Inspection on 02/05/06 for Beech House (Binfield)

This inspection was carried out on 2nd May 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 (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) 06/03/06

Beech House (Binfield) 27/09/05

Beech House (Binfield) 12/04/05

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 (Binfield) London Road Binfield Bracknell Berkshire RG42 4AB Lead Inspector Kerry Kingston 2 nd Unannounced Inspection May and 8th May 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Beech House (Binfield) DS0000011071.V289778.R01.S.doc Version 5.1 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 (Binfield) DS0000011071.V289778.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Beech House (Binfield) Address London Road Binfield Bracknell Berkshire RG42 4AB 01344 451949 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) Charnley Care Limited Mrs Gill Kirk Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Beech House (Binfield) DS0000011071.V289778.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th March 2006 Brief Description of the Service: Beech House offers accommodation 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 (Binfield) DS0000011071.V289778.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection, the site visits took place between 3 pm and 8.15 pm on the 2nd May 06 and between 1pm and 3pm on the 8th May 06. Information for this report has been obtained from service users questionnaires, talking to service users, staff, the manager and the owner of the service. The homes’ written records and a tour of the home also provided evidence for the report. What the service does well: What has improved since the last inspection? What they could do better: The service users needs are not assessed very well which means that care plans are not helping staff to make sure that they can give them the best possible care. The home must ensure that service users are properly assessed so that they can be properly cared for, in the way that they need and prefer. Care plans must have enough information to enable staff to look after the daily physical and emotional needs of the service users. There have not always been enough staff on duty, who are properly supervised and trained to enable them to meet all the needs of the service users. Beech House (Binfield) DS0000011071.V289778.R01.S.doc Version 5.1 Page 6 The home must provide enough staff on duty to keep the service users safe at all times. The home must make sure that staff are properly supervised and trained so that can give the best possible care to the service users. The home cannot, currently, make sure that the quality of care is of an acceptable to offer to its’ service users. The manager must develop robust management systems to ensure that the quality of care is monitored and developed so that service users have the best quality of life, possible. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Beech House (Binfield) DS0000011071.V289778.R01.S.doc Version 5.1 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 (Binfield) DS0000011071.V289778.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is poor. EVIDENCE: The needs assessments seen for new service users were poor. There was no background information, they did not include the purpose of the stay, duration (if it was long or short term) or how the home could meet the needs of the individual. There was no reference to the service users mental/emotional state or how staff should approach their care. Information about the service users care was verbally given by staff members but not included in the assessment. There were five service users who had been admitted for short-term care but there were no specific assessments for these service users, what their specific needs were or how they might be assisted to maximise their independence for their planned returned home. No plans were in place for returns home and service users could not be helped to understand how long they would be staying. One service user told the inspector that she was returning home after her chair lift had been fitted but a staff member was not sure if this was the case and had to check with a senior staff member if this was accurate. This was accurate Beech House (Binfield) DS0000011071.V289778.R01.S.doc Version 5.1 Page 9 but was not noted on the assessment or care plan and was known to only some staff. Beech House (Binfield) DS0000011071.V289778.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 The quality in this outcome area is poor. EVIDENCE: Some service users’ care plans are poor, they include little information and are formulated from inadequate assessments. Several areas of care are not included in the care plans, such as emotional state, mental state and deteriorating physical conditions. Health care records are not always kept current and some care plans have not been formally reviewed since 2003. This has been an issue since the last inspection and no progress has been made in this area. Care plans did not reflect the changing needs of some service users or state how the home could meet those needs. Service users health care needs are not always met because staff do not have enough information in the care plan, to enable them to offer them the appropriate care. The medication administration procedure is safe but action taken to deal with medication errors needs to be recorded. A new controlled drugs book is needed and it needs to be clear what medication is still being used. Beech House (Binfield) DS0000011071.V289778.R01.S.doc Version 5.1 Page 11 The low staffing levels result in service users needs not always being met for example a service user had excess facial hair, how to deal with it is not included in the care plan and did not evidence respect for the individual. Beech House (Binfield) DS0000011071.V289778.