Inspection on 07/06/07 for Beech House

This inspection was carried out on 7th June 2007.

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

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

Other inspections for this house

Beech House 14/08/09

Beech House 03/02/09

Beech House 18/08/08

Beech House 20/02/08

Beech House 20/09/07

Beech House 25/09/06

Beech House 10/01/06

Beech House 05/07/05

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Beech House Wollerton Market Drayton Shropshire TF9 3DB Lead Inspector Janet Adams Key Unannounced Inspection 09:30 7th June 2007 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.V333965.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Beech House DS0000064947.V333965.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beech House Address Wollerton Market Drayton Shropshire TF9 3DB Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01630 685813 01630 685014 Ash Paddock Homes Limited vacant post Care Home 54 Category(ies) of Dementia - over 65 years of age (8), Old age, registration, with number not falling within any other category (46) of places Beech House DS0000064947.V333965.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of Service User`s must not exceed 54 Older People who require Nursing Care. This number may include a maximum of 8 Service User`s who suffer from Dementia. Staffing levels in the home must meet the minimum levels required throughout the 24 hr day, including weekends, for service users who have low to medium dependency nursing needs. Additional staff must be on duty when high dependency service users are accommodated. These minimum levels are for direct nursing and personal care only. They do not include ancillary staff. 08:00-14:00 22:00-08:00 Nursing Beds 1 RN 34-40 3 Care Asst 41-45 2 RN`s 3 Care Asst 46-50 2 RN`s 3 Care Asst 51-56 2 RN`s 4 Care Asst 3 RN`s 9 Care Asst 3 RN`s 8 Care Asst 3 RN`s 8 Care Asst 3 RN`s 7 Care Asst 3 RN`s 6 Care Asst 2 RN`s 7 Care Asst 2 RN`s 5 Care Asst 2 RN`s 7 Care Asst 2 RN`s 4 Care Asst 2 RN`s 6 Care Asst 2 RN`s 5 Care Asst 2 RN`s 6 Care Asst 14:00-17:00 17:00-22:00 Beech House DS0000064947.V333965.R02.S.doc Version 5.2 Page 5 Date of last inspection 18th December 2006 Brief Description of the Service: Beech House is registered to provide nursing and personal care for a total of 54 older people, of whom eight may have dementia related illness. At the time of the inspection an application had been made to CSCI (The Commission for Social Care Inspection) to increase the number of beds for this category to 10. The home is owned by Springcare Ltd, (Ash Paddock Homes) the Managing Director being Mr Lee Cox. The home is located in a rural setting within a large extended country house in the village of Wollerton near Market Drayton. It is set in its own grounds, which are well maintained, and all bedrooms have lovely views of the surrounding countryside. Due to its location, there is limited public transport to and from this home. Accommodation is offered in either single or double bedrooms, some of which have en suite facilities. Some bedrooms are provided on the ground floor, and the remainder are accessed by a passenger lift onto the first floor. Springcare Ltd makes the services of Beech House known to prospective residents in their statement of purpose, and its brochure/service user guide. A copy of the most recent CSCI (The Commission for Social Care Inspection) Inspection report was also seen to be freely available at the entrance of the home for people to look at. The current fees charged vary between £445 and £640 per week depending on the care, support and accommodation provided. Additional charges to service users are for hairdressing, toiletries, and newspapers. Beech House DS0000064947.V333965.R02.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out the key announced inspection lasting a total of six and a half hours Since the last key inspection in September 2006, the home has also been inspected by CSCI on two other occasions, on 26th October 2006 by The CSCI specialist pharmacy inspector, and on 18th December 2006.Copies of these reports are also available upon request, from CSCI. A range of evidence was used to make judgements about this service. This includes: information from the provider, staff records kept in the home, medication records, discussion with people who use the service, discussions with the staff team, discussion with the manager, tour of the premises, observing activity within the home observing, talking and listening to more than half of the people living there, previous inspection reports, quality assurance information, Fire Authority reports, and Environmental Health Office reports. A total of one resident and eight relatives returned written comments about the home back to CSCI. Everyone, including residents and staff were very welcoming and helpful throughout. A total of 28 out of a possible 38 National Minimum Standards for Older People were assessed on this occasion. A CSCI specialist pharmacist inspector will also be re -assessing the way medications are managed in the home in the near future as a part of this key inspection process. What the service does well: People commented that staff are kind and caring and look after them well. There were no adverse comments about the care and attention delivered by all levels of staff. One relative wrote, ‘the care residents receive is second to none, and the home is a credit to the cleaners and kitchen staff. The home is always spotlessly clean and there is always a happy atmosphere.’ Robust management systems makes sure all necessary information is collated and available to see ‘at a glance’ how important issues such as accidents and complaints are dealt with. The ongoing monitoring and support provided by the company area managers have enabled the new management of the home make steady progress to Beech House DS0000064947.V333965.R02.S.doc Version 5.2 Page 7 improve many aspects of the way day to day care and administration has been carried out. What has improved since the last inspection? What they could do better: Although the home has a statement of purpose and service user guide they are not up to date with information about funding/payment arrangements and fee rates. Prospective service users need full information before making a choice to live at a home. This was highlighted when a requirement was made for this matter at the Unannounced Inspection in December 2006. Beech House DS0000064947.V333965.R02.S.doc Version 5.2 Page 8 The service needs to improve its care plan and assessment record keeping taking into account good practice guidance such as that of the Nursing and Midwifery Council, especially with regard to ongoing assessments and care of people with dementia related illness. A suitably qualified and experienced nurse needs to be recruited to offer support and guidance to staff caring for the people who live at the home who have dementia related conditions Staff recruitment and vetting procedures must be robust to make sure residents are in safe hands at all times. 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.V333965.R02.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beech House DS0000064947.V333965.R02.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3, &4 (6 not applicable to this home.) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives are provided with most of the information needed for them to choose a home, which will meet their needs. Individuals have their needs fully assessed before they move into Beech House to make sure that the facilities, staffing and specialist services available meet the ethnicity and diversity needs of the person. EVIDENCE: Springcare, the Registered Providers for the service have introduced a new corporate styled information pack for prospective residents, which contains the home Statement of Purpose and Service User Guide. It is presented in an eye catching, easy to read and understand folder. However, examination of the one on display at the entrance to the home, as well as the sample given to the Beech House DS0000064947.V333965.R02.S.doc Version 5.2 Page 11 inspector by the manager shows that it lacked all of the necessary information it needs to contain. This omission of information was similar to those reported when the home was inspected in December last year. The information pack lacks details of when the contents were put together, and more importantly it does not fully comply with the change in The Care Homes Regulations of September 2006, with regard to the detail concerning fees and funding arrangements. Evidence seen in paperwork for three residents admitted since the last inspection shows there have been some major improvements in the way the home manages this process. A wealth of information gets gathered by the home team from a variety of sources, including the local authority social work team, health professionals including hospital staff, and community nursing teams where necessary, to make sure the home can fully meet any prospective residents’ needs. The details written down also confirm that the assessments are conducted professionally and sensitively and have involved the resident, as well as family members or representatives of the person, as deemed necessary. During the home tour, the bedrooms of three new residents contained pretty fresh flower arrangements the company now send newcomers as part of their welcome procedure – all residents and relatives were most appreciative of this thoughtful gesture. The most recent admission to the home was a person with dementia related illness and the assessment carried out by the community mental health nurse described an excellent ‘pen picture’ of the person’s needs as a result of a thorough review of the care and support the person would require. The home now follows the ‘Springcare’ company admission policies and procedures. These have also been recently updated. There is now a specially designed form which staff sign to say when any prospective resident is issued with the Statement of Purpose and Service user Guide. The staff also use this form to write down the fees that have been quoted to the person. Discussion and written comments from recently admitted residents confirms that the home were ‘Very Helpful and kind’ when asked about what information they had received before moving into the home. They all commented they were shown round by the manager and had a full explanation about life at Beech House. One person commented that following a tour of the home, ‘Beech House just seemed the perfect place for my wife.’ Beech House DS0000064947.V333965.R02.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8, & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all service users’ social care needs and risk assessments are set out in their individual plans of care. This does not ensure that all care needs have been addressed and will be fully met. The principles of respect, dignity and privacy are put into practice. EVIDENCE: All written comments received about the care the staff team carries out for its residents were very complimentary. All nine people agreed residents always received the care and support they needed. One resident commented, ‘Nothing is too much trouble. If you need anything a member of staff is always at hand.’ A relative commented, ‘I cannot fault Beech House. The standard of care is excellent; all the staff are caring and helpful. You are treated like family.’ Beech House DS0000064947.V333965.R02.S.doc Version 5.2 Page 13 It is obvious the staff team have been working especially hard to improve the recordkeeping in residents care plans since the last key inspection in September. An in depth look at three sets of records as well as ‘spot checking’ of four sets of records for individuals with dementia showed great improvement in content and attention to detail. The care records confirmed that the majority of health needs are monitored and appropriate action and intervention taken, although more attention should be given to the changing needs of the people after they are admitted. This is more apparent in the in the care records for people with dementia related illness. Although some care plans identified areas of need with regards to their dementia related conditions, all care records lacked ongoing assessment of their mental health needs to show the home was doing all they can to keep these people safe and make sure all their behavioural needs are being met. The daily records of one person showed the person was displaying increased aggression, and although there was a care plan about this matter, it was evident it lacked the necessary detail to offer guidance to staff how to manage this challenge effectively. On the day of the inspection, the clinical nurse manager obtained a copy of the specific assessment tool that the company are introducing for this purpose in order to remedy this issue, and plans to utilise the expertise of a Registered Mental Nurse who is seconded to Beech House from another ‘Springcare’ home to assist her in this matter. It is obvious there have been a lot of changes to the way the home now manages it medications. As a result, the treatment room has been totally revamped to make more room so that medication can be stored properly. Discussion with the manager as well as one of the nursing staff confirms this area of the service much improved, and four nurses are currently attending a medication training course at a local college to further improve their knowledge and skills for this topic. Shortly after the last key inspection, the home had a full review of its medication systems by a CSCI specialist pharmacy inspector. He will be returning to Beech House in the near future to fully assess the progress they have made to comply with regulations for this matter. Beech House DS0000064947.V333965.R02.S.doc Version 5.2 Page 14 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 excellent. This judgement has been made using available evidence including a visit to this service. People who use services are able to make choices about their life style, and supported to develop their life skills. Social, educational, cultural and recreational activities meet individual’s expectations EVIDENCE: The home now employs two staff members as activity organisers. This means this part of the service has been further improved, as there is someone on duty at weekends as well as during the week to coordinate meaningful activities for the residents. An activity planner seen on a notice board as you enter the home lets people know what is happening on a day-to-day basis. One person spoken to confirmed how thrilled a person with dementia related illness had been when a baby lamb had recently been brought to the home especially for him to hold. Records in residents care plans show that individuals get allocated time to pursue their hobbies and interests – one gentleman’s interest in fishing has Beech House DS0000064947.V333965.R02.S.doc Version 5.2 Page 15 resulted in library books being obtained for this topic, and one to one time spent with him to read them. The home has recently just obtained a mini bus to get the residents further a field. This has already been used to residents’ advantage, one lady commented she had particularly enjoyed going for afternoon tea at a garden centre. Discussion with three visitors confirmed they are made very welcome, and the visitors book showed there had been plenty of people coming to the home during the week the inspection was held. It was confirmed by the manager that specific training to ensure more appropriate activities for people with dementia related illness was still in the process of being explored. Observations and discussions with staff on duty confirmed they were knowledgeable about people’s dietary needs, and the best way to serve their residents’ food so they can dine independently. The way the dining tables are organised makes sure people who need assistance or may be embarrassed about feeding themselves get the privacy and support they need to enjoy their meals.Lunch was also seen to be served on beautifully presented trays for the few people who preferred to have their meals in their bedrooms. The home currently accommodates a lot of residents who have swallowing or chewing difficulty, and their meals were all seen to be presented in an appetising manner. All residents who made comments about the meal provision were in agreement that the food was very good, and they always had plenty of choice if they did not fancy the main meal of the day. Discussion with the cook confirmed she gets regular verbal and written comments about the quality of the meals, and she always incorporates any suggestions when the seasonal menus are prepared. Beech House DS0000064947.V333965.R02.S.doc Version 5.2 Page 16 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. Beech House 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 people are protected from abuse and have their legal rights protected. EVIDENCE: The home complaints procedure seen 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. All written comments received from residents and relatives were unanimous that they knew what to do if they had to make a complaint. One person commented, ‘I know what to do but if I forget, it’s on the notice board beside where I sign in to visit.’ It is of note that the newly launched newsletter for Springcare, the company who owns the home, have included a reminder from the company area manager to prompt its readers if the service provided at the home does not meet expectations, to discuss the matter at the earliest opportunity with the Beech House DS0000064947.V333965.R02.S.doc Version 5.2 Page 17 manager. This shows the company actively welcomes comments in order to improve the service they provide. CSCI have not received any complaints about this home since the last inspection. A new complaints recording system has been managed effectively by the new management team at the home. The home now has the recordkeeping to show that residents’ and any of their representative’s views are acted upon and managed appropriately. All four complaints seen logged in this record described issues CSCI have been made aware of. The policies and procedures for safeguarding adults are freely available at the nurses’ station, for all staff to access. There is clear specific guidance for anyone who needs to use this information. Since the last inspection the home have been involved in an adult protection investigation, and the professionalism demonstrated by Springcare Ltd Showed the home management has a good understanding of the procedures for safeguarding adults. The outcome of the latest investigation resulted in the local County Council Adult Protection Chairperson commenting that the home’s management had ‘done a good job’ in immediately dealing with such an incident. Beech House DS0000064947.V333965.R02.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,24, 25, & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home has improved to enable service users to live in a safer, better-maintained and comfortable environment, which encourages independence. EVIDENCE: The home is well lit, clean and tidy and smells fresh. One relative commented,’ The lovely clean surroundings make Beech House a pleasure to visit.’ An extensive guided tour of the home confirmed that the home offers a good standard of personal and communal living facilities. Many of the plans Beech House DS0000064947.V333965.R02.S.doc Version 5.2 Page 19 discussed at the last inspection to improve the communal areas in the home have already been carried out, and the home now offers a variety of areas for its residents to congregate for activities and meetings or just to relax in peace. Residents and relatives met during the inspection commented that the new sofas were comfortable and made the place look more homely. Since the last inspection the home has been the subject of a lot of redecoration and refurbishment. The new décor in communal areas and residents bedrooms are in the process of being complimented by new carpets curtains and bedding. On the day of the inspection the home had just taken delivery of these items. It is positive that the upgrade of the home has also included the remedial works the Fire Service advised at their last inspection in December 2006. The upgrade of the bathroom facilities in the home also means that residents have a new ‘wheel in’ shower facility, as an option to having a bath. It positive records show that water temperatures are tested at every resident’s bath time. Over half of the bedrooms were looked at during the tour of the home. All were appropriately personalised, furnished and equipped to meet resident’s needs. A larger bedroom is now specifically allocated for residents to use for short-term respite care. The manager reported this to be a positive change, as it meant it was big enough to cope with any care equipment a temporary resident may need. The management has a good infection control policy; and recent changes at the home shows Beech House management are making good progress with the recommendations made by a recent Health Protection Agency infection control audit. It is of note that the clinical manager has already obtained a newly published Department of Health information pack entitled ‘Essential Steps to Safe Clean Care’ which she will be using as a tool to measure and monitor the home’s infection control systems. Beech House DS0000064947.V333965.R02.S.doc Version 5.2 Page 20 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. Staff in the home are being trained and are in sufficient numbers to fill the aims of the home and meet the changing needs of residents. The lack of thorough recruitment steps does not ensure the service secures suitability of candidates before working in the home and service users may not be in safe hands. EVIDENCE: Inspection findings confirmed Beech House has had several challenges to deal with in order to achieve appropriate staffing levels to meet the needs of the 42 people currently living at the home. Beech House management are still in the process of recruiting appropriate permanent staff. At the end of last year four permanent team members had their work permits withdrawn by the Home Office, and this has not helped matters. At the time of the inspection the clinical nurse manager reported that the home currently has vacancies for part time carer positions on day and night duty. In addition, home has not had any success in recruiting an RMN Beech House DS0000064947.V333965.R02.S.doc Version 5.2 Page 21 (Registered Mental Nurse) to be employed at the home on a permanent basis. In the meantime it is positive they have seconded an RMN from another home owned by the same company to work one 12 hour shift a week at Beech House to offer guidance and supervision to staff caring for the needs of its residents with dementia related medical conditions. Springcare have its own bank of agency staff, and currently they are being used to cover any vacant shifts in the duty rota. The files of three new recruits were seen and showed that the recruitment and vetting practices carried out before they started work at the home were not as robust as the staff files checked at the last inspection. Two of the