Inspection on 30/10/06 for Beech House

This inspection was carried out on 30th October 2006.

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

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

Other inspections for this house

Beech House 15/10/08

Beech House 06/12/07

Beech House 07/08/07

Beech House 30/01/06

Beech House 22/06/05

Beech House 27/09/04

Beech House 02/08/04

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

CARE HOMES FOR OLDER PEOPLE Beech House 29 Great Bowden Road Market Harborough Leicestershire LE16 7DE Lead Inspector Keith Charlton Unannounced Inspection 30th October 2006 09:35 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 DS0000001806.V317440.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 DS0000001806.V317440.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beech House Address 29 Great Bowden Road Market Harborough Leicestershire LE16 7DE 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) 01858 464289 beech_house@harborough.uk.com Mr Keith Burrows Mrs Lesley Burrows Mrs Lesley Burrows Care Home 13 Category(ies) of Dementia - over 65 years of age (5), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (5), Old age, not falling within any other category (13) Beech House DS0000001806.V317440.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service User Numbers. No-one falling within categories DE(E) and MD(E) may be admitted into the home when there are 5 persons of categories/combined categories DE(E) and MD(E) already accommodated within the home. Date of last inspection 30/1/06 Brief Description of the Service: Beech House is a residential home, which is registered to accommodate up to thirteen older people, including five within the category of mental disorder and dementia. Beech House is situated in a residential area, close to the Market Harborough town centre. The home is accessible by car or public transport. Parking is available to the front of the home. The home provides a large lounge to the front of the property and a dining room to the rear. There is a patio area to the rear of the home, which is accessible to residents using wheelchairs and walking aids. Bedrooms are located on the ground and first floor that is accessible by the stair lift or the passenger lift. Bath/shower and toilet facilities are located close to the bedrooms. The weekly fees range from £380 to £400 - this information was provided on the day of the inspection. There are additional costs for individual expenditure such as hairdressing, dentist, optician and private chiropody. Beech House DS0000001806.V317440.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of the inspections undertaken by the Commission for Social Care Inspection is upon outcomes for service user and their views of the service provided… The primary method of inspection used was ‘case tracking’ which involved selecting three service users and tracking the care they received through looking at their records, discussion, where possible, with them and care staff and observation of care practices. This was an unannounced Inspection, conducted with the Registered Manager. Planning for the Inspection included checking on the notifications of significant events sent to the Commission for Social Care Inspection and Requirements from the last Inspection Report. There have been no complaints made to the Commission for Social Care Inspection since the last inspection. The Inspection took place between 9.35 and 14.25 and included a selected tour of the home, inspection of records and indirect observation of care practices. The Inspector spoke with six residents (though this was limited for some owing to the difficulty with communicating with some residents with a high level of mental frailty) one staff member, and one visitor. There were 13 residents accommodated at the time of this inspection. What the service does well: The home is a small, personal and friendly residence. Service users reported that visitors are welcome and some said that they thought the food provided to them was good. Service users said staff and management were friendly and caring towards them. Staff were observed to be friendly towards service users. The visitor spoken with had high praise for the standard of care provided. The main meal indicated the provision of three vegetables plus potatoes, thereby offering healthy food choices. Beech House DS0000001806.V317440.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Beech House DS0000001806.V317440.R01.S.doc Version 5.2 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 DS0000001806.V317440.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission process is well managed and meets the needs of residents. EVIDENCE: Residents said that they could visit the home prior to their admission to give them a good idea of what services the home has. There was evidence of the assessment undertaken by the Registered Manager available on the residents files examined. The Registered Manager was asked to incorporate all issues contained in the National Minimum Standard for future assessments. A trial period of stay is offered to all prospective residents and to discuss how individual care needs can be met. Intermediate care is not offered. Beech House DS0000001806.V317440.R01.S.doc Version 5.2 Page 9 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 good. This judgement has been made using available evidence including a visit to this service. Care plans do not fully describe identified care needs; this has the potential for omissions in care occurring. Medication is suitably and safely managed this protects the safety and welfare of service users EVIDENCE: No residents asked knew they had a Care Plan – this needs to be followed up. Resident’s needs are detailed in their care plans and all residents case tracked had a plan of care in place. The registered manager stated that care plans are reviewed weekly in conjunction with the daily report and a six monthly evaluation of care was seen in two care plans tracked. Plans included records of the service users care needs. One had instructions from the physiotherapist as to how to carry out exercises for a resident to deal with an injured arm. Risk assessments also form part of Plans to reduce the risk of harm for identified risks. Beech House DS0000001806.V317440.R01.S.doc Version 5.2 Page 10 Some Care Plans did not clearly set out dental needs as regards routine dental checks, or whether the service user needed a chiropodist. No Care Plan seen by the inspector had a signature of a service user agreeing to its contents. The Registered Manager said this would be followed up. It is also recommended that residents personal histories are compiled so that they can be seen as individuals with a valued history. Residents said that if there was a medical problem then staff would call a GP to see them. Accident records were viewed and the GP was appropriately called if there had been potentially serious injuries, e.g. a head injury. Residents all said that staff and Manager were friendly. The inspector observed that staff were friendly and respectful and carried out tasks at residents pace. The medication system was inspected and was found to be well managed and appropriately administered. The Registered Manager confirmed that only senior staff issue medication and have undertaken medication training. This was recorded in the medication folder. Medication is securely kept in a locked trolley. Beech House DS0000001806.V317440.