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Inspection on 20/06/05 for Beech House, South Molton

Also see our care home review for Beech House, South Molton for more information

This inspection was carried out on 20th June 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides comfortable, safe accommodation for residents. Residents can choose to spend time in their own private rooms or in a variety of comfortable shared areas. The enclosed courtyards are attractive and provided with seating and shade. Residents say that staff are kind, polite and treat them with respect. One resident commented that "nothing is to much trouble" for staff. Staff usually have time to do activities with residents. One resident who had been having a respite stay at the home said they were "hoping to come back again". Residents say that the food provided is tasty and varied.

What has improved since the last inspection?

The ratio of staff to resident is generally higher allowing them more time to spend with residents doing activities.

What the care home could do better:

For residents with more complex needs care plans need to be more detailed to help ensure staff know how to care for them properly. Where residents manage their own medicines their ability to do this safely should be properly assessed so support can be given if needed. Evidence that proper recruitment procedures are being followed to protect residents from people who should not work in care, should be kept in the home.To confidently meet the needs of resident with dementia staff need more specialist training. Fire extinguishers should be check regularly as recommended by fire officer to help minimise the risk of fire within the home.

CARE HOMES FOR OLDER PEOPLE Beech House North Road South Molton Devon EX36 3AZ Lead Inspector Stephen Spratling Unannounced 20 June 2005 10:00hrs The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Beech House D54 D06_s39190_beechhousesouthmolton_v228876 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Beech House Address North Road South Molton Devon EX36 3AZ 01769 572124 01769 572996 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Devon County Council Judy Ann Flanagan Care Home 37 Category(ies) of OP Old age (37) registration, with number of places Beech House D54 D06_s39190_beechhousesouthmolton_v228876 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 18 November 2004 Beech House D54 D06_s39190_beechhousesouthmolton_v228876 stage 4.doc Version 1.30 Page 5 Brief Description of the Service: Beech House is a care home providing personal care and accommodation for up to 37 older people. Most people live at the home on a long term basis, but short stays are avaiable. Many of the people living at the home need care as they have been diagnosed as having Dementia. An application to vary the registration of the home to register it as a specialist home for people with dementia, as well as for older people with problems that relate to old age, is currently being considered by CSCI. The home is owned by the Local Authority, Devon County Council and is centrally located in South Molton, North Devon. First opened in 1975 the home consits of a two storey purpose built buililding which is close to shops and local amenities. All service user accommodation is on the ground floor with private accomodation provided in single bedrooms. There are 3 lounges, 3 dining rooms, 2 conservatories and a quiet room for residents shared use. The home is divided into three wings, Verney, Loosemore and Carter.The home is surrounded by its own grounds, which are easily accessible. Beech House D54 D06_s39190_beechhousesouthmolton_v228876 stage 4.doc Version 1.30 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out by one inspector, Stephen Spratling, it was started at 10.15 am and finished at 2.45 pm. The inspector spoke with nine of the residents. He also met with six of the care staff, speaking to four in private, one of the cleaning staff and the home’s registered manager, Judy Flanagan. During the day all of the shared areas of the home were looked at and the inspector visited ten of the residents private bedrooms. A variety of records were also looked at. What the service does well: What has improved since the last inspection? What they could do better: For residents with more complex needs care plans need to be more detailed to help ensure staff know how to care for them properly. Where residents manage their own medicines their ability to do this safely should be properly assessed so support can be given if needed. Evidence that proper recruitment procedures are being followed to protect residents from people who should not work in care, should be kept in the home. Beech House D54 D06_s39190_beechhousesouthmolton_v228876 stage 4.doc Version 1.30 Page 7 To confidently meet the needs of resident with dementia staff need more specialist training. Fire extinguishers should be check regularly as recommended by fire officer to help minimise the risk of fire within 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. Beech House D54 D06_s39190_beechhousesouthmolton_v228876 stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Beech House D54 D06_s39190_beechhousesouthmolton_v228876 stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Residents benefit from good admission and assessment practice, which ensures that the home is able to meet their needs. EVIDENCE: Three residents records looked at contained detailed and relevant information describing the residents’ needs, circumstances and preferences. All three files contained information provided by health and social care professionals, and had been developed by the home staff. Residents indicated that staff ask them what they want and need help with. Beech House D54 D06_s39190_beechhousesouthmolton_v228876 stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 9, 10 Some care plans are adequate, but for people with complex needs care plans do not contain enough information to ensure all identified needs are met. Risks in relation to residents managing their own medication are not properly assessed, potentially placing residents at risk. Residents’ benefit from being treated with kindness and respect. EVIDENCE: Three care plans were seen, brief summaries of residents needs and how they should be met provide a useful guide for staff where needs are not complex. The care plan for one person, who had complex psychological needs, did not provide adequate description of how those identified needs should be met by staff. An agency member of staff said that he found the summary care plans useful and straightforward. Care plans had been reviewed at regular intervals. A detailed medications management policy and procedure document is now available to guide staff who administer medication. The inspector was shown it by the senior carer who administered mid day medications. Beech House D54 D06_s39190_beechhousesouthmolton_v228876 stage 4.doc Version 1.30 Page 11 The procedure refers to performing a “check list” with residents who wish to self administer medication. One resident who the inspector was told was handling his own medication had signed a form to confirm he would take responsibility for his own medications, but a check list/risk assessment about his ability to safely manage this medication had not been completed. The manager said that these risk assessments are done but not documented. Nine of the ten residents who spoke with the inspector confirmed that staff are kind and respectful; one resident said “they are mostly ok” but did not want to elaborate. Another said the “staff are very kind” and another said you can “ask them anything”. Throughout the inspection staff were seen addressing residents warmly, patiently and respectfully. Beech House D54 D06_s39190_beechhousesouthmolton_v228876 stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 & 15 Social activities are provided at the home and provide daily variation and interest for residents. A varied balanced diet is provided, served in a pleasant atmosphere. EVIDENCE: Staff spoken with said that they have more time than they used to, to spend doing activities with residents. Two said that though things are better they still do not have the time to give residents the one to one attention which they think they need. One resident said that there “ is always something to do” others indicated that they are satisfied with the activities offered. One resident said they feel that staff are usually too busy to spend time chatting as they would like. During the morning of the inspection two care staff were seen playing skittles with a group of residents who were enjoying this; down the other end of the home another member of staff was running a quiz with a group of four residents. One resident described the standard of the food as “very high”; this person said that they had been loosing weight but that efforts by the kitchen to provide food in a form that they can eat means that they were now putting on weight. Another said the food is “lovely” others indicated that they are happy with the choice of food provided. Beech House D54 D06_s39190_beechhousesouthmolton_v228876 stage 4.doc Version 1.30 Page 13 Meals were served in three separate areas with residents sitting around small tables, some residents had chosen to sit together others on their own. Beech House D54 D06_s39190_beechhousesouthmolton_v228876 stage 4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Residents can be confident that their concerns and complaints will be listened to and acted upon. EVIDENCE: The homes service user guide contains copy of the complaints procedure, this was seen available in all bedrooms visited by the inspector. Devon County Council complaints procedure is available in the entrance hall to the home. The manager reported that there have been no formal complaints recorded in the last 12 months. None of the residents spoken with expressed any concerns about the service they receive, several residents indicated that they can tell staff if they have any concerns, one person commented that “you can ask the staff anything”. Beech House D54 D06_s39190_beechhousesouthmolton_v228876 stage 4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 & 26 The home provides a clean safe and well maintained environment for residents. EVIDENCE: All residents asked said that the home is always kept clean. One of the cleaning staff said that they work hard to keep the home clean but that an unfilled