Inspection on 03/02/09 for Beech House

This inspection was carried out on 3rd February 2009.

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 18/08/08

Beech House 20/02/08

Beech House 20/09/07

Beech House 07/06/07

Beech House 25/09/06

Beech House 10/01/06

Beech House 05/07/05

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2009.

CARE HOMES FOR OLDER PEOPLE Beech House Wollerton Market Drayton Shropshire TF9 3NB Lead Inspector Janet Adams Unannounced Inspection 03rd February 2009 10:50a 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.V374035.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.V374035.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beech House Address Wollerton Market Drayton Shropshire TF9 3NB 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 Manager post vacant 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.V374035.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care with nursing to service users of both sexes whose primary care needs on admission to the home are within the following categories:old age not falling within any other category, OP, 54; dementia - over 65 years of age, DE(E), 10. The maximum number of service users to be accommodated is 54. 2. Date of last inspection 18th August 2008 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. The home does not have a separate unit for people with dementia related illness. These individuals share their living accommodation and access the communal areas alongside the rest of the residents in the home. 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 fees charged depend on the care, support and accommodation provided. Additional charges to service users are for hairdressing, toiletries, and newspapers. The reader may wish to obtain more up to date information from the care service about this matter. Beech House DS0000064947.V374035.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor outcomes. Three inspectors carried out this key unannounced inspection. It was carried out in the form of five separate visits to the home and lasted over nineteen hours. On two of the inspection days, a CSCI specialist pharmacy inspector assisted by carrying out an inspection of Beech House’s medicines management systems. This is the fourth occasion we have inspected Beech House in the last 12 months. We also inspected the service in February, June and August 2008. We, the commission, used a range of evidence to make judgements about this service. 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 31 people living there. On the first 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. Several of the staff on duty at the time of the inspections 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. On the first inspection day a postal survey was organised to get some comments about Beech House from the people living, visiting and working at the home. On this occasion no replies were received. We also used the opportunity to review progress in the plans the service told us they had to improve the service before the inspection. In total, we assessed a total of 24 out of a possible 38 National Minimum Standards for Older People. Discussions with the management team took place throughout, and feedback about the conclusions of the inspection was given at the end of the inspection days. Beech House DS0000064947.V374035.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Systems need further development to make sure people thinking of living at home have all the information they need to make this decision, and staff are fully prepared to look after them from the point they move in. Some care practices are not adequate and the way staff record what they do to care for people continues to be an issue. The measures staff have been taking have not kept people safe at all times. The care that people receive to manage their medications, wound care, nutrition and reduce risks in their daily life, is not adequate and is not being properly accounted for. People cannot be confident that they are getting the professional nursing they need and pay for to keep them healthy and active. Beech House DS0000064947.V374035.R01.S.doc Version 5.2 Page 7 Sixteen months ago we issued an ‘Immediate Requirement’ notice to ensure people living in the home who needed bedrails were being cared for safely. Our findings on this occasion showed the improvements the home made at the time have not been maintained. As a result we issued two more enforcement notices before the home complied. We visited the home on a further two occasions before we were happy with this situation. The planning, timing and service of mealtimes needs careful consideration and reorganisation to ensure that everyone gets maximum benefit from the excellent food the home provides. Staff need to show they are following health professionals’ advice so that people with special dietary needs have the best opportunity to stay well. Not all records were available on this occasion to assure us the home was recruiting staff and ensuring people were being properly supported when they start work at Beech House. This means the home is not demonstrating they are doing all they can to protect people who use and work for this service. Staff training is not geared up to support the team to improve in the areas of care where it is needed. Lack of communication and teamwork has resulted in some care practices not being satisfactory. Priority must be given for this matter to ensure all people who need the support of the care team can be confident the staff they rely on are competent to meet their needs. Staff have not received adequate managerial supervision to make sure they receive the professional support and advice necessary to praise them or improve their performance. We were not able to confirm the home is adequately managed and maintained, as several records we requested could not be located. Systems are in need of further development so people living working and visiting the home are safe, secure and feel confident that their welfare and safety needs are always promoted. 