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have the opportunity to lead full lifestyle and can exercise choice. EVIDENCE: Residents said that there were some activities but this was kept to their preferred low level of activity. They said that they were glad that the TV was not on all day and didn’t mind that there was no radio in the lounge. As for outings they said they liked going to the garden centre but were not interested in having too many outings. The inspector recommended that memory boxes, containing valued items, be set up for residents, particularly for residents with dementia, so as to provide valuable reminiscence material. They said that there were no rules that they knew of, e.g. no one reported that there were set going to bed and rising times, and thought the atmosphere of the home was friendly and relaxed. The residents spoken with were glad staff gave them medication so they didn’t need to worry about keeping it themselves. Beech House DS0000001806.V317440.R01.S.doc Version 5.2 Page 12 Residents said that they maintained control of their personal finances. Inspection of residents accommodation demonstrated that they were able to bring in to the home their personal possessions. However personal choices were not identified in individual care plans. It is recommended that this is included during assessment of potential residents. Both service users and relatives stated that visitors are always welcomed to the home and no one reported any restrictions. The visitor spoken to was very impressed with the standard of care delivered by the Registered Providers. There were positive views regarding the food and a number of comments received: ‘There is good variety’. ‘We like proper roast meat and two vegetables meals’. ‘No one could complain about the standard of food. Its always tasty’. Menus were inspected and found to have choice though it is recommended that it clearly shows on records, and residents reminded, that the breakfast choice includes a cooked breakfast and teas offer a choice of cooked snack. The food was tasted and was found to have flavour with three vegetables served with mashed potato. This extensive vegetable choice was confirmed each day on the menu. This situation is commended. Beech House DS0000001806.V317440.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are confident in the system of managing complaints though all staff need to have a good level of understanding regarding the prevention of abuse. EVIDENCE: Residents said that they thought that if there was a problem then they were confident that the Manager would sort it out. The Complaints Procedure is satisfactory but does not give the complainant the opportunity to contact the Commission for Social Care Inspection at the initial stage, as per the National Minimum Standard. The Registered Manager said this would be altered to reflect this standard. Complaint records were inspected and no complaints were recorded in the file. There have been no complaints regarding the service since the Commission for Social Care Inspection was set up. This situation is commended. Policies and procedures for are in place for protecting Vulnerable Adults. A staff member spoken with was unaware of the full procedure regarding which agencies to contact if the in house arrangement failed. The Registered Manager said this person was new to their post and would receive training in this area and that a short procedure would be set up to remind staff of which agencies to contact. Beech House DS0000001806.V317440.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a clean and well-maintained environment. Some equipment is needed to ensure the protection of the Health and Safety of residents. EVIDENCE: Residents said that they liked the facilities of the home and they could organise their bedrooms in the way they wanted. It was observed that all areas were generally well decorated and furnished, clean and tidy and well maintained. The Registered Manager said that there were plans to redecorate where paintwork had been damaged and this would be carried out in 2007. Rooms had been personalised to accommodate personal possessions. Beech House DS0000001806.V317440.R01.S.doc Version 5.2 Page 15 It was recommended that the Registered Manager investigate a signing system for residents with dementia, e.g. colour coding wc/bathroom doors, having pictures on bedroom doors, having a board to indicate date, weather etc, so as to provide more clarity. It was noted by the inspector that the heating was not switched on, though at the temperature was not cold. One resident complained of being chilly. The registered manager indicated that the thermostat on the boiler regulates heating, which is set to 70c, and that heating is constantly on during cold weather conditions. The Registered Manager said radiator guards are currently being fitted in the old part of the building, to minimise any risk of burning to at risk residents, though this has been held up due to them not being of standard size and therefore they have had to be specially made up. This needs to be completed as soon as possible due to the impending cold weather conditions. Beech House DS0000001806.V317440.R01.S.doc Version 5.2 Page 16 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. This judgement has been made using available evidence including a visit to this service. Recruitment processes are not thorough and staffing levels need to be reviewed to ensure that resident’s needs are always met. Training needs to be improved to ensure staff have the skills to meet residents needs. EVIDENCE: No adverse comments were made by residents regarding staffing numbers though often, from the rota inspected by the inspector, there are only two care staff on duty, one of the two being the Registered Manager. The Registered Manager has stated that it is not a regular occurrence that she is the second carer as normally there are two Care Assistants and a trainee Care Assistant plus herself. As the home currently accommodates thirteen residents, a high proportion of those with dementia/ mental frailty, and the majority needing assistance with physical care, it would