Inspection on 22/10/08 for Beech House (Binfield)

This inspection was carried out on 22nd October 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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) 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 16/12/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Beech House (Binfield) London Road Binfield Bracknell Berkshire RG42 4AB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Denise Debieux     Date: 2 2 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Beech House (Binfield) London Road Binfield Bracknell Berkshire RG42 4AB 01344451949 01344864709 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Gill Kirk Type of registration: Number of places registered: Charnley Care Ltd care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 28 The registered person may provide the following categories of service only Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Dementia - DE Date of last inspection Brief description of the care home Beech House is located in Binfield, Bracknell and is registered to provide care and accommodation to up to twenty-eight older people and people with dementia. Communal areas include a large lounge and separate dining room, individual bedrooms are located over three floors with a lift providing access to the upper floors. The home has a large and well-maintained garden to the rear of the premises with car parking Care Homes for Older People Page 4 of 35 Over 65 28 28 0 0 Brief description of the care home facilities provided to the front. Bracknell railway station and town centre are approximately 2 miles away and the home is close to local bus routes and the M4 motorway. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This unannounced visit formed part of a key inspection and was carried out by Denise Debieux, Regulation Inspector. The Registered Manager was present as the representative for the establishment. It was a thorough look at how well the service is doing. It took into account detailed information provided by the manager and any information that CSCI has received about the service since the last inspection on 31st October 2007. In January this year the provider company, Charnley Care Limited, was purchased by new owners. Following this the new owners made an application to add dementia to their category of registration. This application was agreed and their registration Care Homes for Older People Page 6 of 35 changed to include dementia in September of this year. Although the home has been registered for many years, this is the first inspection at the home since the new owners purchased the provider company. The new owners were present at the home for some parts of the inspection. Service users at this home prefer to be referred to as residents. For clarity and consistency this term will be used throughout this report. During this visit the inspector was also accompanied by an expert by experience. An expert by experience is a person who has direct experience of using social care services, including carers, and visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The expert by experience spent her time speaking with residents and also had lunch with them. Observations fed back to the inspector by the expert by experience have been included in this report. A tour of the premises took place. On the day of this visit the inspector spoke with eight of the twenty three residents and six on-duty staff. Prior to the inspection, survey forms were distributed by the manager to residents, staff, GPs, care managers and health professionals. Survey forms were returned by five residents, three members of staff, one GP and two care managers. Survey forms returned by residents and staff were correlated and the results were shared with the manager during the inspection. Comments made on the survey forms, both positive and negative, were included in the correlation and shared with the manager. Care was taken to exclude any comments that could identify the writer. The manager demonstrated a pro-active attitude to the results of our survey and plans to explore any concerns raised further as part of the homes quality assurance process. Some of the comments made to the inspector, made to the expert by experience and made on the survey forms are quoted in this report. The home had completed an annual quality assurance assessment (AQAA) and residents care plans, staff recruitment and training records, health and safety check records, policies, procedures, medication records and storage were all sampled on the day of this visit. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. Fees range from 575 - 750 pounds per week. This information was provided on 22/10/08. The inspector would like to thank the residents and staff for their time, assistance and hospitality during this visit and the residents, staff, GP and care managers who participated in the surveys. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 35 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Procedures are in place to ensure that a resident is only admitted to the home following comprehensive needs and risk assessments. However, recent admissions have not been in line with the homes procedure meaning that residents have moved to the home without the home first ensuring that they can meet their needs. This home does not offer intermediate care. Evidence: The inspector was advised that, on the first enquiry from a prospective resident or their representative, the resident and/or their representative will be invited to visit the home. Following the initial visit to the home, and if the resident wishes to continue, the manager will visit the resident and carry out a pre-admission assessment to ensure that the home can meet the residents needs and wishes. In the AQAA to demonstrate what the home does well the manager stated that: We ensure people are confident Care Homes for Older People Page 10 of 35 Evidence: that the care home can support them, by having an accurate assessment of their needs that tells the home all about them and the support they need. A full, comprehensive pre-admission assessment is undertaken to ensure we are able to provide all the care a person needs. This