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.V374035.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beech House DS0000064947.V374035.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3. 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. An appropriately qualified person assesses people considering moving into Beech House before being admitted to make sure the home can meet the person’s needs and wishes. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Springcare, the Registered Providers for the service, produce a corporate styled information folder for prospective residents, which contains the home’s Statement of Purpose and Service User Guide, the information we require them to have by law. Copies of this information was requested and examined after our inspection visit, and were seen to have been updated with most of the information we asked them to provide at previous inspections, however some information was in need of updating to fully comply with our regulations Beech House DS0000064947.V374035.R01.S.doc Version 5.2 Page 10 and keep people informed about the home’s the current management situation. The information the home provides for people about Beech House clearly states that there is no problem with people who live locally to keep their usual doctor. We found no evidence to confirm a local person had been offered this opportunity so that there could be a continuation of the individual’s medical support upon relocation to the home. An in depth look at the admission records of the only person who moved into the home since the last inspection confirmed that adequate standards of recordkeeping are kept for this matter. The person who was the home’s clinical matron at that time had assessed the person. Details seen written down confirmed the majority of information was collected for the home to decide whether they could meet the person’s personal and health care needs before moving in. Details recorded about the person before admission lacked details about the individual’s basic needs and preferences. As the person was self funding there was no backup information provided by the social service team to provide additional details to those collated by the home representative. In addition, it was seen that the care plans and activities of daily living assessment for this individual had not been carried out in until the day after the admission. This meant that was not as prepared as it could have been when planning for this person to live at the home. Beech House DS0000064947.V374035.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 &10. Quality in this outcome area is poor. The support and personal care provided at Beech House does not promote good health for all of the people who live there. Management of residents’ medication has improved, but there are still areas where people have not received medication as prescribed This judgement has been made using available evidence including a visit to this service. EVIDENCE: Although we have not received any replies to our survey, we received complimentary comments from relatives we met during the inspection. One person told us that the home were very good at keeping her informed about her relative’s health and well being. Health professionals who visited the home also reported staff to be working tirelessly to attend the highly dependent needs of people living in the home. Our inspection findings confirm that the home care team have continued to receive a lot of support from ‘Springcare,’ the company who owns the home, to Beech House DS0000064947.V374035.R01.S.doc Version 5.2 Page 12 improve this part of the service it provides. Since the end of 2007, the company area managers have been visiting the home on a weekly basis in order to monitor the team progress with the quality of care and support offered to people living at the home. This has resulted in slow, continual improvements in some care practices. Due to their medical conditions, several people living in the home are not able to communicate their opinions. Therefore the two hours spent observing people in a communal lounge during the first day of the inspection day was helpful in confirming our overall findings during the inspection. Care practices observed were generally satisfactory and the majority of staff were seen to be attending the needs of residents in a respectful, caring manner and were 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 that some people are still not getting all of their health needs fully met. Some aspects of respecting people’s privacy and dignity were in need of consideration. • We overheard a doctor who visited one person discuss her health needs telling her of medication being prescribed in a communal area. • Everyone seated in one lounge area was seen to be wearing the same ‘uniform’ of adult aprons some time before their meals were served. These issues were discussed during the inspection. After our inspection in August 2008 we reported improvements in care practices. Since then we have received concerns about the standards of care carried out in the home from a variety of health professionals. Individuals including ambulance personnel, hospital staff, community nurses and social workers have expressed concerns about people not being cared for as well as they could be. Their findings