Inspection on 12/04/05 for Beech House (Binfield)

This inspection was carried out on 12th April 2005.

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 (Binfield) 22/10/08

Beech House (Binfield) 31/10/07

Beech House (Binfield) 24/04/07

Beech House (Binfield) 20/11/06

Beech House (Binfield) 02/05/06

Beech House (Binfield) 06/03/06

Beech House (Binfield) 27/09/05

Beech House (Binfield) 05/10/04

Beech House (Binfield) 06/04/04

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

CARE HOMES FOR OLDER PEOPLE BEECH HOUSE London Road Binfield Bracknell RG4 2AB Lead Inspector Debbie Willcox Unannounced 12 April 2005 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 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 Version 1.10 Page 3 SERVICE INFORMATION Name of service Beech House Address London Road, Binfield, Bracknell, Berks, RG4 2AB Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01344 451949 Charnley Care Ltd Mrs G M Kirk Care Home 25 Category(ies) of Old age, not falling within any other registration, with number category(OP) of places BEECH HOUSE Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 5th October 2004 Brief Description of the Service: Beech House offers accomodation and care to 28 older people. The home has 25 bedrooms 3 of which are double bedded rooms. The home is located close to the town centre of Bracknell and within close proximity to rail, bus routes and the M4 motorway. BEECH HOUSE Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection visit was unannounced and took place over a period of 6.5 hours starting at 9am on a weekday and was carried out by one inspector. A tour of the building was conducted and records relating to care planning, employment and health and safety monitoring were viewed during this inspection. The inspector had the opportunity to ascertain the views of 8 people in residence, staff and one relative. Feedback was given throughout this inspection to the manager, deputy manager and proprietor. What the service does well: What has improved since the last inspection? Improvements have been made to some parts of the environment such as the kitchen area, which has enhanced the environment for the people living within the home. BEECH HOUSE Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. BEECH HOUSE Version 1.10 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 Standards Statutory Requirements Identified During the Inspection BEECH HOUSE Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4, The admission procedure needs to be more robust to ensure a proper assessment for all people moving into the home. Without this there is no assurance that care needs will be met. EVIDENCE: The files of 3 service users were viewed at this inspection. All 3 service users had been admitted to the home within the last 12 months. 2 files contained evidence of a pre-admission assessment carried out by the home prior to admission. 1 assessment was carried out over the telephone. 1 service user did not have a written assessment of their needs prior to admission to the home. 2 of these service users were spoken to during the course of this inspection. 1 had visited the home prior to admission and the other had come directly from hospital. Both people said they felt the home met their needs well. BEECH HOUSE Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10,11 In the main the health care needs of residents are recorded and reviewed. There is a need however to ensure consistent written information is provided regarding the health care and dietary needs for people diagnosed with diabetes. Without this the home cannot ensure that needs are fully met. Wishes in event of death or terminal illness need to be recorded for all service users. EVIDENCE: Written care plans for 3 service users were assessed at this inspection. There was evidence of review of care planning monthly and risk assessments 6 monthly. There was a written record of health care appointments and recorded outcomes. Service users weights are regularly monitored. The home operates a keyworker system. Most of the care planning records are compiled and reviewed by the manager and deputy. The storage, recording and administration of the lunchtime medication were viewed. The home operates using the Boots MDS system. The providing pharmacy audits the homes medication systems on a regular basis. Eye drops and eye ointments were found to be out of date. BEECH HOUSE Version 1.10 Page 10 Practice observed on the day evidenced that service users privacy was respected. Discussions with service users evidenced that in the main staff are kind and respectful. However 3 service users did say that on occasions some staff can be abrupt in manner and are prone to rush people during meal times. None of the service user files seen had details of service users wishes in the event of death or terminal illness. BEECH HOUSE Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 There is provision of social activities within the home but none provided outside. Consideration will need to be given to providing contact with the local community with variation and stimulation for people living within the home. Service users within this home want to be more involved in the planning of menus and offered more choice. EVIDENCE: Service users told the inspector that regular activities are organised such as Bingo, visiting manicurist and entertainment such as a visiting pianist. One relative spoken to said that the home did not have restrictions on visiting times. Service users have breakfast served