Inspection on 13/03/07 for Beech Lawn

This inspection was carried out on 13th March 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Beech Lawn 05/02/08

Beech Lawn 07/02/06

Beech Lawn 06/09/05

Beech Lawn 15/02/05

Beech Lawn 01/09/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Beech Lawn Beech Lawn Nursing & Residential Home Higher Lux Street Liskeard Cornwall PL14 3JX Lead Inspector Kerensa Livingstone Key Unannounced Inspection 13th March 2007 09:30 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 Lawn DS0000055098.V305077.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 Lawn DS0000055098.V305077.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beech Lawn Address Beech Lawn Nursing & Residential Home Higher Lux Street Liskeard Cornwall PL14 3JX 01579 346460 01579 346469 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) Beech Lawn Care Home Ltd Mrs Julie Ann Weale Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30), Physical disability over 65 years of age of places (4), Terminally ill over 65 years of age (2) Beech Lawn DS0000055098.V305077.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Total number of service users not to exceed 30 Date of last inspection 7th February 2006 Brief Description of the Service: Beech Lawn is a care home with nursing, for a maximum of 30 older people. It is a listed property with purpose built extension situated near the centre of Liskeard in a quiet residential area. Accommodation is provided in 25 single and 2 double rooms, all rooms have television points, and if required telephones can be installed at the service users expense. Service users requiring nursing care are provided with ground floor accommodation and first floor accommodation is accessed using a stair lift. There is a sheltered courtyard patio with flowerbeds at the rear of the home, providing a sitting area for the service users. At the front of the home there are a couple of parking spaces. There is no parking at the rear of the home as an extension is currently being built to provide extra accommodation and a new larger kitchen. The home has a Registered Manager, Mrs Julie Weale who is in charge of the day-to-day management of the home. The Registered Providers Mr & Mrs Stratton visit the home on a regular basis. A qualified nurse is on duty at all times and additional health care is arranged as required e.g. dentistry, chiropody. Social and entertainment activities are provided. Beech Lawn DS0000055098.V305077.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Unannounced Key Inspection was conducted over a full day, finishing at six o’clock. The Inspector had the opportunity to meet and speak to a considerable number of the Service Users, who were extremely forthcoming and informative about their life at Beech Lawn. The atmosphere within the home was welcoming and homely. The Registered Manager and the staff were very helpful during the inspection. Observation, discussion, reviewing of documentation and case tracking were all used as part of the inspection process. Pre inspection information was gathered using a Pre inspection questionnaire and service user (five) and relative (seven) comment cards. This was circulated and returned prior to the inspection visit. What the service does well: What has improved since the last inspection? Beech Lawn DS0000055098.V305077.R01.S.doc Version 5.2 Page 6 The service users enjoy the choice and quality of the meals that are available to them, the menus and choice available has been reviewed since the last inspection. Individual needs are fully assessed prior to moving into the home. Service users contribute to the planning of their end of life care, considerable work has been undertaken to enable families and service users to plan for their future. The Registered Providers visit the home frequently and speak with service users/relatives and staff as required under Regulation 26. 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 Lawn DS0000055098.V305077.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beech Lawn DS0000055098.V305077.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is detailed information to enable service users to make an informed choice, this must be provided prior to them making a decision to move into the home. Each service user has a statement of terms and conditions. Individual needs are fully assessed prior to moving into the home. EVIDENCE: There is a well-presented and comprehensive document that combines the Statement of Purpose and Service User’s Guide, it is laminated with colour photographs. This is made available in each service users room, a copy must be provided to all prospective service users and include a copy of the most recent report. It was compiled in June 2005 and states it will be reviewed six monthly. Beech Lawn DS0000055098.V305077.R01.S.doc Version 5.2 Page 9 The inspector was informed that terms and conditions are included in a contract that is provided to all service users. Evidence was observed of completed contracts in service user’s files. The number of the room offered to the service user has been included as recommended since the last inspection. A breakdown of fees is provided to all service users, including contributions, the inspector was informed. The Registered Manager encourages Service users and their relatives, to visit the home prior to admission. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Emergency admissions are not usually undertaken by the home due to the bed availability and the need for a pre-admission assessment to be undertaken. All prospective Service Users are assessed prior to admission to the home, the Inspector was informed and service user records confirmed this. The pre assessment proforma is comprehensive. Service users informed the inspector how they had known of the home and chosen it themselves. Intermediate care is not provided at the home. Beech Lawn DS0000055098.V305077.