Inspection on 12/07/07 for Beech House (Exeter) Ltd

This inspection was carried out on 12th July 2007.

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

The inspector 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 10/07/08

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Beech House (Exeter) Ltd 157-159 Magdalen Road Exeter Devon EX2 4TT Lead Inspector Ms Rachel Fleet Unannounced Inspection 12th July 2007 9.00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Beech House (Exeter) Ltd DS0000069035.V338344.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.V338344.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.V338344.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 28.11.06 Brief Description of the Service: The last inspection (see above) was carried out under the previous ownership arrangements. Since then, a limited company has been registered as the home’s registered providers or owners, although the management team has remained the same. The home is very much a family business, with the previous registered providers’ family working there for several years. They are now the stakeholders in the owning limited company. Beech House is a care home 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 district nursing services can provide. And they do not offer intermediate care. On a bus route and close to some local shops, the home is not far from the centre of Exeter. There is ample parking space at the front of the home. At the rear, there is a large lawned garden, a patio area with seating, and a bird aviary. 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. The weekly fees were £270-373 at the time of inspection. Additional costs, not covered in the fees, include chiropody, hairdressing and personal items such as toiletries and newspapers. Current information about the service, including the latest Commission for Social Care Inspection (CSCI) report - which is also kept in the home’s entrance hall - is given to prospective residents. Beech House (Exeter) Ltd DS0000069035.V338344.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place as part of the usual programme of inspection. The unannounced site visit took just over eight hours. There were 22 people living at the home on the day, the majority being over 65 years of age. Two went out for the day as we arrived, with others going out during the day as they wished. Prior to the site visit, the manager Daniel Wilson had provided information about the management of the home, an assessment of what they do well, and their plans for improvement. The Commission had also sent surveys to 10 people who lived at the home, with six being returned. One of five surveys sent to staff was returned. Of surveys sent to five health and social care professionals (including GPs, community psychiatric nurses and care managers), two were returned - neither raising any concerns about the home. We looked closely at the care and services offered to three people as a way of judging the standard of care and services generally. This group included men and women, people new to the home, someone who did not have any visitors, and people with more complex physical or mental health needs. Where possible we spoke with these people in depth, looked at their care records and related documents closely, and spoke with staff about their knowledge and understanding of their care. We looked at the environment in relation to their care needs. We spoke with ten other people around the home, either in lounges, the garden or their own rooms, with some observation of the care and attention given by staff. We also spoke with someone’s visitor, two visiting professionals, and staff - care staff, the manager and the Company’s representative, who was present in the role of cook. We visited communal and service areas such as the kitchen and laundry, and looked at other records including staff training and recruitment information, maintenance certificates and safety checks. We discussed our findings with the manager before leaving. Information gained from all these sources and from other information about the home given to the Commission since the last inspection is included in this report. We have not received any complaints about the home in that time. What the service does well: One person, when asked this question, said, “They are improving things all the time. They are keen on getting everything comfortable for people - especially helping new people.” Prospective residents’ care needs are assessed well by the home, which also promotes the success of their admission to the home if they choose to live there. Beech House (Exeter) Ltd DS0000069035.V338344.R01.S.doc Version 5.2 Page 6 Ongoing improvements have helped to provide a pleasant, clean and homely place to live. One person particularly appreciated the redecoration of the lounge, the new armchairs, and they thought the dining room was brighter new furnishings having been provided. People benefit from good management of the home, with efforts taken to make sure it is run in their best interests. People are enabled to have choice and control of their lives, with respect for their privacy, and promotion of their dignity. Staff have good understanding of safeguarding issues, helping to protect people from abuse, whilst staff numbers, level of basic skills and supervision ensure that peoples’ needs are met safely. Their health needs are met through good multidisciplinary working. And catering arrangements ensure people are offered a balanced diet that includes their preferred foods. A staff member felt the home was good at providing a variety of recreational activities that people really enjoyed. This was reflected by those living at the home, who also benefited from fulfilling old and new relationships. What has improved since the last inspection? What they could do better: Two people living at the home said there was nothing to complain about. A third said, “They’re doing as much as they can for me.” One person felt they could be consulted a bit more, but was not more specific. Beech House (Exeter) Ltd DS0000069035.V338344.R01.S.doc Version 5.2 Page 7 Whilst people are confident that the home takes complaints seriously, some additional information in the written complaints procedure would clarify the response they can expect. Some care records must have additional detail to inform staff better about individuals’ needs and how to meet them, so that all their needs are met and met in a consistent, person-centred way. More staff training in mental health care would further ensure the home is able to provide the mental health care service it offers. Aspects of how the home deals with medications must be improved to ensure they are safely used, promoting peoples’ welfare. Recruitment practices must be made more robust, to ensure people are suitable to work in the home. Some maintenance and other health and safety matters should be attended to in a timely manner, to ensure the continued welfare of everyone at the home. 