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): 12 and 13, The home offers a range of activities and social outings for residents to take part/join in with. However, further work needs to be undertaken, to ensure residents with dementia, are offered a range of activities, suitable to their needs/interests. EVIDENCE: Core standards 14 and 15 were assessed as met during the last inspection (30/06/05). Relatives said that they felt comfortable to visit when they wanted, and staff made them feel welcome. All but 1 of the relatives asked (CSCI comment cards) if they felt staff kept them informed of any important matters concerning residents welfare, had said ‘yes’. Further information written on the comment card, identified that there was another of the residents relatives, who lived more local, who could have been given information and kept updated by the home. Time spent with residents confirmed that they felt in control of their lives, choosing when they got up, went to bed and how they wanted to spend their day. Residents did not feel that the home imposed any rules, but were flexible around their needs. Residents asked (CSCI comment cards) if the home provided suitable activities?’, 14 had stated ‘yes’ and 1 resident had ticked Beech House DS0000029245.V268867.R01.S.doc Version 5.0 Page 14 ‘Yes’, as well as only ‘sometimes’. Before the inspection a relative raised concerns, that residents were at times, left for long periods sitting in the dementia unit’s lounge, without any staff interaction. This they felt was because staff were so busy, and asked if more activities should be made available/provided. On arriving at the home, 4 residents from the main home had just left with staff (which include the Manager), in a mini bus, on a shopping trip to Norwich. The 2 staff working on the dementia unit were busy working, which did not allow for a member of staff to be with the residents in the lounge. Discussions with 2 visitors to the unit, confirmed that residents were left for long periods, as staff were busy. It was felt that sometimes staff relied on leaving residents to watch the television, which was just left on, without looking to identify what programmes where on, and if they were suitable. Discussions with staff on the unit confirmed that they found it hard during the morning to be able to undertake activities, as it was a busy time. Instead they would try to arrange activities in the afternoon – when it was quieter. The 2 members of staff were asked if they had received any specialist training, to support them in carrying out activities with residents who had dementia, replied “no”. Staff said there was an Activity Coordinator who covered the whole home. The Manager confirmed that the person worked part time, and that they had not received any specialist (dementia) training. The Manager said they were still looking at the situation, by changing the hours the activity person worked, to give more cover. Time was spent during this visit, sitting with 2 residents at the dining table (with their permission) to observe the lunchtime routines. The atmosphere was found to be relaxed, with staff interacting well with residents. This was undertaken by including residents in conversations, and whenever they undertook a task, such as placing a meal in front of the resident, addressing the resident by name, and confirming what the meal was. Staff also made comments such as “smells lovely”, and “that’s your favourite”. The 2 staff sat at different tables, assisting residents that required support. Staff sensitively supported residents to feed themselves, with gentle encouragement. Time spent talking to 1 resident confirmed that they thought the food was “nice”. Although meals were brought to the unit (from the main kitchen) in a heated trolley, and served up hot, staff were heard to comment when removing 2 residents unfinished pureed meals, that the food had gone cold. Staff were asked if they had any specialist individual plates, which are designed to keep the meal hot for as long as needed. They said they had not, but thought they may be useful. Beech House DS0000029245.V268867.R01.S.doc Version 5.0 Page 15 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): 16 and 18. People living at the home, can expect any concerns they have to be listened to, and acted on in an appropriate manner. EVIDENCE: Staff (11) had all replied ‘yes’ when asked (CSCI comment cards) if they were aware of the home’s complaint policy. From the 10 relatives/visitors who had also completed feedback cards, 4 out the 10 were unaware. The complaints policy was displayed on the wall at the entrance – close to the signing in book. A copy was also contained in the Home’s Statement of Purpose, and Residents hand Book. Residents (15) asked (CSCI feedback cards) if they were unhappy with their care – did they know who to speak to, all 15 had replied ‘Yes’. Residents asked during the inspection said that they would tell staff, or the manager if they had any concerns. Staff asked (CSCI comment cards) if they had received training in the home’s abuse policy, 3 had not. From these 3, 1 member of staff had stated that they had not received training as they worked in the kitchen, and felt they did not have the 1 to 1 contact. The Manager confirmed that training had been arranged for all staff working at the home, which was