about poor wound management triggered us to explore this matter further. Although record keeping for this matter is not to the expected standard of qualified nurses, it is positive that the efforts of the home team have resulted in several people no longer having pressure sores. However, the way the staff team handle wound management when people have accidents resulting in injury care is in need of improvement. An in depth look at the records of two people who have had accidents which occurred in the home did not fully account how their injuries were being managed and monitored, nor did their care information account for actions taken to prevent them from the accidents happening again. In one case the home management were not aware an accident had occurred, as the staff involved had not reported it as they are expected to by law. On our tour of the home we saw equipment being used for people in an unsafe manner. • We saw special mattresses plugged in and operating at the wrong settings on beds of frail people. Beech House DS0000064947.V374035.R01.S.doc Version 5.2 Page 13 Special feeding and moving and handling equipment was in an unclean condition. • Bedrails were installed in an unsafe manner, which posed entrapment hazards. We checked the care records of five people to see if staff had written guidance to follow to make sure they knew how to use and maintain the above equipment. Our findings confirmed this area of care paperwork to be inadequate. It was a major concern that staff on duty on the day of the inspection staff had signed paperwork to confirm they had checked bedrails were safely installed when in fact they were not. As a result of our findings we issued an Immediate Requirement for the home management to check out all bedrail installations in Beech House and confirm to us that the staff responsible for making sure the equipment was safe to use knew what they were doing when carrying out their checks. We expected the home to comply with this notice within 48 hours. Seven days later, upon our return to the home our findings confirmed that the home team had not taken appropriate action in response to our Immediate Requirement, and a check of 22 bedrail installations confirmed 10 sets of this equipment were still installed in an unsafe manner. Poor recordkeeping for this matter could not evidence the actions the home had taken to improve bedrail safety and retrain staff so they were competent to carry out this task. As a consequence copies of bedrail safety records and associated documentation were seized and removed from the home under conditions laid out in Police and Criminal Evidence (PACE) Act 1984. At this stage we provided the management team with advisory guidance from the Health and Safety Executive for them to consider using. This included an interactive training programme staff could access to train with whilst they were at work. We also issued a second Immediate Requirement notice for this matter with another 48 hour timescale to fully comply. Upon our third return to the home two days later appropriate action had been taken to ensure most care practices had been improved so that people could be safe in bed. It remained a concern that some safety assessment paperwork to guide staff how to make sure people were safe in beds without bedrails was not available. Discussions with the staff on duty confirmed a good working knowledge for this matter and we were offered assurance that the recordkeeping was in the process of being updated at the time of the inspection. Health professionals also expressed concerns that people were not getting the right food and drink to keep them safe and well. Our findings confirmed that although some improvements had been made to ensure the dietary needs of people were being met, we remain concerned there is a lack of recordkeeping to monitor this issue and not all specialist guidance and advice that has been offered by health professionals has been acted upon. Beech House DS0000064947.V374035.R01.S.doc Version 5.2 Page 14 • A dietician recommended one person to have six small meals a day. Our findings confirmed this was not happening all the time. There were time intervals of up to 14.5 hours overnight where the person wasn’t offered food, and then she was being offered food with less than an hour and a half interval during the day. Although it is positive the person has gained some weight, staff were not following the professionals advice or demonstrating sound nursing practice to maximise the person’s potential for more weight gain. During all three visits to the home, details seen written on people’s food and drink charts were seen to have large gaps, which meant they did not fully account for their fluid and dietary intake. On the third visit to the home upon checking a resident’s bedroom in the late evening, a person was seen to be in an unkempt state. She was wearing a damp heavily soiled jumper, which had soaked through to underwear, and had two stale sandwiches in her lap. A bowl of pudding was untouched on her bed table alongside three full beakers of drinks. Her care chart had not been completed since 10.20 am. The nurse in charge was requested to come and see the person. Although she recognised the person must have been like that for some time, there was no urgency expressed to make the person comfortable. Communication about care matters has been a concern at Beech House for some time. At the last inspection we wrote about some of the successful actions the home had carried out to improve this matter. • As the home cares for a lot of people who cannot express their needs, the company had introduced a form especially designed to record important information about a person in