is also a way of ensuring that the person meets someone from the home. This can help to make the transfer into residential care easier, as this is not an easy decision to come to terms with and it is important we understand the emotional impact of this. Following the last inspection the manager advised that she had redesigned the preadmission assessment form. The forms now used are comprehensive and include questions designed to identify any special equipment needs plus preliminary risk assessments to ensure that any risks related to falls and nutrition are identified prior to a persons admission. In this way the home have met requirements made at the last inspection and, provided the form is completed fully, they are able to ensure that any required equipment is obtained and that measures can be put into place on admission to reduce any identified risks. Two files were sampled for residents who had recently moved into the home. In each case pre-admission assessments had been carried out but they had not been dated or signed by the person completing the form so it was not possible to ascertain that these had been carried out prior to admission. The manager advised that both of these people had been assessed and admitted to the home during her annual leave, that the forms had been completed by a senior member of staff in her absence and would have been completed before the residents moved in. The manager also advised that some additional information had been added to the forms by her after her return from leave. However, neither of the forms had been fully completed meaning that the home had not fully assessed that they were able to meet the persons needs prior to them moving into the home. The form includes columns for the person carrying out the assessment to record risk levels, in each case the risks, where identified, had been recorded as m (medium risk) although this was not always appropriate. (E.g. on one form, under the mobility section, the person had noted that the person did not use a wheelchair and had identified this as m risk.) The falls risk assessment had not been fully completed on either form and there was no indication that the resident or their representative had seen or agreed the pre-admission assessment information. One additional file was sampled where the manager had completed the pre-admission procedure. The pre-admission form had been fully completed, and provided detailed information for the home to ensure that they could meet the persons needs prior to offering them accommodation at the home. In discussion with the manager it is clear that this issue is something that the manager has already identified and in their AQAA, to demonstrate what the home needs to do Care Homes for Older People Page 11 of 35 Evidence: better, the manager had stated: Develop a group of recognised seniors to be trained to undertake pre-admission assessments in my absence. It is of concern that, having already identified the need for improvement, pre-admission assessments and admissions to the home were made during the managers absence and a requirement has been made. The manager advised the inspector that, until such time as other staff have been fully trained, and are confident, to carry out pre-admission assessments and also have a full understanding of the risk assessment process, no residents will now be admitted to the home unless she has carried out the pre-admission assessment and risk assessments herself. Data provided in the homes AQAA does not identify any residents with specific religious, racial or cultural needs at this time. However, from the evidence seen by the inspector and comments received, the inspector considers that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. Care Homes for Older People Page 12 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal care and healthcare support and assistance is planned and was seen to be provided, where needed, in a respectful and sensitive manner. Policies, procedures and practices are in place to ensure the safe administration of medication. Evidence: The care plans sampled during this visit were well set out, included risk assessments and covered all areas of personal and healthcare needs identified during the preadmission assessment and since admission. These care plans set out the actions which need to be taken by care staff to meet the identified needs of the residents. Residents or their representatives sign a separate sheet to say they have seen and agreed their care plan. Care plans are reviewed on a monthly basis and daily notes are kept that reflect the care given. The daily notes evidenced that newly identified needs are noted and promptly acted upon. For example, one person recently admitted had notes from the discharging hospital that the person did not have pain. In the daily notes shortly after Care Homes for Older People Page 13 of 35 Evidence: admission a member of staff had noted that they felt the person had pain, making them reluctant to walk. The staff had discussed this with the GP and pain medication was prescribed. A plan was put in place to give the medication before the person got up in the morning and within two days it was noted that the person was mobilising much more and being more active. With reference to the two people who had been admitted with incomplete preadmission assessments, it was seen in their files that the manager had obtained missing information and drawn up detailed care plans and risk assessments on her return from leave. At this time the manager draws up and reviews the majority of care plans and risk assessments for all residents. In their AQAA the manager has identified that she wants to develop a group of recognised seniors to be trained to undertake pre-admission assessments in my absence. Care staff to be more involved in developing plans of care. Steps have already been taken towards meeting these goals. The manager is currently looking at ways to integrate the documentation used for pre-admission assessments, care plans, risk assessments, daily notes and monthly reviews so that they flow from one to the other and so that staff new to care planning will find the system easy to use. The home has a new computer set