three sets of records did not have appropriate reference validation, and the agency Springcare commissioned to recruit overseas staff has not provided the home with adequate evidence to show employees have been vetted appropriately. It is positive to note The files of four staff were audited as part of the inspection process. Two files were of the newest recruits to the agency. All files were well organised and contained all required information that staff training has improved. A total of 22 of the 30 carers are now a minimum NVQ level 2 qualified. Excellent tracker systems have been set up by the management so they have an ‘at a glance’ picture of the training staff have had and what they need. The company currently employ two ‘in- house’ trainers for its homes, and priority has been given to focus on the training needs of the Beech House team. This has resulted in a wealth of mandatory training being carried out, covering topics such as moving and handling people and safeguarding adults. Specialist training has only just started, and so far eight out of a total of 38 care team members have received training in dementia related illness, which clearly accounts for the shortfalls in the care records detailed earlier in this report. It is of note that more training for this matter is planned for July. As the company have currently submitted an application to CSCI to increase the number of places for people with dementia related illness, this training must be considered to be a priority. Beech House DS0000064947.V333965.R02.S.doc Version 5.2 Page 22 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect, has effective quality assurance systems developed by qualified, competent managers EVIDENCE: Since the last inspection day-to-day management systems in the home have been reorganised to ensure the staff team receive the monitoring and supervision they need in order for standards within the home to continue to improve. Pat Amos, the administration manager for the home has recently submitted an application into CSCI to be the Registered Manager for the service. The person originally transferred to Beech house to take up this position has now been Beech House DS0000064947.V333965.R02.S.doc Version 5.2 Page 23 appointed the role of clinical nurse manager. This means she is more actively involved with the nursing and care personnel to ensure they get the ‘hands on’ support they need. Comments from several staff and residents confirmed this to have been a favourable management strategy. One staff member commented that the up to date knowledge and skills of this person made her a good role model and care in the home had improved as a result of this person leading by example. With the support of both company area managers, the management systems at Beech House have gone from strength to strength. Excellent detailed recordkeeping in quality audit files confirms there is close monitoring of important issues such as pressure sores and complaints. The audits carried out by the area managers as part of their monthly unannounced visits show that care plans and medication systems are especially being looked at closely. However, this auditing system needs to be further developed to make sure all actions recommended by the area managers in their reports are actually carried out within a reasonable timescale. This issue was discussed with the clinical nurse manager during the inspection. The home management are keen to let ‘everyone have their say’ how the service can be improved. A suggestion box has been installed at the entrance to the home and it is checked weekly for any comments. Staff meetings are now held regularly and are well attended. The minutes of the meeting for May 2007 confirmed 36 out of 38 staff were present. As recorded earlier, the company have also introduced a newsletter to keep everyone up to date and welcome comments about the service. The safe working systems in the home has continued to ensure good management of monies and valuables kept in safekeeping for residents The majority of the necessary service and maintenance records requested were seen to be up to date and complied with necessary health and safety legislation although the Legionella risk assessment needs further details to clarify how the pipe work in the Jacuzzi bath is monitored to keep it safe. Checks carried out confirmed all other equipment seen in use has been regularly serviced and is in good working order. On the day of the inspection an engineer was seen carrying out maintenance to the fire alarm system. Robust accident monitoring systems show that appropriate auditing and follow up of all accidents and incidents is carried out to raise staff awareness and appropriate care plan review to keep people as safe as possible. The records of one person who was prone to falls were looked at in depth, and confirmed this system works very well. CSCI were not made aware of the Home Office withdrawing work permits for four of the home’s employees at the end of 2006.This is a concern as this Beech House DS0000064947.V333965.R02.S.doc Version 5.2 Page 24 incident had the potential to affect the well being of the people living and working in the home. Beech House DS0000064947.V333965.R02.S.doc Version 5.2 Page 25 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 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 3 3 3 3 X X 3 3 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 X X 3 Beech House DS0000064947.V333965.R02.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 5(1)(bb) Requirement Timescale for action 18/07/07 2 OP7 14 (2), 15(1)(2) The service user guide must include details of the fees payable and by whom. (Previous Timescales of 19/03/07 not met.) The registered person must 18/08/07 ensure an appropriately qualified and experienced individual is involved with the ongoing assessment and care planning of the people living at the home with dementia related conditions. 