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.V338344.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.V338344.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. This judgement has been made using available evidence including a visit to this service. Good systems are in place to ensure prospective residents’ needs are fully identified, promoting the success of any admission to the home. EVIDENCE: A person new to the home said they had visited the home before choosing to move in, and that the manager had met them to discuss what help they needed. A full assessment of their needs was seen in their care records, which included information from the person’s Social Worker and people who supported them previously. A staff member said they had been informed about people and their needs before the person moved in. The manager said a letter is now sent to people before their admission, regarding admission arrangements and confirming the home can meet their assessed needs – a new procedure since the last inspection. One current resident had been admitted since then but no copy of the letter was available Beech House (Exeter) Ltd DS0000069035.V338344.R01.S.doc Version 5.2 Page 10 at the home, although there was a copy of a letter sent to the person’s care manager confirming the home was offering to admit the person. If a copy were kept, staff could be clear about arrangements agreed with each new person. Beech House (Exeter) Ltd DS0000069035.V338344.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 adequate. This judgement has been made using available evidence including a visit to this service. Some care records do not adequately inform staff about individuals’ current needs or how to meet them, creating a risk that some of their needs may not be met, or needs may not be addressed in a consistent, person-centred way. Peoples’ health needs are well met through good multidisciplinary working. Medication is adequately dealt with, but some improvements must be made to fully ensure they are safely managed, to promote peoples’ welfare. There is good respect generally for peoples’ privacy, with promotion of their dignity. EVIDENCE: Office-held care plans generally gave staff sufficient information about peoples’ various needs. However, although the pre-inspection information said all Beech House (Exeter) Ltd DS0000069035.V338344.R01.S.doc Version 5.2 Page 12 people living at the home were Christians, two of three care records seen did not have any information about the individuals’ faith or otherwise. Two people confirmed they had copies of their care plan, with one saying they were always consulted when anything new arose that meant a change to their care. Two of the three care plans seen had been reviewed regularly with the person for whom they were written, to ensure planned care was still appropriate and agreed by the person who was needing support or care. However, some plans lacked detail of how staff should support people to meet the needs identified. For example, where someone might ask staff to stay with them, what staff should do in view of other care responsibilities. Or what they should do specifically, where a care plan said, “Support to ease depression”. Some records were not dated or signed, so it was not clear how current or relevant the information was. A third person’s care plan had not been reviewed recently, so although action was being taken to address their changing needs, records did not reflect the person’s current state of wellbeing or current daily routine. Also, some reviews lacked information about the outcome of previously recorded information or action taken. For example, whether a Community Psychiatric Nurse had been visited monthly as indicated in someone’s care plan. And someone said they would like to do more baking, after enjoying a cake-making activity, but there was no further reference to this. Care records included monitoring of skin condition in relation to risk of pressure damage and monitoring people for risk of falling. One person said the district nurses were getting them a pressure-relieving mattress. Health professionals (including a district nurse) were satisfied with the working relationship they had with the home, saying their advice and input was sought in a very timely way. A community-based psychiatric nurse felt the home was “very able in caring for/managing clients with challenging health issues”. Another said the district nurses regularly monitored their diabetes. People are weighed regularly, although this currently relies on them being able to use ‘stand on’ scales. There were no medication records available for one person who was selfmedicating, although their care plan indicated they were self-medicating, the person said they had a lockable facility to keep their medication in, and there were satisfactory records for another person who self-medicated. The manager said he would attend to the record-keeping issue, to ensure all medicines brought into the home were accounted for. Stock held by the home was kept securely. However, the fridge used to store medication was running at 12°C when seen - above recommended temperatures; no regular temperature records were kept, to ensure recommended storage temperatures were maintained. A staff member gave out medication appropriately – signing after individual people had taken their medication, etc. - apart from being