Inspection on 10/07/08 for Beech House (Exeter) Ltd

This inspection was carried out on 10th July 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Beech House (Exeter) Ltd 12/07/07

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Beech House (Exeter) Ltd 157-159 Magdalen Road Exeter Devon EX2 4TT Lead Inspector Ms Rachel Fleet Unannounced Inspection 10 July 2008 8.45 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 (Exeter) Ltd DS0000069035.V363771.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Beech House (Exeter) Ltd DS0000069035.V363771.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beech House (Exeter) Ltd Address 157-159 Magdalen Road Exeter Devon EX2 4TT 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) 01392 215989 Beech House [Exeter] Limited Daniel James Wilson Care Home 23 Category(ies) of Dementia (23), Dementia - over 65 years of age registration, with number (23), Mental disorder, excluding learning of places disability or dementia (23), Mental Disorder, excluding learning disability or dementia - over 65 years of age (23) Beech House (Exeter) Ltd DS0000069035.V363771.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Client groups (MD) Mental Disorder and (DE) Dementia (50 years and over). Date of last inspection 12/07/07 Brief Description of the Service: ‘Beech House’ is very much a family business. The previous owners have worked at the home for several years, and are now the stakeholders in the limited company that is the current registered provider. The home provides accommodation, care and support for people with mental health problems over the age of 50 years, and for people with dementia over 65 years of age. They do not offer nursing care other than that which the community nursing services can provide, and do not offer intermediate care. On a bus route and close to some local shops, the home is on a main road in a residential area of Exeter, not far from the centre of the city. There is ample on site parking. Accommodation is on three floors. For those who cannot use the stairs on foot, there are stair/chair lifts between floors. The majority of bedrooms are for single occupancy, and some have en suite toilet facilities. At the rear, there is a large lawned garden, a patio area with seating, and a bird aviary. The weekly fees were £234-378 at the time of inspection. The fees do not include the cost of chiropody, hairdressing, continence products if not provided by local health services, health-related transport costs (to health check-ups, outpatient appointments, etc.), and newspapers. However, the fees include toiletries, most of the organised activities, and transport as well as admission fees for most social outings. Current information about the service, including the latest Commission for Social Care Inspection (CSCI) report, is kept in the home’s entrance hall, the lounge, and is also given to prospective residents. Beech House (Exeter) Ltd DS0000069035.V363771.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection took place as part of our usual inspection programme. There were 22 people living at the home on the day of our unannounced visit to the home, which took place over eight hours on a weekday. Most of the people living at the home were over 65 years of age. Daniel Wilson, registered manager, had previously returned a CSCI questionnaire about the home (the Annual Quality Assurance Assessment, or ‘AQAA’). This included their assessment of what they do well and their plans for improvement, as well as information about the people living at the home, staffing, policies in place, and maintenance/servicing of facilities. We had also sent surveys to the home for them to give to 10 people living at the home, 10 of their relatives/supporters, and to 10 staff. We received six back from people living at the home (who had been helped by staff to complete them), two from relatives/supporters, and two from staff. We also sent surveys to nine community-based professionals supporting people at the home, and received one back. We met eleven people who lived at the home, eight of whom gave us their views in more detail. We found out from them what it was like living at the home, and also did this through observations, talking with two care staff, and looking around the home. We also spoke with two visiting health professionals and the manager. We looked in more depth at the care of three people living at the home, by reading their care records and related information (personal monies records, etc.), and checking how their medication was managed. We met with them, spoke to staff about their care, and looked at the accommodation in relation to their needs. Staff recruitment and training files, quality assurance information and records relating to health and safety – such as accident and maintenance records were seen. We ended the visit by discussing our findings with the manager. Information included in this report is from these sources and from communication with or about the service since our last inspection. Beech House (Exeter) Ltd DS0000069035.V363771.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Beech House (Exeter) Ltd DS0000069035.V363771.R01.S.doc Version 5.2 Page 7 Care plans are much more comprehensive and person-centred, ensuring each person is cared for as an individual. They have been reviewed regularly, so reflect current needs and care. Aspects of medication handling, recording and storage – as identified at our last inspection - have been improved, although further action is necessary (see below). The complaints policy has been amended to include timescales, so people can be sure of when they will get a response to any complaint they make. Recruitment procedures are more robust, protecting people from unsuitable staff. Fixtures and fittings such as lighting and call bells are checked regularly, to ensure prompt attention to any repairs needed. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Beech House (Exeter) Ltd DS0000069035.V363771.R01.S.doc Version 5.2 Page 8 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 (Exeter) Ltd DS0000069035.V363771.