cleaning vacancy makes this very difficult. Care staff said that at the moment they sometimes have to do cleaning duties to ensure standards are maintained. The manager acknowledged that a shortage of cleaning staff did put extra pressure on other staff, but that the post had been advertised. On the day of the inspection all areas of the home seen had been cleaned by early afternoon. The laundry area is clean, organised, with sealed floors and suitably equipped. All shared areas of the home and ten bedrooms looked at by the inspector were maintained safely. Beech House D54 D06_s39190_beechhousesouthmolton_v228876 stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30 Staff are employed in sufficient numbers to meet the needs of residents. Residents cannot be assured that they are properly protected by the homes recruitment procedures. Though skilled and competent to meet many needs of residents, staff do not have the knowledge required to meet all the specialist needs of people with Dementia. EVIDENCE: All four staff spoken with confirmed that staffing levels are always sufficient to ensure residents personal care needs are met and that most days they have time to do activities with residents; two staff felt that staffing numbers are not sufficient to spend enough time with residents on a one to one basis. One resident said that the staff “are always short handed”. Five other residents indicated that there are always enough staff on duty, one saying they always get “prompt” help. On the day of the inspection there were thirty one residents at the home, with eight care staff (including an agency carer) plus the manager and deputy manager on duty. The atmosphere in the home was relaxed with staff spending time doing activities with residents. Staff recruitment files were not available for inspection in the care home. The manager reported that staff files are kept off site. Beech House D54 D06_s39190_beechhousesouthmolton_v228876 stage 4.doc Version 1.30 Page 17 The three permanent staff spoken with confirmed that they have received training regarding abuse, health & safety, manual handling and recognition/reporting of abuse, within the last year. One had attended one short training session with a psychologist about dementia, another said that a student social worker had helped them develop their understanding of dementia. Two staff members said they would like opportunity to better understand how to care for people who have dementia saying that they are not always sure how to respond properly to the behaviours presented. The manager acknowledged that there is currently no formally training programme to help develop staff or mangers knowledge of dementia care. The manager said that she believed that 13 of the current residents main needs relate to them having dementia. Beech House D54 D06_s39190_beechhousesouthmolton_v228876 stage 4.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 Attention to the health and safety of residents is generally good but safety may be compromised by failure to conduct proper checks on fire fighting equipment. EVIDENCE: The fire log book indicated that alarms are checked as recommended by Devon Fire and Rescue Service; however fire extinguishers are still not checked monthly as recommended. Fire extinguishers had however been professionally serviced within the last two months. Staff confirmed that they know what to do if the fire alarm goes off. The agency staff member confirmed that he had been told the fire procedures and shown where fire exits/equipment are. Cleaning products were properly stored. Staff have had health and safety training. The building is safely maintained. Beech House D54 D06_s39190_beechhousesouthmolton_v228876 stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x x x x 2 Beech House D54 D06_s39190_beechhousesouthmolton_v228876 stage 4.doc Version 1.30 Page 20 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP29 Regulation 17 (2) Requirement The registered person must maintain in the care home the records specified in Schedule 4. (previous requierment timescale of 18/02/05 not met) The registered peson must after consultation make adequate arrangements for the maintainance of all fire equipment (fire extinguishers must be checked monthly) Timescale for action 20/09/05 2. OP 38 23 (4)(c 29/09/05 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 OP 7 Good Practice Recommendations The service user plans should set out in detail the action which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the resident are met. Risk assessments should be recorded and action taken to manage risks as indicated by these assessments where service users take responsibility for administering medication themselves. Staff should be provided with training that helps them to fully meet the needs of service users who have dementia. D54 D06_s39190_beechhousesouthmolton_v228876 stage 4.doc Version 1.30 Page 21 2. OP 9 3. OP30 Beech House 4. Beech House D54 D06_s39190_beechhousesouthmolton_v228876 stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Beech House D54 D06_s39190_beechhousesouthmolton_v228876 stage 4.doc Version 1.30 Page 23 - 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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