being undertaken in 2 sessions. Training plans viewed, and training certificates issued, showed that 1 of the 2 sessions had already taken place. The home had a copy of the Suffolk Vulnerable Adult Protection Committee’s Inter-Agency Policy Operational procedures and Staff Guidance (June 2004), Beech House DS0000029245.V268867.R01.S.doc Version 5.0 Page 16 which was used as part of the home’s Abuse policy training. The company owning the home, Partnership in Care, have produced their own Whistle blowing and Abuse Policy for staff, which is used in all their homes. Beech House DS0000029245.V268867.R01.S.doc Version 5.0 Page 17 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, 22, and 26. Although staff are committed to ensuring a clean odour free environment, further action needs to be taken, where staff are unable to keep bedrooms free from unpleasant odours. EVIDENCE: Standards 20,21,23 and 24 were assessed as met during the last inspection (30/06/05). Before the inspection, concerns were raised by 1 relative, over a resident’s bedroom, which often had an ‘unpleasant odour’. On arriving at the home, the Inspector went straight to the special needs unit, and checked all the bedrooms. They found 1 bedroom, where there was still an unpleasant odour, although it was evident that staff had just shapooed the carpet. Discussions with staff identified that the carpet cleaner was very heavy to use, and was not working properly. Staff said that they were waiting for a replacement, but did not know when it would be arriving. Beech House DS0000029245.V268867.R01.S.doc Version 5.0 Page 18 This was fed back to the Manager, who stated that they had experienced problems with the contractor, which had caused delays in the equipment being replaced. A letter from the contractor was shown, which confirmed that the new carpet cleaner was due to be delivered at any time. Staff said that although they cleaned the resident’s carpet each day – they were unable to get rid of the odour, which they felt might have impregnated the carpet. This led to further discussions with the Manager, over the resident’s continence needs, and replacement flooring. Staff were asked if they had any other bedrooms, where they had problems getting rid of odours. They identified another resident’s bedroom in the main home, which was visited. Although an odour was not detected at the time, it was noted that staff had just cleaned the carpet, and were taking advantage of airing the room, whilst the resident was out. Residents (2) who lived in the main part of the home said that they had no problem with the standard of cleaning. One resident commented that they always seemed to be a member of staff “hoovering and cleaning the corridors” and that they had “been impressed that everywhere you go is clean”. One relative wrote (CSCI comment card) ‘the surroundings/interior of the building is clean, but look a little tired’. Another wrote ‘the building is in need of some refurbishment’. The home’s on-going maintenance plans, showed internal redecoration programme (January 2005 to February 2006), which gave detailed information on areas to be redecorated each month. The Manager confirmed that besides the on-going work, any bedrooms that become vacant are redecorated before they are re-occupied, if needed. Although the home had looked at maintenance work needed internally, there was no plan for work to be undertaken to address the comments made by relatives, concerning the outside of the home. Staff (11) asked if they felt they had sufficient mobility aids (for example hoists, handling belts, sliding sheets) to support individual residents needs, had all replied ‘yes’. No concerns were raised by the residents, relatives or staff during the inspection, over not having enough mobility equipment. Residents were seen to be able to get freely around the home, although some required help with the passenger lift. This was due to the lift being fitted with doors that had to be closed manually. Beech House DS0000029245.V268867.R01.S.doc Version 5.0 Page 19 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, and 30. People using the service can expect staff to be trained, and supervised, to deliver the level of care/support required. However, the home needs to continue monitoring their staffing hours/rotas, to ensure all residents physical and social care needs can be met, in an un-rushed manner. EVIDENCE: Relatives/visitors asked (CSCI comment cards) if there were always sufficient numbers of staff on duty, only 2 had stated ‘yes’, 4 ‘No’, 1 had written ‘mostly’, 1 ‘don’t know’ and 1 had written ‘95 of the time’. Before the inspection, contact was made with 1 of the relatives, to gain further feedback. Their concerned that at busy times residents “may be left alone in the lounge (dementia care unit) for considerable periods of time” (See section Daily Life and Social Activities). During feedback from a resident and their relative, when asked about the staffing levels, they confirmed that the staff were very busy at times. The resident said bells tend to go off together, that “staff work hard” and “will always go off to and help – they are good like that”. They felt some residents expected that as “soon as they ring the bell staff will appear”, they said staff do come as soon as they can, which was always within a short time, and they personally