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Service Users health, social and personal care needs are met in a manner that respects their privacy and dignity. The Registered Manager must ensure that there is evidence that the Service User has the opportunity to contribute to the planning of their care. Medicines were observed to be administered safely. Service users contribute to the planning of their end of life care. EVIDENCE: The Service Users plans of care are comprehensive, clear and detailed taking into account physical, psychological, spirituality and social needs. Risk assessments are completed for all Service Users, these were observed to be reviewed regularly. It is recommended that the plan of care be drawn up with the Service User agreed and signed by the Service User and/or representative. In the service user files inspected there was no evidence of service user involvement. The Registered Manager identified this as an area needing more work. Plans are reviewed at least monthly, inspection of care plans enabled the Beech Lawn DS0000055098.V305077.R01.S.doc Version 5.2 Page 11 inspector to identify that the plans are regularly updated to reflect the changing needs of the individual. The staff are committed to promoting and maintaining the health of the service users, ensuring that they receive access to appropriate health care services. All service users are registered with a General Practitioner. Service users have access to external health care services such District nurses, dentists, chiropodist and optician as required. Service users informed the inspector that they enjoyed visiting the hairdresser and has access to the chiropodist and optician regularly. One person commented ‘I only have to ask to see the Doctor, nothing is too much trouble’. Service Users informed the Inspector wherever possible they are supported to maintain their independence, however help is available as required. The home has established links with other specialist services such as dietetics, Speech Therapist and the local Primary Health Care teams. Service users are supplied with appropriate continence aids. Pressure relieving equipment such as Airwave mattresses and various cushions were evident. Moving and Handling assessment, wound classification, Pratt nursing scale, Tullamore falls risk assessment and Barthel activities of daily living assessment tools are used within the home. The inspector was informed that a nutritional assessment tool is used as required. A personal care plan is kept in the service user’s room, these include daily care needs e.g. continence, tissue viability, bathing and daily routine. Two General Practitioner’s visited during the day of the inspection. There is a designated qualified nurse who takes responsibility for the medicines, ensuring the home is not overstocked and keeping an overview of the medicines administered. There are Policies and Procedures relating to the administration, storage, receipt, recording, disposal and handling of medicines. A record is kept of specimen signatures. The Pharmacist visited in October 2006 and recommended an update in training, this is yet to be arranged. All medicines are administered by a registered nurse. There are two medication trolleys on the ground floor and a further one on the first floor. The Inspector was informed that the staff find that these trolleys are suitable. They are stored in the treatment room. The Inspector observed that medicines were safely dispensed to the Service Users. The Medication Administration Records (MAR) all have a photograph of the service users with them; and were signed and dated appropriately. There is a Controlled Drugs cupboard and register, these were inspected. There were no Controlled drugs on the day of inspection, as good practice Temazepam is stored in this facility. The medicines checked were accurately recorded. There is a designated medication fridge, which is locked and the temperature checked daily. Staff were observed to treat service users with respect, spoke in a courteous manner and knocked prior to entering bedrooms. The Inspector spoke at length with Service Users regarding how it was to live at the home, as at the previous inspection all without exception felt that there right to privacy was upheld and they were treated with respect. Service users have access to a Beech Lawn DS0000055098.V305077.R01.S.doc Version 5.2 Page 12 telephone; several were seen to have their own private lines. Clothes are individually sorted in the laundry to ensure that service users only wear their own clothes. Screening is provided in shared rooms. Since the last inspection considerable work has been undertaken in gathering the wishes of the service user about end of life care. This has been formalised and information is provided to all families, this done in a very sensitive way. Service users can make decisions about what they would wish to happen if they were to become unwell and families can clarify the level of involvement that they wish to have. The families and significant others have been involved depending on the service user’s wishes. The home has established links with the Macmillan nurses and prides itself on being able to offer a high standard of care when someone is coming to the end of their life. Beech Lawn DS0000055098.V305077.R01.S.doc Version 5.2 Page 13 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, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Recreational activities are offered for service users that meet their needs. Service users like living at Beechlawn. Visitors are welcomed