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 The quality in this outcome area is poor. The quality is poor, predominantly, because of low staffing levels. Service users felt the quality in this outcome area was ‘o.k’. EVIDENCE: Recreational activities in the home are limited, this was confirmed by staff and service users. Service users said that there was little to do except bingo and a quiz once a week. They said that they never left the home unless taken out by family or friends. Service users felt that this was a result of shortage of staff. Staff confirmed that activities were dependent on staff availability and that one staff member provided bingo and quiz prizes from her own resources. A service user questionnaire noted that although there were some activities provided for the more able service users the less able ones had no activities and were disadvantaged because of this. The home welcomes families and friends and keeps them informed of any significant events in the lives of the service users. Service users choices are limited by the availability of staff, service users felt that there were times when there were not enough staff to fully support them. Three service users reported that they could not have toast for breakfast as the staff did not have time to provide an alternative to their usual choice, staff confirmed this. Two service users said that there are sometimes ‘not enough Beech House (Binfield) DS0000011071.V289778.R01.S.doc Version 5.1 Page 13 staff around’ and one said that sometimes they were of ‘poor quality, especially their English’. Generally service users felt that the care given in the home was ‘o.k’ The meal was observed and the food was adequate but service users commented that mustard would be nice, they could not see the menu and they had no choice of main meal or starter ‘if you don’t like it you go without’. It was observed that service users who declined the starter and main meal were not offered alternatives. One service user was seen to have two crackers and a piece of cheese and there was a limited choice of sweet (cheesecake or yoghurt.) A service user with sight problems was seen to be given very hot food without being warned, she had only one mouthful of food and declined to eat any more. Other service users assisted her with her meal. Service users also commented that they did not like to ask for alternatives and ‘it was not liked if you provided alternative food for yourself as you had adequate’ (provided by the home). One service user commented that the food was ‘adequate but not tasty’. Beech House (Binfield) DS0000011071.V289778.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The quality in this outcome area is poor. EVIDENCE: The service has improved its’ recording of complaints but staff were unaware of the complaints procedure or recording process. Service users appeared to be reluctant to complain or discuss any changes they would like and there was no service user-friendly information available to assist them to make a complaint if they wished to. Staff could not describe the Vulnerable Adults procedures although many had received Vulnerable Adults training. Service users well-being is compromised when there is not enough staffing and when there is not appropriate equipment available. (See staffing and management) Beech House (Binfield) DS0000011071.V289778.R01.S.doc Version 5.1 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 the following standard(s): 19,22 and 26 The quality in this outcome area is poor. The environment is generally well kept and the home offers a comfortable environment but there are no specialist equipment assessments to ensure service users comfort and safety. EVIDENCE: The home has completed all the repairs required at the last inspection. The home was generally clean and tidy although the kitchen surfaces and skirting boards were in need of a deep clean. Several service users physical needs are increasing and the home does not have Occupational Therapy assessments to ensure that individual rooms and communal facilities are adequate to meet their changing/changed needs. The television set in the lounge is not large enough for all of the service users to see. Some lounge chairs are not within the viewing area of the television. Beech House (Binfield) DS0000011071.V289778.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 The quality in this outcome area is poor. EVIDENCE: On the day of the site visit the staff numbers between 4pm and 8pm had been increased by two. This change was described as temporary, by a staff member and the manager,and had been put in place because of incidents the week before when there had been two accidents, a service user could not be fed and other essential tasks could not be completed because there were not enough staff (i.e two on the shift). The manager advised that a minimum of four staff are to be provided, during daytime hours, but there was no evidence that this had been planned for on future rotas. Staff felt that four was the minimum staff that was safe and service users confirmed that they often felt that there were not enough staff around. There had been sixteen accidents between 04.04.06 to 09.05.06. The majority of accidents were reported when staff had found service users on the floor. Four of these did not have a time recorded but six were recorded during the evening shift. A service user said that call bells are not always answered at night and so ‘you don’t drink too much and you go to toilet before bed.’ A staff member said that the mornings are so busy getting people up that you are unable to answer call bells during that period. Staff reported that they did not feel they had adequate equipment, manual handling training or time to ensure the safety of the service users. They also Beech House (Binfield) DS0000011071.V289778.R01.S.doc Version 5.1 Page 17 felt that the care they could give service users was compromised and they did not have time to complete all the essential tasks, even to completing feeding those who needed assistance. It was clear that the dependency levels had steadily increased with no subsequent increase of staff to meet those needs. The home has a robust recruitment policy and process and all the necessary information was included on the staff files. Staff reported limited opportunities for training and records showed little recent training. A new programme is being developed by a senior staff member but little has been completed yet. Health and Safety training is out of date and staff felt that this was urgently required to ensure that they could keep service users and themselves safe. Night staff are unable to move and handle one service user who is ‘too heavy’ to deal with, with the equipment available. Beech House (Binfield) DS0000011071.V289778.