3. OP9 13(2) 4. OP9 13(2) For all handwritten entries the 31/07/07 name, strength and form of the medication and the directions must mirror what appears on the dispensing labels. The double check procedure must include checking whether the MAR charts exhibit the same information as the dispensing labels. (Not assessed on this occasion for review by CSCI pharmacy inspector by July 2007.) The MAR charts must exhibit all 31/07/07 DS0000064947.V333965.R02.S.doc Version 5.2 Page 27 Beech House medication that the resident has been prescribed along with accurate administration directions. The home must pay particular attention to the transcribing of the information for the administration of the Warfarin tablets. (Not assessed on this occasion for review by CSCI pharmacy inspector by July 2007.) 5. OP9 13(2) All medicines administered/not administered must be recorded immediately after each transaction with either a signature or a defined abbreviation so that gaps in the administration record do not occur. (Not assessed on this occasion for review by CSCI pharmacy inspector by July 2007.) For all variable doses the home must seek information from the residents’ GP as to when it is appropriate to give the higher dose. The home must also start recording which particular dose was administered to the resident on the MAR charts. (Not assessed on this occasion for review by CSCI pharmacy inspector by July 2007.) The home must regularly audit the medication and MAR charts to ensure that the residents are being administered their medication as prescribed. (Not assessed on this occasion for review by CSCI pharmacy inspector by July 2007.) A written criterion for the administration of prescribed as required medication in respect DS0000064947.V333965.R02.S.doc 31/07/07 6. OP9 13(2) 31/07/07 7. OP9 13(2) 31/07/07 8. OP9 13(2) 31/07/07 Beech House Version 5.2 Page 28 9. OP9 13(2) 10. OP9 13(2) 11. OP9 13(2) 12. OP9 13(2) 13. OP9 13(2) of individual residents must be available and based on documented medical advice. (Not assessed on this occasion for review by CSCI pharmacy inspector by July 2007.) The prescriber’s directions must be adhered to without fail. If it appears that the directions are not appropriate for the circumstances of the resident then the GP must be consulted. (Not assessed on this occasion for review by CSCI pharmacy inspector by July 2007.) Nursing staff must carry out the administration of all medication to the residents. (Not assessed on this occasion for review by CSCI pharmacy inspector by July 2007.) Medication must be administered only to the resident it was prescribed for. (Not assessed on this occasion for review by CSCI pharmacy inspector by July 2007.) All as directed doses must be confirmed in writing by the prescriber and the MAR sheets must be amended accordingly. (Not assessed on this occasion for review by CSCI pharmacy inspector by July 2007.) The home must ensure that the administration of the rectal diazepam is carried out in accordance with the prescriber’s detailed directions. (Not assessed on this occasion for review by CSCI pharmacy inspector by July 2007.) DS0000064947.V333965.R02.S.doc 31/07/07 31/07/07 31/07/07 31/07/07 31/07/07 Beech House Version 5.2 Page 29 14. OP9 13(2) The home must develop a 31/07/07 programme to assess and monitor the staffs’ competency in administering medication to the residents. (Not assessed on this occasion for review by CSCI pharmacy inspector by July 2007.) The disposal of all medication must be completed in accordance with the home’s procedures. An accurate record of all disposals must be kept so that the audit trail can be completed. (Not assessed on this occasion for review by CSCI pharmacy inspector by July 2007.) Products that have a short shelf life when opened must be dated upon opening and discarded after the specified time period. (Not assessed on this occasion for review by CSCI pharmacy inspector by July 2007.) The manufacturers storage requirements for all medication must be adhered to. (Not assessed on this occasion for review by CSCI pharmacy inspector by July 2007.) All medication must be securely stored so that unauthorised personnel do not have access to it. (Not assessed on this occasion for review by CSCI pharmacy inspector by July 2007.) The Registered provider must employ a permanent member of nursing staff with appropriate qualifications and experience to DS0000064947.V333965.R02.S.doc 15. OP9 13(2) 31/07/07 16. OP9 13(2) 31/07/07 17. OP9 13(2) 31/07/07 18. OP9 13(2) 31/07/07 19 OP27 18 (1)(a) 20/08/07 Beech House Version 5.2 Page 30 20 OP29 19(1) 21 OP30 18(1)(a) (C), (2) offer staff and service user guidance to meet the specific needs associated with the dementia related illnesses of the people living at Beech House. The manager must not confirm new employees in post before all recruitment checks have been completed. This ensures that service users are supported and protected by the home’s recruitment policy and practice. Staff must receive all necessary specialist training to meet the needs of the people it is registered to care for, including: - dementia, and peoples’ ongoing needs assessment to make sure residents are safeguarded and get the care they need at all times.(Previous timescales of 31/12/06 not met.) 20/07/07 20/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations The nursing care plans of residents with dementia related illness must show evidence of guidance in managing such needs by an appropriately trained and experienced nurse. Beech House DS0000064947.V333965.R02.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Beech House DS0000064947.V333965.R02.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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