seen to Beech House (Exeter) Ltd DS0000069035.V338344.R01.S.doc Version 5.2 Page 13 handle the tablets themselves during the process, which is not good practice. Records and stock levels for the one controlled drug in use were checked and found to be satisfactory. A female resident said only female staff helped her with personal care, as she wished. The manager is the only male member of the care staff; men living at the home who were asked did not have concerns about receiving care from female carers. People felt their privacy was respected, and said staff listened, doing as they were asked. A community-based professional observed during their visits that staff were respectful to the people they cared for, and that people living at the home seemed happy. Moveable screens are provided in shared rooms. However, in one of these rooms the washbasin was close to one bed, making it difficult to ensure privacy whilst using the basin. The manager said there were plans to rearrange the room specifically to address this problem. Beech House (Exeter) Ltd DS0000069035.V338344.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. This judgement has been made using available evidence including a visit to this service. The home provides good support and recreational opportunities, which ensure peoples’ lives are enriched by fulfilling activities and relationships. People are encouraged to exercise choice and have control of their lives, maintaining their independence. Good catering arrangements ensure people are offered an individualised, varied and balanced diet. EVIDENCE: People felt they had enough to do with their time. Several went shopping (independently) during the visit, it being the day that weekly allowances were available. Others enjoyed sitting out in the garden. A staff member spent time playing tabletop games with one person, the latter clearly getting enjoyment from this. One person was happy that they could help with the washing up and other household jobs. Beech House (Exeter) Ltd DS0000069035.V338344.R01.S.doc Version 5.2 Page 15 Someone said the home had taken them to the airport when they went to visit family abroad. There was evidence in care records that the home respected peoples’ personal relationships and peoples’ right to maintain friendships, providing sensitive support if needed. A visitor said they always felt welcome at the home. The manager said there is no regular church service at the home, but people currently go to local churches or are visited individually by their priest. People felt they were consulted regularly about their care. One person said the home had helped them find a new GP, whom they were able to see independently. They also said if they went out, the home always kept a lunch for them to have on their return, if they were late back. One person has been able to keep their pet with them at the home. The manager said it was now the home’s policy that no-one would share a room unless they wished to, and those currently in shared rooms would be offered single rooms when they became available. People said the food was ‘ok’, ‘very good’, that it had ‘got better’, with choices and alternatives provided. We saw a variety of meals were served at lunch during the visit, with regard for peoples’ preferences. Tables in the dining room were set with linen, drinks, etc., and it was a well-managed social occasion. One person said they didn’t like the food much, but declined to discuss this further. The manager said he was aware, referring to recorded information about the person’s previous diet, and he had asked for input from communitybased professionals. Fresh fruit was seen in the kitchen, with the cook saying fruit and vegetables were delivered twice a week, and people confirming they were provided regularly at meals. Beech House (Exeter) Ltd DS0000069035.V338344.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. This judgement has been made using available evidence including a visit to this service. People are confident that complaints are taken adequately seriously, although some additional information in the complaints procedure would clarify the response they can expect. Staff have good understanding of safeguarding issues, which helps ensure people are protected from abuse. EVIDENCE: One person said they would raise any concerns or complaints with certain staff members with whom they had a good relationship. Others also felt able to complain, and felt they would be listened to. One showed us the complaints procedure, which was on the back of their bedroom door (and seen in all rooms visited). This has been revised since the last inspection but it still did not include timescales for responses to complaints. The manager said he would address this. The home’s complaints log was seen, which included action taken to address complaints, and the manager intends to use a complaints audit tool as part of the home’s quality assurance procedures. People asked said they felt safe with staff, and felt safe at the home. One staff said they had not had training on protection of vulnerable adults. However, they were able to describe their responsibilities, and knew organisations that could be contacted if they had concerns they felt unable to speak to the Beech House (Exeter) Ltd DS0000069035.V338344.R01.S.doc Version 5.2 Page 17 manager about. Another staff who was new to the home said they were due to have relevant training during their induction, but they also showed a good level of knowledge on safeguarding. The home has a very readable policy, which has been revised since the last inspection to fully inform staff on relevant safeguarding matters. The manager has contacted relevant professionals to discuss upholding of an individual’s rights, because others were in effect suggesting some of the person’s rights should be removed because they were placing themselves at risk of harm. He thus ensured individuals receive appropriate support to exercise their rights but as safely as possible. One other concern about a person’s welfare is currently being dealt with under multidisciplinary safeguarding procedures. Beech House (Exeter) Ltd DS0000069035.V338344.