up with internet access and an administrative assistant has been employed who works Monday to Friday, five hours per day. At the last inspection requirements were made regarding assessing risks related to moving and handling, falls and nutrition, all these requirements have been met and the manager now has links with the local falls clinic, nutritionalist and other local health care professionals that she consults when further advice or information is needed. Referrals are made by the GP if there are any specific concerns related to a particular resident. Recommendations were also made at the last inspection regarding recording residents agreement with their care plans and contacting the falls clinic. These recommendations have been met. Of the residents who returned surveys, two said that they always receive the care and support they need and three answered usually. One care manager commented that her client feels that her personal care is managed sensitively and that her dignity is respected and maintained. Another care manager commented that: The residents I have met are happy with the care provided. The GP felt that staff demonstrate a clear understanding of the care needs of residents, that any specialist advice they give is incorporated into the care plan and that they are satisfied with the overall care provided to residents at the home. Care Homes for Older People Page 14 of 35 Evidence: Observations made by the expert by experience included: One lady needed to be moved, but clearly her skirt was undone and could not be adjusted while she was seated. One of the carers brought another skirt, put it over her head and thus decency was maintained as two of the carers assisted her into a wheelchair. The lunchtime medication round was observed and the medication administration records, medication storage, policies and procedures were all sampled and found to be in order. The legislation regarding the storage of controlled drugs in care homes has recently changed. Although no residents are prescribed controlled drugs at present, the manager is aware of the new legislation and is looking into purchasing a cupboard that meets the new requirements as part of the homes current refurbishment programme. In the AQAA, to demonstrate what the home does well, the manager stated that: Care Plans are extensive and informative and reviewed monthly and whenever anything changes. These are based on collated information and consultation with residents, their relatives and staff. Where appropriate residents or their representative sign to confirm their involvement. Daily reports are completed on all residents. Residents physical and emotional health needs are met because we have procedures in place that staff follow. Carers treat all residents with dignity and respect and, whilst supporting and assisting with personal care needs, encourage independence and self motivation. During the tour of the home staff were observed to always knock before entering the residents bedrooms and all interactions observed between staff and residents were seen to be caring and respectful. Care Homes for Older People Page 15 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are given the opportunity to take part in a variety of activities within the home. The need to ensure that each resident has a social care plan that is tailored to their individual ability and interests has been recognised by the manager who plans to employ an experienced activities coordinator, purchase transport and develop individual care plans. Contacts with family and friends are encouraged. Menus seen were varied with individual choices and preferences catered for. Evidence: The routines of daily living are arranged to suit individual residents preferences and choices. This was confirmed by residents spoken with. In their AQAA the manager stated that they provide a range of activities including: exercise sessions monthly; monthly keyboard player; staff participate in word games & bingo; manicures weekly; hairdresser weekly. The hairdressing room has recently been moved from the third floor to the ground floor to enable easy access for all residents. Also in the AQAA the manager stated that: Residents are encouraged to spend the day in the sitting room but a few do not wish to do this and we must respect Care Homes for Older People Page 16 of 35 Evidence: that not everyone wants to socialise with others all the time. We spend time talking with residents who often like to reminisce or talk about life in general. We consider all activities as a social interaction. On the day of this visit an exercise class was being run by a local organisation in the lounge. The exercises were geared to suit the abilities of the residents and were to music. The majority of the residents attended and were clearly enjoying the session. Staff were sitting with the residents and offering assistance when requested or needed. Residents are able to choose which activities they attend or participate in and their individual rooms were all seen to contain many personal possessions which were arranged to suit their individual wishes. Feedback received by the inspector from the expert by experience included: Apparently activities are arranged on alternate afternoons. I spent nearly two hours talking and listening to the residents before they gradually were directed to the toilet prior to lunch. Most of the residents were seated in a two-part lounge. There was a television at either end of the room showing different programmes. No one appeared to be interested in the programmes. The position of the chairs around the room did not facilitate actual watching of television, but did enable carers to access residents easily. There were five or six different carers all in pale blue tunics, as well as students/trainees. The attitude of all staff at this time was sympathetic and supportive. This was a long period of inaction, residents were free to get up and move about the lounge or go to their rooms, but until 11:20 no activity, apart from serving morning drinks and biscuits, seemed to take place. I understood that some of the residents might be having their weekly bath. At 11:20 a tape of wartime songs was put on to the evident enjoyment