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. The home does not offer intermediate care. Quality in this outcome area is good. Prospective residents’ needs are fully identified and considered, promoting the success of any eventual admission to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Someone relatively new to the home said they had visited the home before moving in. We saw a comprehensive pre-admission assessment of their care needs, carried out by the manager and another senior staff from the home who had gone to meet them in their previous care setting. There was related information from Social Services care management staff. Having spoken with this person, we found the assessment reflected their mental and physical needs well. Staff told us they knew about people and their needs before they moved in, the manager alerting them that the written assessment, etc. was available to them. Beech House (Exeter) Ltd DS0000069035.V363771.R01.S.doc Version 5.2 Page 10 We saw a copy of a letter that had been sent to the person before their admission, regarding admission arrangements and confirming the home could meet their assessed needs. This showed the home has continued to improve its admission processes. The letter stated the weekly fee, and offered a choice of bedrooms; the person was invited to visit the home again before making a decision, because it had been some months since their first visit. A copy of the letter had been sent to the Social Services Care manager, who was helping them find a care home. Other information sent with the letter was also listed – a copy of the home’s assessment of the person’s care needs, the proposed care plan to meet those needs, the Service User’s Guide, and our latest inspection report. All eight surveys from people living at the home said they got enough information about the home before they moved in, as was reflected by two relatives/supporters of people at the home. Daniel Wilson, the manager, told us in other conversation that although people had been referred to the home when it had vacancies, some of these people had not been offered a place, even though that meant some vacancies remained for a while. Senior staff had felt some had different needs to existing residents, which could have affected the lives of those already living at the home. We saw recently updated versions of two people’s contracts in files we looked at, which gave clear information about the terms and conditions of admission to the home. Most surveys from people living at the home said they had a contract, although two said they did not. Beech House (Exeter) Ltd DS0000069035.V363771.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 – 10. Quality in this outcome area is good. Development of care plans is helping to ensure each individual’s needs are met in a person-centred way, although further work is needed to some to give staff all the information they need to meet people’s needs consistently. Their health needs are met through good multidisciplinary working. Medication is generally well managed, promoting peoples’ wellbeing, although some changes to current practices will promote overall safety of procedures. There is good respect generally for peoples’ privacy, ensuring their dignity is upheld. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People we spoke with were satisfied with the care they received. Two relatives/supporters of people living at the home and a community-based professional thought the home usually or always met the needs of the people they supported. Staff we spoke with described peoples’ routines, preferences and support needs, appearing to understand and accept them as individuals. Beech House (Exeter) Ltd DS0000069035.V363771.R01.S.doc Version 5.2 Page 12 Care records we looked at included detailed comprehensive care and support plans, based on the individual’s needs. Their social, physical, personal and mental health needs were included. We saw the manager was beginning to ask and include whether or not people had any spiritual needs and related practices, as well as any wishes to be followed should their health deteriorate, or in the event of their death. Care plans had been reviewed monthly, again with some evidence from records and from one person we spoke with that people were consulted about their planned care and changes made to it. We also saw that people’s needs and care were re-assessed if they were in hospital, in consultation with other professionals supporting the person concerned. The manager then confirmed that the home could still meet their needs before the person returned to the home. Of three people’s files we looked at, there was no photograph of two of the individuals concerned. For one of these, a risk that they might go missing had been identified prior to admission (although this had not been a concern since), so a recent photograph was particularly important. Information recorded by staff had been signed and usually dated, although in places the full date was not included. The manager said he would address these two matters. A visitor to the home told us their relative often declined help they needed from staff with personal care, going on to say, “Difficult to resolve, but the staff still manage to keep them well turned out.” We spoke with community nurses who visited some people at the home daily. They were positive about the way staff at the home communicated with them and sought their advice; they said they were contacted in a timely way, and had no concerns about the home. They confirmed they regularly visited certain people with diabetes, as individuals had told us, reviewing relevant records kept by staff. We saw risk assessments for certain potential health problems were used monthly. The manager said they had discussed their scores generally with a community nurse, who thought the scoring was not as was commonly used and generating higher scores than usual. He was going to clarify this further. We saw a nutritional assessment for someone newly admitted to the home, and that their weight had been recorded on their admission. The manager was introducing these for each person living at the home. One person attended a local club that helps people control their