the event of their admission to hospital. Examination of the records of the last two people admitted to hospital confirmed this document had not been used, and on one occasion resulted in hospital staff being not being fully aware of a person’s health needs. • At previous inspections we commented it was difficult to read records to understand what care had been carried out, and more importantly what additional care was needed for people. This issue has not been fully resolved and for this reason it was difficult to investigate an incident when a person had an accident involving bed rails. The pharmacist inspector visited the service on the 10th and 11th February as part of the key inspection. The reason for the inspection was to establish whether the home was complying with the regulation around the safe handling of medicines following the repeated issuing of requirements and a statutory requirement notice. During the inspection we found a number of anomalies with the medication records and as a consequence copies of the medication records and associated documentation were seized and removed from the home under conditions laid out in Police and Criminal Evidence (PACE) Act 1984. Beech House DS0000064947.V374035.R01.S.doc Version 5.2 Page 15 Although the home had continued to record the receipt of medication and use the carry forward system to account for the medication carried over from the previous monthly cycle, further anomalies were discovered during the course of the inspection. We found that the home had themselves identified some of the anomalies during their medication counting processes. One of the more serious anomalies was the administration of a blood pressure tablet. This tablet had been administered twice on the same day rather than once as prescribed by the doctor. Unfortunately this mistake was not identified until two days after the incident. Even after the mistake had been discovered there did not appear to have been any contact with the person’s doctor for advice nor did their appear to have been an investigation to determine what went wrong and what could be done in the future to prevent it happening again. Another anomaly discovered by the home was that another person who used the service had not received two of their prescribed medicines on the morning on the 5th February 2009. Again we found no evidence that the person’s doctor had been alerted or that an investigation had been carried out. The home had also identified that an antidepressant tablet had not been administered but the administration records had been completed to indicate that it had. The home had also identified for another person that the Medicine Administration Record (MAR) chart had not been signed for three medicines on the same administration round. When we audited this MAR chart we found there to be no gaps in the administration record. We were told that it was likely that the nurse concerned had been identified and had been asked to return to the home and sign the records. The home was informed that the practice of retrospectively signing the MAR charts put the integrity of all the MAR charts into question. We found for another person who used the service that on one occasion this person had not received the correct dose of their calcium supplement tablets. We also found that this person had not received a dose of their medication used to treat Parkinson’s disease. We also found that another person’s nutritional supplement was not being administered as prescribed and as a consequence had received less of the supplement than had been required by the person’s doctor. We also found that from the sample of MAR charts examined some of the medication could not be accounted for. The home was also using the generic abbreviation “O” to identify where medication had not been administered but were not defining what “O” meant. Therefore it was not possible to establish why the medication had not been administered. We found that a number of people who were using the service were having their medication administered to them through a PEG tube. We sampled the care plans of two of these people and found that the care plans did not have any information about how the medication should be administered. We also found that staff were having to dissolve some of the medication before administering through the tube. The dissolution of these particular tablets Beech House DS0000064947.V374035.R01.S.doc Version 5.2 Page 16 meant that the staff were administering unlicensed medication to this person and the implications of this were explained during the inspection. We also found that the home had not clarified with a pharmacist that the dissolution of these tablets did not cause detrimental harm to the tablets and consequently harm to the person receiving them. We also found that the staff were administering the early morning medication to one of the people whilst the person was asleep. In this situation we would expect to see evidence that the person had been involved in the decision to do this and had given their consent. We unfortunately did not find any evidence of the person’s involvement or whether consent had been given. We found that the maximum and minimum temperatures of the fridge were being monitored on a daily basis. We found that on the 18th January 2009 and the 10th February 2009 the fridge temperature had dropped below the minimum temperature of two degrees centigrade. The Area Manager confirmed that following the temperature drop on the 18th January the insulin contained in the fridge had not been discarded. An immediate safety risk to the person prescribed the insulin was averted because a new supply of insulin had arrived in the home six days later