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. This judgement has been made using available evidence including a visit to this service. People are benefiting from ongoing improvements, enjoying pleasant, clean and homely accommodation, although more adequate checks of fixtures and fittings would ensure peoples’ continued comfort and safety. EVIDENCE: People liked their own accommodation, and felt it was a safe place to live in that there were no hazards such as damaged carpets or unduly hot water. One person pointed out the radiator could be adjusted, and said their bedroom was always warm enough in winter. Most had a key for their bedroom door. Lockable facilities are on order, so that people can have their own safe storage for items of personal value, etc. The lounges have been redecorated since the last inspection. When asked about certain facilities, people in one lounge pointed out that some light bulbs Beech House (Exeter) Ltd DS0000069035.V338344.R01.S.doc Version 5.2 Page 19 (not in use during the visit) and the call bell were not working. The bulbs were replaced once brought to the attention of the manager, and he was going to address the call bell problem. A new person felt they would benefit if more grab rails or handrails were available in certain areas. The manager had already requested a full care management review regarding this person’s needs, but agreed to get specialist advice about this matter. The home - including shared bathrooms and toilets - looked clean. People said this was usually the case. And they confirmed staff wore disposable gloves and aprons for certain aspects of care, promoting infection control. Staff also said they had antiseptic hand gels, and described appropriate systems for disposal of clinical waste. We saw the contract for collection of such waste. We noted that a newly installed sluice room and a toilet had no hand-cleansing facilities, although there were facilities in two adjacent rooms. The manager agreed to seek advice about this, to ensure good levels of hygiene were maintained. The laundry area was orderly, with information available to staff on which of the machine programmes they should use to clean laundry properly. Beech House (Exeter) Ltd DS0000069035.V338344.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. This judgement has been made using available evidence including a visit to this service. Staff numbers, basic skills and supervision are good enough to ensure that peoples’ needs are met safely. However, more training in mental health care would further ensure the home is able to provide the mental health care service it offers. Recruitment practices do not adequately ensure people are safeguarded from unsuitable staff. EVIDENCE: Most people felt there were enough staff around, one saying they were always about, and that they had the skills or abilities needed to do their job. Two people felt there were staff shortages sometimes, partly due to care assistants having to carry out domestic duties. The manager confirmed he is trying to recruit domestic staff. One person said, “The staff are lovely.” Three felt one or two staff were not always sympathetic or patient (which one put down to staff being busy) but indicated they got on well with the rest of the staff. The manager said he would look into this. Four staff will be commencing a care qualification course in the next month. Although less than a quarter of the care assistants currently have an English care qualification, the staff from overseas have healthcare qualifications Beech House (Exeter) Ltd DS0000069035.V338344.R01.S.doc Version 5.2 Page 21 (nursing, etc.) obtained in their country of origin. The manager is going to clarify the equivalent level of these qualifications, to confirm the home is achieving the recommendation that at least half of staff have a care qualification at a specific level. Staff felt they got support either through one-to-one supervision, or through group meetings. Supervision notes were seen in staff files. There were regular staff meetings. A new staff member, who had a professional healthcare qualification obtained abroad, was undergoing a nationally recognised 12-week induction course. They said this had included some training on medication, and their practice had subsequently been observed to ensure they gave out medications correctly. A majority of people are living at the home because they have mental health needs (- few have dementia needs). Surveys from community-based professionals said staff demonstrated clear understanding of people’s needs, and the home took appropriate decisions when they could no longer manage the care needs of individuals. The manager confirmed he is still trying to source training on mental health care, to ensure staff are adequately trained and updated for their work. Staff recruitment files generally had required information. A staff member recruited since the last inspection had had a timely police check. However, there was a two-year gap in one person’s employment history without any record that this had been explored with the candidate. It was also seen that some references for people who had been recruited through an agency were addressed ‘to whom it may concern’, without evidence that the agency had checked the authenticity of these references. Beech House (Exeter) Ltd DS0000069035.V338344.