to the home. Service users are able to make choices about how they live their lives. The service users enjoy the choice and quality of the meals that are available to them. EVIDENCE: The levels of dependency of some service users restricts their wish to participate in group activities. Individual client records are kept of the activities that are provided. In February the following activities were offered; card making, dominoes and board games, bingo/quiz, one to one and armchair activities. It is recommended that a central record of activities be kept and who attends the activities. People carrier trips are offered periodically when the Provider’s vehicle is available to Beechlawn. This vehicle cannot take wheelchair users. Service users informed the inspector that they had enjoyed a trip out to Cremyll and enjoyed the local pantomime at Christmas. There is a large selection of reading books in the home. Families and friends are encouraged to participate in activities offered in the home. Five of the Beech Lawn DS0000055098.V305077.R01.S.doc Version 5.2 Page 14 completed service user questionnaires all stated that they liked the activities that were on offer. The home operates an ‘open’ visiting policy, with visitors welcome at any reasonable time. Service Users confirmed that their visitors are made to feel welcome by the staff. Service users are able to choose who they see and do not see, and are able to receive visitors in private if they wish. All relatives commented positively about the home (seven). A visitor’s book is maintained. Service users are helped to exercise choice and control over their lives. Personal allowances are managed by the administration department, with receipts and records maintained of all monies. The Service User’s rooms are personalised and personal possessions are brought into the home. Service Users informed the Inspector that they exercised control and choice over their lives. One service user was observed during the course of the inspection to make clear choices about what they wished to do and this was facilitated by the Registered Manager. Another service user commented ‘I can do what I like’. The inspector was informed that assistance was on hand when needed but service users were encouraged to maintain their independence as much as they felt able. Lunch and teatime were sociable occasions, mealtimes appeared unhurried, with service users given sufficient time to eat. The food was presented in an attractive and appealing manner. Service users commented that the food was always hot, wholesome and plentiful. On the day of the Unannounced Inspection, lunch was Pork Casserole or Sweet and Sour Pork served with mashed potatoes, swede and cabbage followed by Plum Crumble. Alternatives of a jacket potato, salad and sandwiches were observed to be chosen on the day of the unannounced inspection. One of the cooks has completed their Intermediate food hygiene certificate since the last inspection, as recommended. There was evidence of a clear choice available at lunchtime as had been discussed at the last inspection. There are several choices at teatime. Records are kept as required and a nutritious diet is offered. Fresh fruit and fresh vegetables are available. Fruit is provided in a bowl in the lounge. One Service Users commented that the food was ‘marvellous’ and ‘I have a choice’. The comments were generally complimentary about the food and choice offered. ‘I am always offered a cup of tea if I wake up in the night’. There are two comfortable, homely dining rooms. One dining room is used by those able to generally attend to their own needs and the other smaller room kept for those requiring more assistance from staff. Staff offered assistance in a discreet and sensitive manner. Mealtimes can be taken in individual rooms if service users are unwell or prefer not to go to the dining room. Each service user is offered three full meals per day. Special diets are catered for. The menu is written on a board in the dining room and available in the reception of the home. The kitchen is small and a new one is being provided as part of the extension. Beech Lawn DS0000055098.V305077.R01.S.doc Version 5.2 Page 15 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 adequate. This judgement has been made using available evidence including a visit to this service. Service users are confident that their concerns would be listened to and acted upon. All staff must receive training on the protection of vulnerable adults and there must be clear procedure advising the staff of the action they must take. EVIDENCE: The home has a Complaints Policy, which is clearly displayed in the entrance hall and the statement of purpose and service users guide. The Commission for Social Care Inspection has received no complaints since the last inspection. The service users that the inspector spoke to stated that that if they had any concerns they knew they would be acted upon promptly and felt that the Registered Manager was very accessible. There is information relating to the Protection of Vulnerable Adults, including a copy of the local procedure. There is an abuse policy. The home’s procedure needs to be clearer so staff are aware of the action that must be taken and should be updated as it states that the Manager must be informed prior to any further action being taken. It is has been updated since the inspection, however it still states that the staff member must speak to the home’s management prior to reporting the allegation. Two staff have attended the Protection of Vulnerable Adults training provided by the Cornwall County Council. There has been no in house training for staff to ensure that they are Beech Lawn DS0000055098.V305077.R01.S.doc Version 5.2 Page 16 aware of the