of two of the residents. One of the five residents surveyed stated that there were always activities they could participate in, two answered usually and one left this answer blank. One resident stated that they couldnt attend the arranged activities due to her specific needs and one resident commented: A trip out would be nice, just to get a little change and see other places (i.e. garden centre or local park). The manager confirmed that, at present, residents only go out if their relatives take them and one person attends a local day centre. The manager has already identified that individualised activity provision is something the home needs to improve on, especially as the home starts to admit more people with dementia. In their AQAA, plans for improvement over the next twelve months include: more reminiscence for all and specialised activities for confused, partially sighted, hard of hearing. They plan to recruit an experienced, full time activity coordinator and funds have just been agreed for the home to purchase its own transport for outings. In their AQAA the manager stated that: we gather as much information as we can about the individual, particularly their medical history, life history, interests and social Care Homes for Older People Page 17 of 35 Evidence: interactions. However, not everyone has a completed life history at this time and at present the care plans do not address individual social care needs. The manager plans to introduce activity plans for each individual resident as she is developing the new care planning system. A requirement has been made and the inspector gave details of the National Association for Providers of Activities for older people (NAPA). This is a voluntary organisation dedicated to increasing the profile and understanding of the activity needs for older people, and equipping staff with the skills to enable older people to enjoy a range of activity whilst living in care settings. Further information can be found on the NAPA website at: http:/www.napa-activities.co.uk/m This organisation also provide a free self-assessment document Activity Provision : Benchmarking good practice in care homes that is available for download from that site and that the manager may find helpful. There are no restrictions to visiting times and staff support and encourage residents to maintain family links and friendships inside and outside the home. The inspector was advised that the chef has recently been on a healthy eating course and has made some changes to the menus. The lunchtime meal was taking place during this visit, the food was well presented, the atmosphere in the dining room was pleasant and relaxed and there were ample staff available to offer help and assistance as needed. Feedback received by the inspector from the expert by experience included: I was told by all those I spoke to that the meals were very good and tasty. On smelling the curry being prepared I commented on it and one lady said But I dont like curry. I asked if she could choose something else and she said that it might be possible. I noted that at lunchtime she had curry but ate only rice and chips leaving the meat. I saw no evidence of the offered menu until, as residents sat at table, the notice board was written up with lunch and evening meal menus. As lunch was being served, some residents were offered a choice of curry with rice and/or chips or chicken with peas and chips. There were at least five or six staff on duty in the very pleasantly furnished dining room. Of the five residents surveyed, three said that they always liked the meals at the home, one answered usually and one left this answer blank. Although the chef does ask for feedback and suggestions from residents, the manager said that they hope to get the residents more involved in menu planning in the near future. Care Homes for Older People Page 18 of 35 Care Homes for Older People Page 19 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a simple, clear and accessible complaints procedure which includes timescales for the process. Policies and procedures are in place to protect residents from potential harm or abuse. Evidence: The home has a complaints procedure in place that is available to all residents and their relatives and is also included in the residents guide. No resident or their representative has contacted the Commission with information regarding a complaint or allegation made to the service since the last inspection. The concerns and compliments book was sampled at this inspection and it was seen that concerns raised to the home are logged with clear recordings made of actions taken to resolve issues. There is a whistle blowing policy in place and the home have a copy of the latest Berkshire Safeguarding Adults policy and procedure, which is available in the office for all staff to refer to. Training in safeguarding adults is included in the homes staff induction and is part of the homes ongoing training schedule. In the AQAA, to demonstrate what the home does well, the manager stated that: We have a clear, detailed complaints procedure, displayed opposite the front door and copied in every residents guide. The home follows Berkshire Safeguarding Adults procedure and I attend forums in Bracknell, dealing with issues and attended by the Care Homes for Older People Page 20 of 35 Evidence: Safeguarding Adults Co-ordinator – who is easily contactable for advice. Staff attend study sessions about the protection of vulnerable adults and there is a whistle blowing policy in the home. Relatives/representatives are also able to talk to me at any time to voice concerns and can usually resolve problems quickly. All complaints are investigated speedily and thoroughly. The need to review staff recruitment procedures to protect residents is addressed in the Staffing section of this report. Of the five residents who returned survey forms, four said that they always knew who to talk to if they were not happy and one answered usually. All residents spoken with said that they felt safe at the home with one resident adding very and another commenting I feel safe here, this is my home. Care Homes for Older People Page 21 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The