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,37and 38 The quality in this outcome area is poor. EVIDENCE: The manager does not have time to manage the home efficiently, she spends approximately 20 hours per week managing the home and is counted as part of the care hours for the rest of the time. The staff reported that the manager did not have the power to effect certain necessary changes although she supported their views and opinions. Two service users said that they did not see the manager very often and mainly spoke to the senior carers if they had any problems. Staff are not regularly supervised or appraised and the last staff meeting held was in October 05. The manager does not acknowledge messages left in the communication book and there is no record of action or taken in relation to these messages. Beech House (Binfield) DS0000011071.V289778.R01.S.doc Version 5.1 Page 19 The home deals only with service users personal allowances, these are kept in a safe in the proprietors office, only the manager and proprietor have access to this money. The records are kept accurately and the cash balanced with the records. The manager does not audit some vital records and there are no comments or actions noted on accident reports, to improve or minimise the safety of the service users. There have been sixteen accidents in the home between 4/04/06 and 9/05/06.There is no evidence that the accident reports have been audited or analysed to improve the safety of the service users. Wheelchairs have been identified as being dangerous and no action has been taken to address this issue. A wheelchair service is now due on 09/05/06. No training records were available and staff confirmed that they had not had Health and Safety Training,(including food hygiene training) and are therefore unable to promote the safety of service users or themselves. Staff felt that morale is poor and most were unhappy about their pay, giving examples of frequently not being paid fully for overtime worked and having to ‘chase’ the proprietor for monies owed. Some are concerned at the validity of handwritten payslips and are not clear whether their tax and national insurance contributions are accurate. These are issues, which need clarification by the proprietor. The proprietor has not supplied the financial information to C.S.C.I as was agreed at a meeting on 21/03/06. Beech House (Binfield) DS0000011071.V289778.R01.S.doc Version 5.1 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 X 2 X X 1 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X 1 X X X 3 STAFFING Standard No Score 27 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 1 3 X 1 1 Beech House (Binfield) DS0000011071.V289778.R01.S.doc Version 5.1 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 2 Standard OP3 OP6 Regulation 14 14 Requirement To ensure service users are properly assessed and the home can meet their needs. To ensure service users are properly assessed so that the home can enable them to return home To ensure that a written care plan is developed from a detailed assessment of individual service users needs and that the plan is reviewed to ensure changing needs are met. (01/05/06) To ensure are plans enable staff to uphold the dignity and respect of service users at all times. To review day care activities available in the home. To ensure there is a method of ascertaining the views of service users. The registered persons should make sure Food Hygiene Training is up to date. (06/05/06) The registered person must ensure Health and Safety training is completed. DS0000011071.V289778.R01.S.doc Timescale for action 01/06/06 01/06/06 3 OP7 15 01/06/06 4 5 6 7 OP10 OP12 OP14 OP15 12.4 01/07/06 01/07/06 01/08/06 16.2(m) 12.2 .3 16 (2)j 01/08/06 Beech House (Binfield) Version 5.1 Page 22 8 OP16 17, 22 9 10 OP18 OP22 13.6 13.4(c),5 23.2(n) 18 11 OP27 Complaints records to detail the timescales taken to investigate complaints and detail outcomes. (01/12/05) To ensure staff are able to protect service users. To ensure individuals have the correct equipment to enable staff to offer proper/safe care.(Including properly maintained wheelchairs) The registered Person must ensure that adequate numbers of staff are employed in the home at all times in such numbers as appropriate for the health and welfare of service users. (01/11/05) To implement the training, supervision and appraisal plan for individuals and for the home (which includes professional training) To ensure the manager has the time and skills to properly manage the home. To ensure there is a method of reviewing the quality of care in the home. To provide the commission with documents to evidence the financial viability of the home. The manager to ensure records are up-to-date reviewed and audited as necessary. The Registered Person to provide to the CSCI without delay written notifications as required within Regulation 37. (12/04/05) To ensure that staff are able to promote the safety and well being of service users. 01/06/06 01/07/06 01/06/06 01/06/06 12 OP28OP30 18.1(a) 18.2 01/08/06 13 14 15 16 17 OP31 OP33 OP34 OP37 OP38 9.2(b i) 24 25.2 17.3 24.1 37 01/06/06 01/08/06 01/06/06 01/07/06 13.4 01/06/06 Beech House (Binfield) DS0000011071.V289778.R01.S.doc Version 5.1 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Beech House (Binfield) DS0000011071.V289778.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Berkshire Office 2nd Floor 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 (Binfield) DS0000011071.V289778.R01.S.doc Version 5.1 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!