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from good management of the home, which is working hard towards trying to make sure it is run in their best interests. There is adequate attention to health and safety matters, although certain responsibilities must be carried out in a timely manner to ensure the continued welfare of everyone at the home. EVIDENCE: The manager has a care qualification and has managed the home for some years. He has recently been registered by CSCI, confirming he is considered fit to run this home; however, he agreed to undertake a higher qualification to update and add to his existing knowledge, so he can fulfil the expectations of a Beech House (Exeter) Ltd DS0000069035.V338344.R01.S.doc Version 5.2 Page 23 registered manager. People who lived or worked at the home felt he was approachable and helpful. There was evidence that he has tried to address requirements and recommendations made at the last inspection. A newsletter was put in each lounge, informing people of planned events. The manager said there had been one residents’ meeting in recent months. Two people weren’t aware of this but said they wouldn’t go to them if they took place, saying they were regularly consulted about things, and, “Things are usually alright anyway.” People said the home sent round surveys, which could be completed anonymously. Few completed surveys had been returned to the manager, who was considering how to improve the response rate for the next survey that was due shortly. This was going to be sent to community-based professionals as well. The manager said the home does not keep personal monies for anyone – if Social Security benefits are payable to the home, they are obtained and handed straight to the person to whom they are due. People confirmed they were satisfied with existing arrangements, with two signatures seen recorded on individual records when the money was given to them. The home acts as appointee for only one person, who has no next of kin. A risk assessment had been completed and reviewed, where someone did not want their bedroom radiator covered, to ensure this was still a safe situation. One person confirmed staff always checked the temperature of the water before they were helped into the bath. Staff felt they had a safe work environment, with minor repairs attended to quickly, sufficient equipment and appropriate facilities to do their job safely. Fire safety systems had been tested at recommended intervals, and serviced in June 2007. The stair lifts and hoists were serviced during this visit. Testing of portable electrical appliances had not been done for over a year, and an electrical wiring certificate was not available. The manager said he was trying to set a date with a contractor to carry out these checks. Kitchen fridge and freezer temperatures were within recommended ranges during the visit, but temperature records had not been completed recently. Some food portions in the fridge were undated, which the manager said he would monitor since they were usually dated, to ensure food was safe to use. The home has guidance relating to food regulations issued in 2006, but still has to set up systems to show appropriate food safety practices are in place. This issue was raised at the environmental health officer’s last visit. The manager has agreed these would be in place by September 2007. Staff said they had manual handling training from an external training organisation; this had included use of the home’s hoist to help people up from the floor if they fell, as sometimes occurred currently, as well as encouraging people to move independently. The manager provides fire safety training for Beech House (Exeter) Ltd DS0000069035.V338344.R01.S.doc Version 5.2 Page 24 staff, which includes practicing use of fire extinguishers; he confirmed he is booked to attend a specialist course to ensure he is able to fulfil this role adequately. An overview of mandatory staff training was seen, which helps monitor that staff receive updates at recommended intervals. Beech House (Exeter) Ltd DS0000069035.V338344.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 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 2 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 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.V338344.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 15 Requirement You must a) Include sufficient detail in care plans, so that it is clear how individuals’ needs (including any spiritual needs) are to be met; b) Keep the care plan under review, so that it shows current needs & care; c) Use these reviews or evaluations of care to update care plans, showing that action has been taken as a result of reviews, where applicable; d) Sign and date information, - To ensure that people receive appropriate, person-centered and consistent care or support. 2 OP9 13(2) You must ensure there are 31/08/07 proper arrangements for the recording, handling & administration of medicines received into the home, so that a) All medication received into the home, even if it is to be selfadministered by individuals living at the home, can be accounted for; b) It is stored as recommended DS0000069035.V338344.R01.S.doc Version 5.2 Page 27 Timescale for action 31/10/07 Beech House (Exeter) Ltd by manufacturers, with regard to storage temperatures, etc., to ensure its effectiveness; c) Administering staff & recipients are not put at risk through handling of tablets - To fully ensure medication is safely managed. 3 OP29 19 You must ensure that all documentation listed in Schedule 2 of the Regulations – which includes a full employment history, together with a satisfactory written explanation of any gaps in employment - is held in respect of anyone working at the home. And you must be satisfied on reasonable grounds as to the authenticity of the references referred to in paragraph 5 of Schedule 2 - To ensure that people are fit to work at the home. 31/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP16 OP19 Good Practice Recommendations It is recommended that the complaints policy be amended to include timescales. It is recommended that fixtures & fittings such as lighting & callbells are sufficiently checked, and people are offered lockable storage in their rooms, to ensure there are adequate facilities. It is recommended that staff undertake training in mental DS0000069035.V338344.R01.S.doc Version 5.2 Page 28 3 OP30 Beech House (Exeter) Ltd 4 OP38 health care. It is recommended that more timely action is taken with regard to health & safety matters, particularly testing of portable electrical appliances & electrical wiring circuits. And that food safety practices are established in line with the guidance ‘Safer food, Better business’ (Jan. 2006). The manager agreed these would be in place by September 2007. Beech House (Exeter) Ltd DS0000069035.V338344.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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.V338344.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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!