location and layout of the home and gardens are suitable for their stated purpose. The recent and ongoing redecoration and refurbishment of the home is providing residents with much improved, pleasant and homely surroundings in which to live. Evidence: Beech House is located in Binfield, Bracknell. Communal areas include a large lounge and separate dining room, individual bedrooms are located over three floors with a lift providing access to the upper floors. The home has a large and well-maintained garden to the rear of the premises with car parking facilities provided to the front. The home was toured during this visit and it was noted that many improvements have been made. Throughout the home the staff have started to provide dementia signage with large signs acting as prompts and reminders for the location of the lounge, dining room, toilets etc. All bedrooms have the persons name on the door and the staff are gradually adding pictures that have an association for that resident. Since the last inspection the new owners have implemented a major programme of refurbishment and redecoration. The home has been rewired throughout, successfully addressing concerns raised at the last inspection and meeting the requirement that had been made. Care Homes for Older People Page 22 of 35 Evidence: All bedrooms have been redecorated and completely refurbished with new carpets, curtains and furniture. Personal bedrooms were all seen to be personalised to the individual residents wishes, residents spoken with confirmed that they had been consulted on the decoration of their own rooms. The lounge and dining rooms have been redecorated with much of the old furniture replaced and new carpets and curtains fitted. Major structural work has also been carried out and is ongoing, including replacing or repairing all windows. At present work is underway to provide a more suitable ramp to the front entrance and to add an enclosed porch area. Much of the work has now been finished with improving and resurfacing the car parking area to the front of the home being the next planned improvement. Once that is done the inspector was advised that the kitchen will be totally renewed with some structural changes to improve the layout and storage provision. The work on the kitchen means that the homes kitchen will be out of action for some time and the owners plan to hire a portable kitchen to ensure that the home are able to continue to provide meals as they do at present. Future work is also planned to improve the access to and the facilities provided in the garden so that all residents will be able to utilise the garden area more and sit out in the warmer weather. The manager and staff are to be congratulated in the way they have made sure that the work has been carried out with as little disruption and inconvenience to the residents as possible. Residents spoken with were all pleased with their new home and a number commented that it had hardly affected them at all, one person commented that it had been a little noisy at times during the day but that that was to be expected and had been worth it. Laundry facilities are sited on the ground floor with washing machines suitable for the needs of the residents at the home. This room is also currently being redecorated with plans to try to rearrange the equipment to provide more storage space. Concerns regarding the management of a safe environment in the kitchen were identified during the tour but are dealt with in the Management and Administration section of this report as they relate more to health and safety. In the AQAA, to demonstrate what the home does well, the manager stated that: We encourage our residents to arrange their room so that it feels like their own, it is comfortable and they feel safe when they use it. We encourage them to bring in their personal possessions and furniture, involve them in choosing the decoration for their room and ensure that there is appropriate light and heat. Care Homes for Older People Page 23 of 35 Evidence: Feedback received by the inspector from the expert by experience included: The internal appearance of the home is newly decorated, carpeted and the chairs well refurbished. The furnishings have been greatly improved, curtains and alternate chair colours being appreciated by a resident. Residents spoken with expressed their satisfaction with the accommodation provided at the home with many commenting positively on the major refurbishment. Comments received on survey forms included: The new owner is modernising everything to a very good standard and Everything is splendid now that the home has been refurbished to a very high standard. Care Homes for Older People Page 24 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Action must be taken to improve the staff recruitment procedures to ensure that the safety of the residents is protected. The home has a staff training programme which is designed to ensure that residents are supported by competent and qualified staff and that, as far as reasonably possible, they are protected from harm. Evidence: The staff rota evidenced that staff are provided in sufficient numbers to meet the needs of the residents at the home. The morning (8am – 1pm) shift is covered by five care workers plus the manager or a senior, three care workers cover the afternoon/evening shift (1pm – 8pm) and the night staff consists of two waking care workers with the manager on call if needed. The home have also employed additional ancillary staff and now have an administration assistant, two housekeeper/cleaners and one maintenance person. Of the five residents surveyed, two stated that staff are always available when needed and three answered usually. Of the fourteen care staff, four hold a National Vocational Qualification (NVQ) level 3 in care, with a further six holding an NVQ level 2 in care. Care Homes for Older People Page 25 of 35 Evidence: During this visit the files of two recently recruited members of staff were sampled. Both files were seen to contain proof of identity, a completed application form and a statement as to the persons health. However, neither applicant had provided a full employment history and there was no written explanation of gaps