weight. Care notes showed people had been seen by their GP, Community Psychiatric Nurse or district nurse in recent months. Some had been seen by the visiting optician, who was expected back soon to complete more eye checks. Beech House (Exeter) Ltd DS0000069035.V363771.R01.S.doc Version 5.2 Page 13 Most people we spoke with were given their medication by staff. They said they were happy with this arrangement and felt staff dealt with it well. Medication records showed sleeping tablets prescribed for individuals to take ‘when required’ had been taken only on some nights and not regularly, which is a good practice. Medication records for people who were self-medicating had been improved since our last visit, with records now kept of medication handed to the person. The manager signed to verify this had taken place, but agreed that it would be wise to obtain two signatures as confirmation. He undertook ordering and recording of medication received into the home, and arranged return of unwanted medication to the pharmacy. We discussed that involving a second person in medication management would be good practice and have various benefits. A staff member we spoke with said they had had medication training from the supplying pharmacy and that the manager had observed their practice to ensure they were competent to give out medication. They described safe practices generally (including for giving people controlled drugs), although some medication was given out from a container that was not lockable. The manager agreed to remedy this. The controlled drug storage facilities, although in themselves robust, were not secured to a solid surface when we first checked them. This has since been corrected. Records for controlled drugs we checked were appropriately kept and tallied with the stocks held. A lockable medication fridge had been obtained recently because someone now required regular medication that needed cold storage. Records of daily temperature readings showed recommended levels for such storage. We advised daily minimum/maximum readings had to be recorded also, to ensure this medication was continually kept at appropriate temperatures to avoid changing its effectiveness. We saw curtains had been fitted around the washbasin areas in double bedrooms, since our last visit, so that people could have privacy. People told us the home had a cordless phone they could use. Surveys indicated people felt staff respected peoples’ privacy; community nurses said there was a dedicated room they could see people in private. Beech House (Exeter) Ltd DS0000069035.V363771.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 – 15. Quality in this outcome area is good. People are encouraged to exercise choice and have control of their lives, maintaining their independence. The home provides support and recreational opportunities that ensure peoples’ lives are enriched by fulfilling activities and relationships, although ongoing attention to this will benefit a few individuals. Good catering arrangements ensure people are offered an individualised, varied and balanced diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Bingo, board games, and specific TV programmes were offered, depending on people’s interests. Someone from the local community held flower-arranging sessions. Staff told us that activities were based on suggestions made at residents’ meetings or through people being asked if they wanted more of what was already offered. We saw from people’s care notes that their interests in music were used therapeutically and to help them, for example, join their peers for certain occasions. A staff member felt the art group helped give people a sense of Beech House (Exeter) Ltd DS0000069035.V363771.R01.S.doc Version 5.2 Page 15 being valued because their work was shared with and appreciated by other members of the group. An aquarium had been set up, as a result of suggestions by people living at the home. Ministers from two local denominations had recently visited people at the home, and staff told us some people from the home attend local churches. During our visit, some people went out independently to the shops, etc., as one of them told us they did regularly. One person we spoke to said they went to a social club regularly; someone else said the club they used to go to had been closed, so they didn’t go to one any more. When asked if there was anything that might be improved at the home, one person said organised activities or things to do. Others said they had enough to do with their time; replies in surveys we received said there were always or usually activities arranged by the home that the individual could join in with. Two relatives/supporters of people living at the home said the home kept them up to date with important matters relating to the person at the home, and helped that person keep in touch with them. They felt staff helped people to live the life they chose. When we asked about maintaining links with the church someone used to belong to, the manager told us the church band came to play for them on their birthday. People told us they liked the food provided. The two-week menu we saw had a variety of dishes, mostly traditional fare (roast dinners, fish, etc.), with the main meal at lunchtime. A fruit bowl was in the lounge, for people to help themselves from. Some people said staff made them snacks if they wanted one. During our visit, we saw at least two dishes were offered at lunch - chicken curry and ham salad, with lasagne or sausages available also. Individuals were given variations according to their specific requests for the meal. Prawn salad and scones with cream were served at teatime. People with diabetes were given alternative, low sugar, puddings where necessary. Beech House (Exeter) Ltd DS0000069035.V363771.