and had been used immediately. The home was advised to discard the insulin in the fridge, ensure that the fridge temperature remained within the accepted parameters and obtain a new supply of insulin. The above findings show that the improvements we reported at our last inspection in August 2008 have not been maintained and it is evident not all recent care practices have been to the benefit and well being of the people living at Beech House. As a result, we the Commission are to make decisions about what appropriate action we need to take to take to ensure permanent improvements are made and sustained. Beech House DS0000064947.V374035.R01.S.doc Version 5.2 Page 17 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 adequate. The daily life and social activities arranged for people living at Beech House takes into account the differing expectations, preferences, lifestyle and abilities of each individual. Not all residents receive a healthy diet according to their assessed requirement and preference. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Visitors continue to be welcomed in a professional manner and obviously have a good relationship with the staff on duty. The home’s strong links with the nearby community continues. Residents’ records show the local clergy visits regularly to offer Holy Communion, and the mobile library also makes regular visits to the home. Our findings also confirmed what one resident told us, ‘Activities are a strength of the home.’ People were happy to tell us about the activities that they enjoyed and they were held in the home on a regular basis. Beech House DS0000064947.V374035.R01.S.doc Version 5.2 Page 18 The home still continue to use an activity diary which the staff use while planning their work to make sure people are supported at the right times to get the opportunity to join in the activities they have chosen to do. People were observed to have a good rapport with the home activities coordinator as she spent time with them on an individual basis. The activity photo album she was using was seen to be most useful to get people stimulated for a chat. Regular shopping trips and activities advertised on the notice board in the corridor with plans for two outings confirmed the home mini-bus, which is suitable for wheelchair use, continues to be well used. A range of ‘in house’ activities for those residents who prefer to stay at the home offered people the opportunity to join in shoe cleaning, crafts and games seven days a week. One person also told us the baking sessions continue to be very popular and successful. Specialist leisure equipment was seen in use in the lounge occupied by people with dementia related conditions. One person was especially receptive to the way the music and coloured lights were operating. During the afternoon of the inspection, a group of 12 individuals were seen to enjoy and appreciate exercise sessions held by the company physiotherapist and activities coordinator. Individuals were approached and asked if they would like to do their exercises but respected their decision not to take part. Discussion with the cook confirmed the meals are planned and presented in line with the company 4 weekly menus, and they get enough supplies to provide meals as expected by Springcare. The local Environmental Health Officer recently inspected the home in October 2008, and the two minor issues raised at that time have been put right. People confirmed the food the home provided continued to be excellent and that there was always a nice alternative if something on the menu was not to their liking. However, since our last inspection we have received concerns from health professionals visiting the home that people were not always getting the support they need to enjoy and benefit from their meals. Staff told us that 10 out of the 36 living at the home can feed themselves and the systems to stagger mealtimes to help the two thirds of people who needed some level of assistance had not improved matters. In order to explore these issues we observed the service of meals in two different parts of the home. It was established that the time people had breakfast did not affect the time their lunch was served. Meals started to be served to bedrooms on trays from midday, and we saw a man eating breakfast at 10:50 being given his lunch at 12:45. The staff told us there was the option of people being able to have their main meal at teatime, but the catering staff Beech House DS0000064947.V374035.R01.S.doc Version 5.2 Page 19 said it rarely happened. This means people are not getting offered meals with appropriate time intervals so they can digest and enjoy them effectively. Another concern people told us about was that residents are not being given the option of being transferred to the dining room for lunch. This results in people not having the opportunity to stretch their legs, or take advantage of mealtimes to socialise with other people who live in the home. Eight people were seen to use the pleasant restaurant style dining room facilities, but the majority of people were left seated in the lounges to dine off their side tables. We got the impression this could be to save time, as a lot of people in the large lounge need hoisting for transfers. Although people in the large lounge were given the choice of starters, main course and dessert in this area, this was not the case in the smaller lounge. In this part of the home, not all people were seen to get the appropriate help they needed. • Four out of five people observed to need help with their meals in the smaller lounge had one person assisting them. One person who took over half an hour to feed herself the main course of the meal was not