in employment. Both had two references but the home had failed to obtain a reference for one person from the last place they had worked with vulnerable adults, reasons for leaving previous employment with vulnerable adults had not been verified for either applicant. One file had an enhanced Criminal Record Bureau (CRB) with a Protection of Vulnerable Adult (POVA) list check but the other file evidenced that the home was allowing the person to work at the home without a valid CRB or POVA check, the manager advised that, as the person had worked at the home previously she had thought that it was not required to obtain a new CRB certificate or check the POVA list again, this is not the case. In 2004 the recruitment requirements of The Care Homes Regulations 2001 were amended and Schedule 2 of those regulations was replaced with a new schedule setting out exactly what recruitment checks and documents are required. The manager was not aware of the change in legislation. The manager was advised that updated copies of The Care Homes Regulations 2001 can be downloaded from the CSCI website: www.CSCI.org.uk. The manager now has a copy. A copy of the amended Schedule 2 was explained to and left with the manager and it is positive to note that the manager took prompt action following this inspection to ensure that staff working with the residents had all the required checks and information in place. On the day following the inspection the inspector received the following written information from the manager: A system is in place to record the complete working record of all staff. No member of staff is working in the home without the necessary documentation. CRB and POVA checks are completed for each person employed in the home. A person will commence work after we receive the POVA confirmation - they will be supervised and work with a mentor until CRB is received. The homes current recruitment practices do not meet the requirements of the amended Care Homes Regulations and are potentially placing residents at risk of harm or abuse, a requirement has been made that must be actioned without delay. Staff induction is in line with the new, mandatory Skills for Care common induction standards and the inspector was advised that staff are supervised until they have completed their induction. Staff are booked on additional training and updates as the courses become available. At present a number of staff are overdue for their update Care Homes for Older People Page 26 of 35 Evidence: training but the manager has already taken steps to rectify this and staff training has already been booked over the next few weeks. In the AQAA, to demonstrate what the home does well, the manager stated that: Beech House is committed to providing quality services for residents by caring, competent, well-trained staff in a homely atmosphere. Our service is mainly provided by a permanent team of staff avoiding the need for agency staff as much as possible. When staff are off sick or unable to come in other staff members inevitably offer to cover the duty. Limiting the use of agency staff, we believe, is one or our strengths as this means we offer a well trained, supervised and consistent group of staff committed to and understanding the needs of our residents. We feel that using staffing effectively is critical to the quality of service we provide and ensure that they are deployed at appropriate times by monitoring shift patterns and their skill mix and experience. When asked on the survey if they felt the homes manager and staff had the right skills and experience to support residents social and health needs, one care manager answered always and one answered usually. Of the five residents surveyed, all said that the staff always listened and acted on what they said. One relative commented: My relative always states how well they are looked after. Care Homes for Older People Page 27 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has a good understanding of the areas in which the home needs to improve in order to further enhance the quality of life and choices available for the residents. The recent introduction of a quality assurance and monitoring system will lead to residents having more input into the running of the home. Policies and procedures are in place to protect residents financial interests. Policies and procedures are in place to protect the health safety and welfare of residents but lack of robust food safety practices are placing residents at risk. Evidence: The manager is a registered nurse, holds her Registered Managers Award and also holds a certificate of dementia awareness. She has been the manager at Beech House for the past eleven years and has twenty years experience working in care. The manager advised that, since the new owners took over the home, staff meetings Care Homes for Older People Page 28 of 35 Evidence: are being reintroduced (last one held in September) and all staff will be having formal supervision every two months. At the last inspection a requirement was made that the home develop quality assurance processes. The manager is now introducing a quality assurance and monitoring system and has recently distributed quality surveys to residents. The manager said that when the surveys are returned she will correlate the results and formulate an action plan to address any issues raised. Minutes from a residents meeting held on the 3rd October were seen. The manager advised that she now intends to introduce residents meeting on a regular, two monthly basis. Policies and procedures are in place to protect residents financial interests. No personal monies are kept at the home, any expenses (e.g. hairdressing) are paid by the home and then the resident or their representative is billed. Records were seen for each resident clearly setting out any monies spent. In their AQAA the manager stated that: We do not have any involvement in residents finances; they control their own money and choose how they spend it. If they cannot manage their money, it is managed by their family in their best interests. Health and safety monitoring check sheets were sampled and found to be generally well-maintained and up to date. Some staff are overdue their safe working