be expected that are always three care staff on duty. In addition there is only one domestic worker and no separately designated cook. Beech House DS0000001806.V317440.R01.S.doc Version 5.2 Page 17 The Registered Manager acknowledged this situation though said this situation would improve with a staff member becoming an additional care worker in December 2006. The registered manager stated that she never uses agency staff preferring to either fill gaps with permanent staff or working the shift herself. Two staff files were inspected and one file contained a Protection of Vulnerable Adults check that had been received by the Registered Manager after the staff member had commenced employment. This was also the case for written references. It was discussed with the Registered Manager that statutory checks need to be in place prior to employment commencing, as detailed in Schedule 2 of the Care Homes Regulations 2001. Staff files contained evidence of training though not all staff had received training on essential care practices – food hygiene, health and safety, fire, first aid, infection control, mental heath issues, training on residents health conditions – stroke, parkinsons disease etc. The Registered Manager said that a number of staff had received training in the past year and she would ensure that all staff were suitably trained. She was recommended to compile a Training Matrix so that this would indicate at a glance what training needed to be organised for individual staff members. The Registered Manager stated that staff are encouraged to undertake National Vocational Qualification level 2 training and upgrade this to National Vocational Qualification level 3. Discussion with the Registered Manager indicated that the staff handbook is used as an induction handbook for new staff. As detailed on the previous inspection this is not considered to be adequate to provide sufficient information required by new staff in relation to care practises. The Registered Manager said she would obtain details of the induction programme to meet the National Training Organisation (Skills for Care) Standards. Beech House DS0000001806.V317440.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems are not fully in place to protect the health and safety of service users. EVIDENCE: Residents said that they thought the Registered Manager was approachable and thoughtful as to the running of the home. There was no evidence that staff are appropriately supervised. The Registered Manager said she was at the point of setting up formal supervisions by delegating some of this area of work to the Deputy Manager. Beech House DS0000001806.V317440.R01.S.doc Version 5.2 Page 19 A Quality Assurance system was not in place for 2006 – the inspector looked at the last residents survey for 2004. This needs to be carried out on a yearly basis and the results included in the Statement of Purpose. The Registered Manager stated that residents and their families deal with their monies, hence there are no monies records. There is a Health and Safety folder with Risk Assessments for safe working practices, though there were no records of hoist maintenance or wheelchair servicing. The Registered Manager said this would be followed up. A staff member was asked the fire procedure but was not fully aware of the whole procedure. All system testing was on required schedules for emergency lighting and fire drills. The home has a fire alarm test each week – a test was performed during the inspection and residents indicated that they knew when it was performed. The hot water temperature was checked in a bathroom and found to be 46.5c, when the National Minimum Standard is 43c. The Registered Manager was asked to reduce this to a safe level, which she said would be carried out. This was subsequently confirmed in writing to the Commission for Social Care Inspection. The Registered Manager said that radiator covers were on order as she recognised that, particularly with a high proportion of residents with mental frailty, in areas where radiators are not suitably guarded this has the potential to endanger persons who are at risk. The Registered Manager said that fitting them has been delayed due to there having to be specially made up as radiators are not of standard size. This needs to be attended to as soon as possible bearing in mind that the cold weather season has now arrived and radiators will be constantly on. The Registered Manager said that a more detailed risk assessment will be undertaken rather the general ones in place at present. Based on this radiator covers will be fitted in priority order. Beech House DS0000001806.V317440.R01.S.doc Version 5.2 Page 20 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 3 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 1 3 STAFFING Standard No Score 27 1 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 2 X 1 Beech House DS0000001806.V317440.R01.S.doc Version 5.2 Page 21 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 OP25 Regulation 13 Timescale for action Radiator guards must be fitted to 30/11/06 radiators in the old part of the home to minimise the risk of burns to residents (This was stated in the last Inspection Report and the timescale for action is overdue). Staffing levels need to be reviewed to ensure that residents needs are met at all times Recruitment/ records must be strengthened to ensure that all documentation as detailed in Schedule 2 of the Regulations is in place before staff are employed (This was stated in the last Inspection Report and the timescale for action is overdue). 30/11/06 Requirement 2. OP27 18 3. OP29 19 30/10/06 4. OP38 13 The Registered Provider must 30/10/06 ensure that Health and Safety systems protect residents, and that there is regular servicing of essential equipment for residents needs. Beech House DS0000001806.V317440.R01.S.doc Version 5.2 Page 22 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. 2. Refer to Standard OP7 OP30 Good Practice Recommendations Care plans need to fully detail all care needs. The Registered Providers should review staff training by way of a Training Matrix to ensure that all staff receive suitable training and that new staff are trained to the level of the National Training Organisation, Skills for Care, standards. The Registered Providers should provide regular formal supervision to staff. The Registered Providers need to carry out a yearly Quality Assurance audit and include this in the Statement of Purpose. 3. 4. OP36 OP33 Beech House DS0000001806.V317440.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Leicester Office The Pavilions, 5 Smith Way Grove Park Enderby Leicester LE19 1SX 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 DS0000001806.V317440.R01.S.doc Version 5.2 Page 24 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!