offered any aids to keep the food warm during this time. It was also a concern that one person who is not able to talk or eat normally and is completely dependant on staff to meet her needs, was located in the lounge having to observe everyone else eating their meals. This person had excessive secretions whilst watching others eat their meals and copying actions of other residents being fed their food. Two out of four portions of hot puddings were left on a tray until the one staff member took it in turns to assist three people who needed help. • • • These issues of concern were raised with members of the home management team at the end of the inspection. Beech House DS0000064947.V374035.R01.S.doc Version 5.2 Page 20 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. The service has a complaints procedure, which is accessible so that people who use the service have information of how to make complaints about the home. Training is provided so that service users are protected from abuse and have their legal 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. The home’s 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 introduced. The administration manager told us have not been any complaints since our last inspection. On this occasion we were not able to confirm this as she was not able to locate the home complaints logbook, and the monthly management audit records lacked its usual details which accounts for any complaints the home may have received. Beech House DS0000064947.V374035.R01.S.doc Version 5.2 Page 21 The policies and procedures for safeguarding adults are freely available at the nurses’ station in Beech House for all staff to access, and the majority of the staff team have received training for this sensitive matter during the past year. Interviews with staff on the day of the inspection confirmed they had a good working knowledge of what to do if people had issues that made them unhappy. We the commission have not received any complaints about the service but are currently involved in exploring the concerns raised by local hospital personnel about Beech House through ‘safeguarding adult procedures’. Our inspection findings throughout this report show the wellbeing of residents cannot be fully safeguarded until all staff are fully trained and operating within Springcare policies. Further work is needed so that people receive a consistent, satisfactory service and the home meets National Minimum Care Standards for Older People that reflects people are safe, secure and feel confident that their welfare and safety needs are always promoted. Beech House DS0000064947.V374035.R01.S.doc Version 5.2 Page 22 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): 19,21, 23, 24 and 26. Quality in this outcome area is adequate. The physical design and layout of the home enables people who use the service to live in a comfortable environment, which encourages independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Everyone who made comments to us about the home were in agreement that the home always had a welcoming, clean and tidy appearance. On the first inspection day both inspectors carried out a tour of the home with the deputy manager. Communal areas both inside and outside the home in the home have been well maintained and in good condition to offer people a variety of locations to socialise and enjoy the surrounding countryside views. Although one of the lounge areas has been converted into an office, there are still plenty of places for people to congregate with their friends and families or just relax in peace and quiet. Beech House DS0000064947.V374035.R01.S.doc Version 5.2 Page 23 Bathrooms were in good working order and checks of hot water temperatures were satisfactory and matched the records of those made earlier by staff. The home is not short of specialist care equipment to meet people’s needs, but our earlier comments confirmed that additional attention to detail is required so the team take ownership to make sure it is clean and safe to use. One lady praised the efforts the home had made to have a suitable chair made especially for her. During the additional inspection visits we made to the home, over 20 bedrooms were seen. These were furnished and personalised according to the wishes of those people occupying them although not all of them were as clean and tidy as we have seen them on previous occasions. • The décor in some bedrooms was showing signs of wear and tear. • At least three bedrooms including a shared bedroom had unpleasant odours. • A discarded tablet was also found in one bedroom, and medicine to thicken drinks prescribed for one person was seen in use for someone else. The home has good hand washing facilities with a plentiful supply of protective equipment stored discreetly in all parts of the home where care is carried out to make sure infection control practices are maintained. Although conditions in the laundry are in need of improvement to keep it easy to clean and hygienic, especially with regard to its flooring and hand washing area, it is positive new equipment has been installed to ensure people’s clothing and bedding is kept clean and cared for. Beech House DS0000064947.V374035.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29, & 30 Quality in this outcome area is adequate. Sufficient numbers of staff are provided 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. Inconsistent arrangements for staff training do not fully ensure staff have up to date knowledge and skills. This could impact on their ability to meet the needs of the people they care for. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Copies of ‘past, present and future’ team rotas were examined and confirmed the home has been satisfactorily staffed in recent months, although there have been occasions where the home has been short of nurses and the home has had to resort to using agency staff. During these times, standards of care have been challenged. It is positive the home has had another successful recruitment drive and most vacancies for the care team including nursing staff positions have been filled. We also met the administration manager’s new assistant during our inspection. Beech House DS0000064947.V374035.R01.S.doc Version 5.2 Page 25 The recruitment records of the only new starter to the home did not contain all the information we need to confirm the home vetting and screening procedures are robust. No references were contained in the person’s file and the administration manager stated they were held at the company head office. It was agreed they would be faxed across for us to look at. However they were not provided. We also asked to look at the recruitment file of the newly appointed manager, but were also told that the records were not available for inspection in the home. There have been very few changes to care team personnel since the last inspection, which means almost 70 of the carers still have the minimum expected care qualification. Review of the ‘tracker systems’ set up by the management so they have an ‘at a glance’ picture of the training staff have had and what they need told us how staff training has continued to progress. • 13 of the 18 staff who were in need of moving and handling training updates at our last inspection have been carried out. We were also told this includes bedrail safety training. • All care staff have done fire prevention and fire evacuation training. This information also confirmed the majority of the care team are in need of chemical safety and health and safety training and over half of the care team were yet to have infection control and dementia training. There was no evidence staff had been trained in risk and safety assessment. Although the home has continued to struggle to maintain its care records, there has been no training provided for the team to deal with this matter. Our inspection findings confirm where there have been issues of concern about care practices adequate training has not been provided to support staff to improve their knowledge and skills. This does not assure people who use the service that their needs are being met by competent and knowledgeable staff. Beech House DS0000064947.V374035.R01.S.doc Version 5.2 Page 26 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 & 38. Quality in this outcome area is poor. Systems for the health, safety and welfare for residents, staff and visitors are not all kept up to date, to fully meet all people’s changing needs and safeguard their well being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since Springcare purchased this home almost 4 years ago they have not been successful in appointing a person with the appropriate skills and experience to be registered with us as the home manager. Although three people have been appointed for this position, it has not worked out, and as a result challenges to the safe and effective management of Beech House continue. Beech House DS0000064947.V374035.R01.S.doc Version 5.2 Page 27 Although the service has weekly input from its area managers and the home employs an administration manager, our inspection findings confirm that company policies and procedures which work very well in other ‘Springcare’ homes are not being followed and carried out by the Beech House staff team. As a result the safety and well being of people living at Beech House continues to be compromised, as there is a lack of sustained permanent improvement at the home. • It is the second time in sixteen months where we have had to issue immediate requirements about bedrail safety. On two occasions we asked the home to tell us in writing what their plans were to improve this situation. Poor communication between management has resulted in the home not keeping us informed about this matter. Systems to monitor complaints and accidents which have always been good at previous inspections were not were not accurate this time. At least three accidents were not accounted for in the home management records. There were delays in management locating information we requested especially with regard to maintenance records. This prolonged the inspection process and prevented us from carrying out some of the checks we had planned. We were unable to check gas safety records and electrical testing records. In addition, the home fire safety risk assessment, which we saw to be out of date at the last inspection, could not be located when we asked for it. Although the area managers are carrying out audits and reporting issues to be rectified, the home team have not adopted effective systems to show all remedial actions are being carried out, as they should be. It is evident from inspection outcomes recorded through out this report that the current quality assurance systems are not adequate. • • • • Checks carried out with the help of the administration manager confirmed people are supported to manage their own money and good records are kept, although the systems would benefit from auditing as part of the home quality monitoring procedures. The home currently looks after the monies of seven people who live there. One of these individuals told us that her monies are always available to her when she needs them. Since our last inspection it was identified at ‘safeguarding of adults’ investigation meetings that staff are not receiving the right day to day managerial supervision to ensure they are aware of the company policies they need to put into practice as part of their daily work routines. Only one out of seven sets of nursing staff records looked at confirmed there had been adequate regular professional support offered for this matter. Similarly the Beech House DS0000064947.V374035.R01.S.doc Version 5.2 Page 28 deputy manager is not receiving regular formal support by the home management to ensure the correct guidance is being offered to motivate monitor and direct the staff team during this difficult period. Beech House DS0000064947.V374035.