practice updates but, as mentioned earlier in this report, the training update sessions have already been scheduled. Two previous requirements relating to electrical safety and repairs needed to reduce the risk of trips and falls have been met by the refurbishment of the home. During this refurbishment a number of safety measures have also been introduced to further reduce the risk of falls with the fitting of hand rails along corridors. During the tour of the home a number of serious concerns were identified in the kitchen and food storage areas. The floors in both areas needed cleaning and there was a build up of dirt underneath and down the sides of the movable appliances, e.g: dishwasher, fridge, stove. There were paper towels fallen behind the stove and one piece of paper towel was seen under one of the burners of the stove, which was in use at the time presenting a risk of fire. The side of one of the work units nearest the stove was noted to have a build up of grease and the stove hob was also in need of cleaning. The insect control machine was not working and there was a fly buzzing round the kitchen while lunch was being prepared. The fridge in the kitchen was showing a temperature of 12 degrees centigrade and the records kept by the chef showed that this fridge had been above the required 8 degrees on at least two days this month, with no note that any action had been taken. This fridge also had a Care Homes for Older People Page 29 of 35 Evidence: yoghurt with a use by date of 24th September that had not been discarded. There was also a bowl of food in this fridge that had a Tuesday sticker on it but was not dated so that it was not possible to tell which Tuesday was referred to. The two freezers in the food store both had a substantial build up of ice on the shelves and needed defrosting. An opened package of ham was seen in the fridge in the food store with a use by date of 14th October. The staff room is accessed by going through the kitchen and throughout the day of this inspection staff were seen to be using the kitchen as a thoroughfare to the staff room without any apparent precautions being taken to ensure that the food preparation area was not contaminated. A representative of the provider had carried out a monthly provider visit earlier this month, this report was seen but there was no indication that compliance with food safety legislation had been checked at that time and there was no evidence to show that management are monitoring the food safety standards even though they identified that they were aware there were issues. On the afternoon of this inspection staff began to thoroughly clean the kitchen and it was noted that the kitchen fridge temperature had reduced to four degrees centigrade. On the day following the inspection the following written assurance was received by CSCI from the manager: This is to inform you that the kitchen at Beech House has been thoroughly cleaned today. The freezers have been defrosted, the fridges cleaned and restocked and all are working at the correct temperatures. A new Insectocuter has been purchased and is working. In addition a deep clean of the kitchen will be arranged next week and at 6 monthly intervals. A monitoring system has been set up to ensure that kitchen cleaning and hygiene will be maintained at a consistently high standard in the future. In the AQAA, to demonstrate what the home does well, the manager stated that: We believe that our residents can have confidence in the care home because it is led and managed in their best interests by myself and my senior team who know how to provide high quality support. I am totally committed to providing the best possible care for the residents. I am always available and offer an open door policy. My philosophy is that people come first. I try to be friendly and open and I do not just accept things but deal with them in an open minded and objective manner. All interactions observed between the staff and residents were inclusive, caring and respectful. Care Homes for Older People Page 30 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 The registered person must not provide accommodation to a resident unless the personal, health and social care needs of the resident have first been fully assessed by a suitably trained or qualified person. In order that prospective residents can be confident that their needs can be met. 22/11/2008 2 12 16 The registered person must 22/01/2009 further develop the homes activity provision and ensure the each resident has opportunities to engage in meaningful activities within the home and to participate in local, social and community activities. In order that residents are able to participate in activities that meet their own preferences, interests and expectations and that takes into account any Care Homes for Older People Page 32 of 35 special needs they may have related to sensory impairments, physical ability, dementia and other cognitive impairments. 3 29 19 The registered person must ensure that the homes staff recruitment procedures and practices are in line with the requirements of the Care Homes Regulations 2001 as amended by The Care Standards Act 2000 (Establishments and Agencies) (Miscellaneous Amendments) Regulations 2004. In order to protect the residents from the potential risk of harm or abuse. 4 38 13 The registered person must 22/11/2008 ensure that robust measures are put in place to monitor staff understanding of and adherence to all legislation related to the safe handling, storage and preparation of food. In order to ensure that residents can be confident that the home takes all necessary steps to protect their health, safety and welfare. 22/11/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 38 It is recommended that the registered person consult with Care Homes for Older People Page 33 of 35 the local Environmental Health Officer with regard to the refurbishment of the kitchen, especially in relation to the layout and current position of the staff room. Care Homes for Older People Page 34 of 35 Helpline: 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 We want people to be able to access this information. 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