in their rooms. Other meals are taken in the lounge. Milky drinks and biscuits are served in the evening. Residents meetings are sporadic the last one recorded was August 2004. The midday mealtime was observed. None of the service users spoken to knew what was on the menu for the day. A menu board is on display in the dining room. On the menu for the midday meal was Smoked Haddock, mash potato, fresh vegetables, apple pie and custard. It was noted that menus detail only one choice daily. All service users spoken to said that they are not invited to be involved in the compiling of menus and would like to do so. One service user complained that BEECH HOUSE Version 1.10 Page 12 there were too many sausages on the menu. Another service user complained that there is too much yellow smoked fish provided which is salty and would like to see more white fish. A daily record of food consumed by individuals is not recorded. There are currently service users with a diagnosis of Diabetes. The manager told the inspector that no special diets are provided for these service users as she has been instructed by the GP that this is not necessary. There will be a need for GP’s instructions to be clearly detailed within service users care plans. The cook will shortly be leaving the home and a replacement has been found. The GP visits the home monthly. BEECH HOUSE Version 1.10 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 There has been limited response to requirements for all staff to be provided with training in how to recognise and respond to abuse of vulnerable adults. This has the potential to put people at risk. EVIDENCE: One anonymous complaint has been received by the CSCI since the last inspection. The manager and the local authority have conducted the investigation into this complaint. The homes complaints record book was viewed. 4 complaints have been recorded within the last 12 months. All complaints have been responded to with action taken recorded. There is an outstanding requirement for all staff to be trained in responding to abuse of vulnerable adults. The complaints procedure detailed within the homes statement of Purpose and Service User guide currently advises complainants access the CSCI to register complaints only after complaints to the manager not receiving a satisfactory outcome. The complaints procedure within the home needs to be revised to instruct complainants of their right to direct complaints directly to the CSCI independent of any contact with the home and at any stage during the homes complaints procedure. Service users were asked how confident they were in accessing the homes complaints procedure. Most spoken to do not know the home had a BEECH HOUSE Version 1.10 Page 14 complaints procedure. Some expressed confidence in approaching the proprietor with any problems they had. There was evidence of the Service User Guide placed within service users rooms. BEECH HOUSE Version 1.10 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25,26 There have been improvements to some areas of the building. However the outstanding matters listed below must be addressed to ensure ongoing provision of a safe, comfortable, homely environment for those living within this home. EVIDENCE: A tour of the building was conducted. There has been improvement to some parts of the home and requirements for improvements to the kitchen met. Some doors were found to be wedged open. One service users relative had been asked to pay for an appropriate door open device. The proprietor was advised that it is the responsibility of the owner to provide this equipment. There is an outstanding requirement from the previous inspection for staff to be trained in hot water temperature recording. Hot water temperatures are checked weekly and recorded. This record showed that several water outlets BEECH HOUSE Version 1.10 Page 16 accessed by service users are at a higher temperature than recommended by the HSE. Management within the home did not have correct information as to safe temperature levels. The inspector recommended that the home access the HSE publication ‘Health and Safety in Care Homes’ The majority of the home was found to be clean. However in two bedrooms and one corridor there was a strong smell of urine. One carpet was soiled. This was cleaned during the inspection. Bathroom flooring to the bathroom sited close to the laundry is in need of replacing. Not all bathrooms had provision of a blind or curtains to ensure privacy and dignity maintained. The downstairs shower room was cluttered and inaccessible as items such as walking frames, commodes and hoists were found stored within this area. Bathrooms are in need of refurbishment. Items such as toiletries and razors were found within communal bathrooms. The garden is of a good size and service users expressed their enjoyment of this area. Service users highlighted as unsafe a pathway sited to the side of the property, which was littered with rubbish forcing service users to walk on what they considered a slippery area. This was fed back to the proprietor during the inspection. Some service users also highlighted a leaking overflow to the back of the building as a concern to the inspector. BEECH HOUSE Version 1.10 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29,30, The procedures for the recruitment of staff need to be made more robust to ensure there are safeguards in place, which will provide protection to people living within the home. EVIDENCE: There has been some staff turnover since the last inspection. The inspector spoke with 2 staff recently employed in the home. New staff are given induction training and are counted as an extra person on the rota for the first week of employment. The home employs 4 care staff in the morning and 3 in the afternoon. The files of two staff recently employed in the home were viewed at this inspection. One staff file evidenced that no CRB or POVA check had been conducted prior to employment and the other file did evidence that a POVA check had been conducted before employment. 