had never been left waiting. Although never left waiting, the resident did feel that they felt “rushed” at times, due to staff being so busy. Beech House DS0000029245.V268867.R01.S.doc Version 5.0 Page 20 The relative said within the first month of visiting they got the impression there was not enough staff. That sometimes “the bells were left ringing – leaving people having to wait”. Staffing rotas (14 to 20 November 2005) showed the normal shift pattern to be 1 senior carer and 5 carers plus 1 flexi shift in the morning, and 1 senior carer and 4 carers in the afternoon/evening. This gave a ratio of 1 carer to 4 residents in the dementia unit) and 1 carer to 7.5 residents in the main home. In addition there is ‘flexi’ shift (where the carer can work anywhere in the home – and help with outings), activity therapist (who also gives support at breakfast time) and senior management cover. The Manager said that the person working the ‘flexi’ shift, in the mornings is also used to cover shifts, if they cannot get cover. The staff rotas showed what action the home had taken to ensure all shifts were covered, even though on 1 day they had 4 off sick. The manager said that they were constantly reviewing staffing hours and rotas, to try and give the best cover. They had also had problems recruiting staff, but had now managed to recruit 2 new staff, who would be starting after Christmas. To ensure the home is following safe system of recruiting staff, and have obtained all the required information – before staff start work in the home, a sample of 2 staff recruitment records were checked. They were found to contain all the required paperwork, including references, and paperwork to validate the person’s identity. The Manager confirmed that all new care staff undergoes induction and foundation training ‘Getting started in care – training for TOPSS’. The home does not currently meet having 50 of their care staff holding a national Vocational Qualification (NVQ) level 2 (or equivalent). However, training records looked at, showed that the home is on-line to meet this, during 2006, when the current carers undertaking the NVQ – successfully complete their training. Staff (11) asked (CSCI comment cards) if they felt the home had a good training and development programme, to support them in fulfilling their role, had all said ‘yes’. Discussions with the manager evidence their commitment to ensuring all staff receives training to support them in their role. Work undertaken since the last inspection included, reviewing all staff’s individual training needs, and producing a training matrix (which was displayed on the wall) to monitor staff’s training needs. Beech House DS0000029245.V268867.R01.S.doc Version 5.0 Page 21 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): 33, 35, 37 and 38. People living at the home can expect to be cared for by approachable, and friendly staff, committed to providing a good level of service. To ensure the safety of all persons living and working in the home, staff must review their Fire Safety procedures, to ensure they meet current fire safety requirements. EVIDENCE: Standards 31 and 32 were assessed at the last inspection. Standards 32 were found as met, and 31 nearly met. Action required to address the shortfall (standard 31) how now been addressed. The new manager has submitted their application to be registered with the CSCI, which is currently being processed. All the Staff (11) who had completed the CSCI comment card, had ticked ‘yes’ when asked if they felt the home was well run, and confirmed that they Beech House DS0000029245.V268867.R01.S.doc Version 5.0 Page 22 received regular supervision. A relative described the Manager as “approachable”. The atmosphere was found to be relaxed, with residents joining in conversations with each other. Staff interacted well with residents, acknowledging residents when they walked past, and greeting relatives and visitors. This was further reflected in a comment made by a relative (CSCI comment card) who wrote that their next-of-kin had ‘made new friends and enjoys a laugh and joke with all the staff’. Residents (15) when asked (CSCI comment cards) if they would like to be more involved in the decision making at the home 8 had replied ‘yes’ and 7 ‘no. No further information was given, as to what area of the running of the home they would like to be involved, and all had ticked to say they did not wish to talk to an inspector privately, during the inspection. Residents (3), spoken to in private during the visit did not express any wish to be further involved in the running of the home. Residents individual saving account sheets were looked at, during the last inspection, which included details of any interest payments on the resident’s savings. Medication records had not been fully completed (see Health and Personal Care section). Care plans were held securely in a lockable cabinet. However, on arriving at the home, attached to the home’s fireboard was a list of all the residents’ names, date of birth and room numbers, which was in full view of people living and visiting the home. The home was asked to remove the list, and find a more appropriate place to ensure residents personal information is kept confidential. Staff removed the list straight away. Whilst spending time on the dementia unit, it was identified that the 2 of the