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X 3 X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 1 2 1 Beech House DS0000064947.V374035.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 13(4) Requirement Beech House systems and procedures need to be further improved so that all equipment staff use whilst caring for people using the service is accounted for and monitored so that it is used safely, especially with regard to bedrails. This will ensure people working for and using the service can be confident care needs will be met safely. Two immediate requirement notices issued at the time of the home inspections with regard to bedrails on 03/02/09, and 11/02/09. Timescale for action 05/04/09 2 OP8 12 People living at Beech House 25/04/09 must receive the care they need by competent staff that deliver necessary care to a consistent standard. Care plans must be kept under regular review by the home management team to ensure they contain all relevant details that ensure staff have the right guidance and paperwork to account for people’s needs and how they are met. This will make DS0000064947.V374035.R01.S.doc Version 5.2 Page 31 Beech House 3 OP9 13(2) sure any alterations in people’s circumstances will be addressed and staff will be working to care plans that reflect the changes in the care that individuals need to keep them safe and well. Staff who administer medication must be trained and competent and their practice must follow current written policies and procedures to ensure that residents receive their medication safely and correctly. (Previous timescales of 19/04/08 and 20/6/08, 30/09/08 not met) Medicines must be administered at the correct time and dose, as prescribed by the clinician and records must accurately reflect practice. 05/04/09 4 OP9 13(2) The records of the administration 05/04/09 of medicines for the people who use the service must be robust and accurate to demonstrate that all medication is administered as prescribed. (Previous timescales of 19/04/08 and 20/06/08, 30/09/08 not met.) A quality assurance system must be implemented to assess staff competence in their handling of medications. Appropriate action must be taken when discrepancies are found, to ensure that all medicines are administered as prescribed and this can be demonstrated. Beech House needs to improve its systems to ensure the provision, timing and organisation of meals can demonstrate all dietary needs of DS0000064947.V374035.R01.S.doc 5 OP15 16(2)(i) 25/04/09 Beech House Version 5.2 Page 32 people living at the home are being met to keep them healthy and well. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations The Statement of Purpose and Service User Guide should contain information about the service as per Schedule 1 and its associated 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. Management systems need to ensure the care plan recordkeeping for people living in Beech House reflects that all care needs are fully reviewed in the event of any accident or incident occurring. It is recommended that daily routines in the home are reviewed to ensure people’s dignity and privacy are respected, especially during mealtimes and when being visited by health professionals, so people can be assured The service they want to receive will meet their needs in a respectful manner. It is advised the home develop the way it cares for people with dementia conditions to show they are being offered choices as part of their day to day lifestyle.so people can be assured the service they want to receive will meet their needs. It is advised systems to make sure the home and equipment used is kept clean and hygienic are reviewed and imroved. This will make people feel confident their welfare needs are safely promoted in a clean and pleasant environment. It is recommended the home continue to evaluate their staff-training plan against the needs of people living in the home. This will ensure staffs are trained and competent to DS0000064947.V374035.R01.S.doc Version 5.2 Page 33 2 OP7 2 OP10 3 OP14 4 OP26 5 OP30 Beech House ensure that residents receive their care and support safely and correctly. 6 OP36 The home is advised to make sure systems are in place so staff receive the professional support they need to advise them of their achievements and development needs. This will offer assurance to people using the service that their needs are being met by an adequately trained and skilled staff team. Records necessary for inspection should be readily available at all times especially with regard to staff recruitment and essential maintenance records so people can be assured we have checked the service to be good enough to meet their needs. It is recommended the home fire safety risk assessment is reviewed and updated to include the team responsibilities for the safe use of stair gates in an emergency situation. This will make people feel confident their welfare needs are safely promoted. 7 OP37 8 OP38 Beech House DS0000064947.V374035.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Beech House DS0000064947.V374035.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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