2 staff have completed NVQ level 3 and 3 staff are currently undertaking NVQ level 2. The proprietor informed the inspector that an external company is now providing all mandatory health and safety training for all staff. Evidence was not provided of this. BEECH HOUSE Version 1.10 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,37,38 Recording within the home is generally improving. There is a need to improve quality assurance systems by providing formats such as residents meetings to ascertain the views of the people living within the home. The management of the home is not focused on canvassing the views of the people purchasing this service and living within the home. EVIDENCE: The manager has completed the NVQ level 4 Registered managers award. The manager has a hands approach style of management. All but one Service user spoken to said they found the proprietor and manager approachable. Residents meetings have been sporadic and service users spoken to say that regular, planned meetings would be welcomed. BEECH HOUSE Version 1.10 Page 19 The records of staff meetings were also sporadic in regularity and evidence a considerable length of time since the last meeting. Records relating to care and health and safety were in the main well organised and maintained. Evidence of boiler servicing was viewed and up to date. Fridge and freezer temps are recorded daily. 2 days gap was viewed but on the whole well maintained. It was evident during this inspection that the CSCI has not been notified of every death that has occurred within the home as required by regulation 37. This was brought to the attention of the deputy manager and proprietor. BEECH HOUSE Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 2 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 2 2 x x x 3 2 BEECH HOUSE Version 1.10 Page 21 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 18 Regulation 18c(1) Requirement All staff to be trained in responding to abuse of vulnerables adults. Confirmation of booked dates to be sent to the CSCI. THIS REQUIREMENT OUTSTANDING SINCE 28/08/03 Staff to be trained in knowledge of safe water temperature setting as recommended by HSE. Outstanding requirement since 5/11/04 Temperature of water from outlets accessed by service users to be regulated to ensure safe temperature levels as recommneded by HSE. All staff to be CRB and POVA checked before starting work in the home. THIS REQUIREMENT OUTSTANDING SINCE 5/11/04 The registered person shall not provide accomodation to a service user unless their needs have been assessed and recorded prior to admission. The homes complaints procedure to be revised to instruct complaintants of their right to contact the CSCI independently of the homes complaints procedure and at any stage if Version 1.10 Timescale for action 12/05/05 2. 25 13(4) 12/05/05 3. 25 13(4) Immediate and ongoing Immediate and ongoing Immediate and ongoing 12/06/05 4. 29 19 5. 3 14 6. 16 22 BEECH HOUSE Page 22 7. 9 13 8. 10 12(4)(a), 18 9. 10. 11. 11 15 15 12,15 Schedule 4, 13 15 12. 19 23 13. 14. 15. 16. 17. 21 21 19 19 21 23 13,23 13,23 23 23 18. 19. 21 38 16 37 also complaining directly to the home. Eye drops and ointments to be discarded after 28 days of opening as directed by the pharmacist. The registered person to ensure that staff are insturcted in the rights of service users to be treated with respect at all times and not to be rushed at meal times and sufficient time given to eat. Service users wishes in event of death and terminal illness to be recorded. A daily record of food provided and consumed to be maintained for individual service users. Care plans to detail GP instructions relating to dietary requirements for service users diagnosed with Diabetes. The registered person to ensure removal of door werdges and appropriate safe door open devices provided. Bathroom flooring to be replaced in bathroom sited close to the laundry. Shower room to be cleared of clutter such as frames, commodes and hoist. Rubbish to be cleared from pathway to the rear of the building. Leaking overflow to the back of the building to be fixed. The registered person to provide a report detailing action to refurbish bathrooms throughout the home with timescales provided. All bathroom windows to have provision of curtains or blinds. The registered person to give to the CSCI without delay Version 1.10 Immediate and ongoing. Immediate and ongoing 12.05.05 12/05/05 12/05/05 Immediatel y. 12/06/05 12/05/05 12/05/05 12/05/05 12/06/05 12/06/05 Immediate and Page 23 BEECH HOUSE notification of death, illness and other events as required within reghulation 37. ongoing. 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 15 Good Practice Recommendations Service users views to be sought when compiling menus on a regular basis and evidenced. BEECH HOUSE Version 1.10 Page 24 Commission for Social Care Inspection 1015 Arlington Business Park Theale Berks RG7 4SA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI BEECH HOUSE Version 1.10 Page 25 - 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!