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. People are confident that they are listened to and complaints will be properly dealt with. Staff have good understanding of safeguarding issues, which helps ensure people are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People we spoke with felt able to complain, and felt they would be listened to. They said Daniel (Wilson), the manager, would deal with complaints properly. A community-based professional said the home had usually responded appropriately if they or a person using the service had raised concerns about their care. This was reflected by the relatives/supporters of two people at the home, who confirmed they knew how to make a complaint. The complaints procedure had been revised since our last inspection to include timescales for responses to complaints. It was by the Visitors’ signing in book when we arrived, and staff told us it was on the back of every person’s bedroom door (as we saw in the rooms we visited). Staff also said they would inform the manager of peoples’ concerns or complaints, if they became aware of them. We have not received any complaints about the home since our last inspection. Beech House (Exeter) Ltd DS0000069035.V363771.R01.S.doc Version 5.2 Page 17 People asked said they felt safe with staff, and felt safe at the home. Staff that we spoke with, including those new to the home, showed a good level of knowledge on safeguarding and local reporting procedures. When we asked one staff member about how they responded if someone was aggressive towards them, they linked this to safeguarding procedures. They also said they would not respond in a similar manner, but would try to find out if there was an underlying problem or reason that they could address. And if not, they would leave the person, telling them they would return again. Current guidance from the local authority and Department of Health were displayed in the office, and the manager was aware of his responsibilities. However, he intends to undertake the local authority’s safeguarding training within six months, to ensure his knowledge is up-to-date, in the light of developments in safeguarding matters. Beech House (Exeter) Ltd DS0000069035.V363771.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. Quality in this outcome area is good. People benefit from pleasant, clean and homely accommodation, due to ongoing improvements that ensure their continued comfort and safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People we asked liked their own accommodation. Bedrooms were very individual, both in size or layout and in that people had their own possessions as they wished, reflecting their personalities, life histories, preferences and interests. Most people had a key for their bedroom. One person new to the home said they had asked for two chairs in their room when they moved in, which were readily provided. One lounge was being used during our visit, and people also used the dining room as an area to sit and chat with peers, often on their way out to or Beech House (Exeter) Ltd DS0000069035.V363771.R01.S.doc Version 5.2 Page 19 returning from the shops. As a relative reflected, the dining areas looked welcoming, with tables set with tablecloths, etc. The décor in these rooms and adjoining hallways was pleasant and well maintained, with a variety of pictures throughout the home adding interest. Shared bathrooms and toilets had been decorated in the last year, so they also looked bright, colourful, and less institutional. Some used the garden if they wanted a smoke; a gazebo has been put up to provide cover if needed. The manager was considering providing a lounge solely for smokers to use, since one lounge was unused. Adaptations included handrails, fixed bath hoists, and gliders on some dining chairs to help people move them when sat. Signs had been put up to help some people find their way to their own bedroom. People felt the home was a safe place to live in that there were no hazards such as damaged carpets, furniture or fittings needing replacement or attention, etc. At our last inspection, people told us about certain repairs that were needed. On this visit, they told us there were no such problems. The AQAA stated that maintenance checks had been introduced since our last visit. Communal areas of the home looked clean. Although some bedrooms looked as though they were still to be vacuumed, people said they were satisfied with the usual level of cleanliness. We saw staff wore disposable gloves and aprons for aspects of care. Antiseptic hand gels were available around the home. Staff we asked were able to describe good practices when using such infection control measures, such as washing their hands after removing gloves. They also told us about the home’s procedures for disposal of clinical waste. Since our last visit, hand-cleansing facilities have been provided in a new sluice room. There were cleaning instructions for staff, in shared facilities such as bathrooms and toilets. The laundry area was orderly, with handwashing facilities, washable floor and wall surfaces, and appropriate washing machine programmes for proper cleaning of laundry. Staff described appropriate procedures for handling soiled laundry. Beech House (Exeter) Ltd DS0000069035.V363771.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 – 30. Quality in this outcome area is adequate. People’s basic needs are met by caring and committed staff, who have time for people and who are very well supervised. Staff would benefit from more training related to basic skills and peoples’ individual needs. This would ensure the home can provide the mental health care service it offers, and safely meet people’s diverse or changing needs. Recruitment practices have improved, to better protect people from unsuitable staff, although related record-keeping needs attention. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People we asked felt there were enough staff around, and that they had the skills and abilities needed to do their job and meet people’s diverse needs, as did relative/supporter who returned surveys. A group in the lounge were very positive about the staff, including new staff and staff from overseas in this, one saying they couldn’t ‘sing their praises enough’. One person said both night and day staff were very good, adding the night staff made them a snack if the person couldn’t sleep and got up in the night. The manager said there were no staff who worked solely on night shifts i.e. they also worked day shifts, helping them keep fully informed about the people they support. Beech House (Exeter) Ltd DS0000069035.V363771.R01.S.doc Version 5.2 Page 21 Unlike on our last inspection, no-one said staff were too busy. Staff appeared organised, and were friendly in their interactions with individuals. Even though no staff have left since our last inspection, two new care staff have been employed. When asked if there were enough staff to meet the individual needs of all the people living at the home, staff said always or usually, with one adding, “The manager arranges extra cover if a service user’s health deteriorates.” The manager also gave examples of extra funding negotiated with Social Services for staffing, to ensure individuals’ diverse needs were met. On the day of our visit, there were two care staff on duty when we arrived, looking after 22 people. They were supported by a cook and a cleaner. People sitting in the lounge told us more staff were due in shortly, and three care staff, the two former owners (who helped with the cooking, administration and maintenance), and the manager had arrived by 9am. There were three staff on duty in the afternoon/evening, with the manager staying until 6pm. From 10pm, there was one awake night staff rostered, with another sleeping in to assist people if needed. Staff files for people employed since our last inspection had most of the required recruitment information, including full employment histories and references relevant to the post for which people were applying – an improvement since our last inspection. However, full police checks had been received some time after two individuals had begun working at the home, with no evidence of an earlier initial police check. On our last inspection, we saw these had been obtained for other staff. The manager thought the information must have been removed, in error, when the full police check was filed, and told us he would try to get copies. A new staff member with social care experience told us they had had a useful and practical induction, with a record of it seen in their file. They had worked with senior carers and the manager, with their own practice observed eventually to check they were competent. They had immediately commenced an accredited care qualification instead of a recognised induction programme, on the advice of the training company used by the home. Most people at the home lived there because of their mental health needs; few had needs related to dementia. Several had developed physical health needs also. Health professionals we spoke with said the home always sought advice in a timely way, and acted on it. One said staff certainly knew the residents well. A mental health professional said the home usually met peoples’ health care needs, with staff usually having the right skills and experience to support individuals’ social and health care needs. Beech House (Exeter) Ltd DS0000069035.V363771.R01.S.doc Version 5.2 Page 22 We saw a training plan for 2008, giving an overview of the updating staff were to have or had received. This reflected what staff told us - that they had had training or updates on health and safety topics, but not on topics specifically relevant to the needs of people living at the home, such as diabetes, epilepsy and mental health conditions. Although the manager said staff researched specific areas and shared their new knowledge with other staff at staff meetings, this was not mentioned by staff or reflected in staff training records. We saw person-centred care was a topic for later in the year. There was information about dementia, and relevant new legislation (the Mental Capacity Act 2005), displayed in the office. Staff told us the manager was trying to source training on mental health care and some physical conditions of older age. Five of 12 care staff were undertaking a recognised care qualification (NVQ 2 or NVQ 3 in care). The staff file of one person we spoke with had no evidence of person-centred training since 2003, and another had had no such training for over a year, but both were currently undertaking the qualification. Some staff from overseas had healthcare or other professional qualifications from their country of origin, but were also working towards this qualification. Staff surveys and those we spoke with said they had regular support from the manager, and received training relevant to their job. Some also said the manager was always on call, to give advice and come to the home if necessary. Staff files we looked at had records of supervision sessions, often where the manager had observed people’s practice and given constructive feedback. There were regular staff meetings, which staff said were two-way discussions between senior staff or the manager and other staff. Beech House (Exeter) Ltd DS0000069035.V363771.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is good. People benefit from person-centred management of the home, which ensures it is run in their best interests. There is attention to health and safety matters, although further action is needed to ensure the continued welfare of everyone at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Daniel Wilson, the registered manager, has a recognised care qualification and has managed the home for some years. He is undertaking a care management course, hoping to complete it before the end of this year. People living at the home said he was nice, very understanding, helpful, and knew his job. Beech House (Exeter) Ltd DS0000069035.V363771.R01.S.doc Version 5.2 Page 24 Requirements and most recommendations made at the last inspection had been addressed. We found improvements to the service or facilities were as described in the home’s AQAA, positively affecting every section of home life as given in the National Minimum Standards for care homes for older people. Such improvements have been included throughout this report. Staff told us they took turns in leading residents’ meetings, which were held at least monthly. We saw from notes made at these that people’s comments and suggestions were used to develop or improve the service, with the manager’s action plan attached to the notes. The AQAA confirmed that the outdoor smoking