marked Fire exits, 1 in the kitchen, and 1 in the corridor, was locked. Staff on the unit were asked for the key, but did not know it’s whereabouts. This was fed back to the senior carer in-charge, who was asked to take action immediately to open the fire exits. The member of staff admitted that it was an oversight, that they normally unlocked the fire exits in the morning – as they were locked at night. They said this action had only recently been undertaken, after concerns that a resident living on the dementia unit may try and leave the building. The member of staff said that advice had been informally sought from a retained Fire Officer. There was no information found or fire risk assessment to confirm this. A Fire Safety Officer was contacted for advice, which led to them visiting the home, to look at the situation. On checking the fire exits on the dementia unit, the 1 in the kitchen had been unlocked – but the 1 in the corridor was still locked. Although the Fire exit in the corridor was marked ‘Fire Exit’ – staff felt this was not an exit. During an environmental tour, the Fire Officer had Beech House DS0000029245.V268867.R01.S.doc Version 5.0 Page 23 trouble opening a fire door, due to the ‘weathering’ of the door and platform leading out. The front door, which was also a fire exit was locked with a key at night. Fire records showed that a risk assessment had been undertaken by the home, for residents who preferred to keep their bedroom open at night. The Fire Officer advised the home on what action they had to take, and the inspector made an immediate requirement, to ensure the safety of all people living and working in the home. Fire records showed that the fire safety equipment was regularly serviced, and weekly checks were undertaken to ensure the fire call system was in working order. Beech House DS0000029245.V268867.R01.S.doc Version 5.0 Page 24 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 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X 3 X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 3 2 2 Beech House DS0000029245.V268867.R01.S.doc Version 5.0 Page 25 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP9OP37 OP26 Regulation 13 (2) 16 (2) (k) Requirement The home must keep a record of all prescribed medications received into the home. The home must write to the CSCI to state what action they are going to take to ensure all residents bedrooms are kept free from unpleasant odours. The home must provide adequate means of escape. Fire exits doors must not be locked using a key – under any circumstances. The upstairs fire exit door and escape platform must be made good, to ensure the door can be freely open. Timescale for action 16/12/05 16/12/05 3 OP38 23 (4) (b) 29/11/05 4 OP38 23 (4) (b) 05/12/05 5 OP38 23 (4) (b) Action must be taken to fit a new 05/12/05 locking device to the front door, which meets Fire Safety Regulations. The home must seek advice to identify, which exits are fire exits, and take appropriate action to ensure all fire signage throughout the building is DS0000029245.V268867.R01.S.doc 6 OP38 23 (4) (b) (c) 05/12/05 Beech House Version 5.0 Page 26 correct. 7 OP38 23 (4) (b) (c) The home must take action (Fire Risk Assessment) to ensure all resident’s bedroom doors can close, when the fire alarm goes off. 05/12/05 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 OP9 Good Practice Recommendations It is recommended that staff write a brought forward on the MAR sheet, to show how many any pills/tablets, not dispensed in a dossett box, is left at the end of a 28-day period. This would support staff in undertaking ‘spot’ audits, to ensure medication has been given out correctly. It is recommended that the home has systems in place to check that medication requested on a resident’s repeat prescriptions, is the actual medication dispensed by the Pharmacist. The home should look at their current activities, to ensure that residents who have dementia are offered a range of suitable activities. It is recommended that the home looks what training is available to support staff on the unit, and activity therapist to support residents to undertake relevant activities (for example reminiscence and validation work, memory boxes and life histories). It is recommended that the home includes any planned external maintenance work with their current programme. Once completed this should be displayed in the home, to enable residents, relatives and visitors know what work is being undertaken to address areas which show signs of wear and tear, both internally and externally. The home must continue monitoring the staff rotas, to ensure they have sufficient care staff on duty at ‘peak’ times. It is recommended that staff attend a recognised training DS0000029245.V268867.R01.S.doc Version 5.0 Page 27 2 OP9 3 4 OP12 OP12OP27 5 OP19 6 7 OP27 OP30 Beech House 8 OP33 course, to able to cut those residents toenails, deemed suitable. The home, as part of their quality assurance work, should seek the views from residents how they would like to be more involved in the running of the home. Beech House DS0000029245.V268867.R01.S.doc Version 5.0 Page 28 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Beech House DS0000029245.V268867.R01.S.doc Version 5.0 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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