area is now cleaned regularly, as requested at a meeting, for example. The area appeared well kept during our visit. Notes of meetings were available in the main lounge, with our inspection report, blank questionnaires from the home about the service they provide that people could fill in if they wished, comment cards for people to complete, a national Code of Conduct for social care staff, and the home’s complaints procedure. The manager told us that surveys had recently been sent to professionals who were involved in the care of people living at the home. We saw one that had been returned from a health professional, which was positive about the home; we found that their one suggestion for improvement had been addressed. People’s Social Security benefits were paid into a bank account set up by the home solely for residents’ monies, and given to most people on the same day as we saw during our visit. People we asked confirmed they were satisfied with existing arrangements. One of the previous registered providers still acted as appointee for one person, who had no next of kin wishing to take on this role. We looked at records for personal monies held by the home for two people who were currently unable to look after it themselves. Receipts were available for spending shown. There had been little expenditure, but we noted two signatures had not always been recorded to verify the transactions shown. The manager said he would ensure this was rectified. The kitchen areas and equipment were clean. Food portions in fridges were covered and dated. The AQAA stated that routine maintenance checks are now carried out. It gave dates indicating that facilities such as gas-fuelled systems and water supplies had been properly serviced or checked in the last year. Labels on portable electrical equipment showed that their safety had been tested within the last year. New staff were aware of their responsibility to report hazards or anything needing repair, saying these were dealt with promptly. Beech House (Exeter) Ltd DS0000069035.V363771.R01.S.doc Version 5.2 Page 25 Windows were restricted for safety where we checked them at random. The manager confirmed that checks were carried out regularly on the restrictors, although no record was kept of this. We saw thermometers in bathrooms, which the manager said staff used to check bath water temperatures before people got in, although thermostats were fitted to control the hot water supply. Hot water temperatures were appropriate where we checked them, but no checks were made regularly to ensure these were still effective (in case anyone ran a bath independently). We noted two fire doors weren’t shutting properly. This was corrected during our visit. The manager told us such doors were checked during the weekly fire alarm test, and said he would remind staff to be vigilant and report such issues. Two people had propped their bedroom doors ajar with footwear. We subsequently spoke with a local Fire Safety Officer, who advised that safer methods are available for holding doors open. All staff had just had manual handling training. Although all staff undertake a first aid course, a risk assessment had not been carried out for the home relating to first aid arrangements at the home, to establish what was needed. Beech House (Exeter) Ltd DS0000069035.V363771.R01.S.doc Version 5.2 Page 26 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Beech House (Exeter) Ltd DS0000069035.V363771.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No 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 OP38 Regulation 13(4)(c) Requirement You must ensure that unnecessary risks to the health or safety of people living at the home are identified and so far as possible eliminated – particularly fire safety in regard to appropriate door holders, seeking advice from the local fire authority as necessary. Timescale for action 31/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations It is recommended that you ensure all care plans a) Are based on the comprehensive pre-admission assessment; b) Detail the action which needs to be taken by care staff to ensure that all aspects of the individual’s diverse personal and social care needs are met, & c) Agreed and signed by the individual whenever capable, and/or their representative (if any). DS0000069035.V363771.R01.S.doc Version 5.2 Page 28 Beech House (Exeter) Ltd 2 OP9 3 4 5 6 OP28 OP29 OP30 OP38 It is recommended that you ensure that there is are robust policies & procedures for the receipt, recording, storage, handling, administration and disposal of medicines, including: a) Robust medication management that involves more than one person (in obtaining & disposing of medication, verification of medication given to people who are self-medicating, etc.); b) Ensuring medication is stored safely, according to legislation and professional guidance, including controlled drug storage and medication during administration; c) Daily minimum/maximum readings of items kept in a fridge, to ensure medication is continually kept at appropriate temperatures to avoid changing its effectiveness. It is recommended that a minimum ratio of 50 trained members of care staff (NVQ Level 2 in care or equivalent), excluding the registered manager, be achieved. It is recommended that you operate a thorough recruitment procedure with evidence of all the required information including POVA First checks. It is recommended that staff undertake training in mental health care and other topics relevant to the individual needs of current or potential users of the service. It is recommended that you keep evidence that the health, safety and welfare of service users and staff are promoted and protected, especially with regard to: a) Risks from hot water (i.e. temperatures above 43°C), & b) Maintenance of window restrictors, Based on assessment of vulnerability of and risk to service users. Beech House (Exeter) Ltd DS0000069035.V363771.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Beech House (Exeter) Ltd DS0000069035.V363771.R01.S.doc Version 5.2 Page 30 - 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. 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