action to be taken in the event of an allegation of abuse being made, the inspector is informed that this is being addressed as a priority. Beech Lawn DS0000055098.V305077.R01.S.doc Version 5.2 Page 17 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, 20, 21, 22, 24 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Service Users live in a very comfortable and homely environment that meets their needs. The Service Users like their accommodation. Hot water temperatures must be regulated in the areas that are identified as a high risk. Specialist equipment is provided on an individual basis. There is inadequate storage and staff accommodation, these are due to be addressed in the new extension. EVIDENCE: Beech Lawn DS0000055098.V305077.R01.S.doc Version 5.2 Page 18 The home is homely and well decorated. The inspector was informed that the registered provider employs a maintenance person who carries out the ongoing maintenance although not exclusively at Beechlawn, as they work at the other homes owned by the Providers. On the day of the inspection there was an ongoing upgrade of all the vanity units in individual service user’s bedrooms. The courtyard garden area is well-kept and accessible to service users. There were two dining rooms and a lounge being used on the day of the inspection, these areas are comfortably furnished and decorated. The main lounge appeared pleasant, homely and well used by the service users. Meals can be taken in here if a service user wishes. There is another activities lounge that was observed not to be being used during this inspection, however this is a quiet area where visitors can see their relatives. There is no designated staff room or office for staff to undertake record writing, this will be needed when the extension is finished. The registered person must provide suitable facilities for staff including storage and facilities for changing. There is a Manager’s office, which is very small. There is adequate natural light and ventilation. There were no unpleasant odours in the home on the day of the inspection. The Service Users informed the Inspector that they liked their environment. Service users have sufficient and suitable lavatories and washing facilities. There are accessible toilets close to the lounge and dining areas and individual bedrooms. There are two bathrooms with assisted bathing facilities on the ground floor. All rooms have wash hand basins, none are ensuite. The bathrooms and toilets were observed during this inspection to be cluttered with equipment, pads, towels, flannels and toiletries etc. The inspector has been advised that these areas have been tidied and are being redecorated, since the inspection. Service users have the specialist equipment they require to maximise their independence. Advice and assessment is sought from other professionals, when necessary, in order to meet the specific needs of individual service users. Service users have access to all parts of the home, some service users may need assistance from the staff to access some areas. The environment poses a challenge to the care of the Service Users, as rooms are often small making it difficult to use equipment and manoeuvre wheelchairs. There are grab rails and handrails in place around the home to promote and support independence. Call systems are available within each room. Storage space is not adequate for the needs of the service users or staff, the Providers are aware of this and seeking to address this in the extension. Rooms appeared comfortable and furnished to meet the needs and preferences of the service users. Adjustable beds are provided for service users receiving nursing care. Screening is provided in the shared rooms to afford privacy. Service users are able to personalise their rooms and this was evident in many of the rooms inspected. New sink vanity units are provided and these are popular with the Service Users. A lockable space is provided in all rooms, Beech Lawn DS0000055098.V305077.R01.S.doc Version 5.2 Page 19 however no room have a lockable door. A door lock should be fitted to all accommodation to provide service users with privacy, which is accessible to staff in emergencies. The key should be provided to the service user unless the risk assessment suggests otherwise. At previous inspections concerns have been raised regarding the programme of installing hot water thermostats throughout the home and the need for this to be based upon risk assessments that have identified high risk. The installation of regulators is still not based upon risk assessment the inspector was informed, the inspector reiterated their concerns regarding this. The home appeared clean and hygienic on the day of the Unannounced Key inspection, there are designated housekeeping staff. There were no offensive odours in the home. There are suitable hand washing facilities for both staff and service users, with liquid soap and paper towels provided. Disposable gloves and aprons were provided in strategic places throughout the home. The laundry was replaced last year, the facilities are greatly improved. The home employs dedicated laundry staff, one service user commented on how well the system worked, with laundry being returned washed and ironed. It is situated away from the kitchen and service user accommodation. Flooring in permeable, there are three washing machines with a sluice facility and a large dryer. Individual laundry boxes are provided on shelving for each service user. All laundry is done at the home. Beech Lawn DS0000055098.V305077.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, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Pre employment checks must be robust to ensure the protection of vulnerable adults including a Criminal Records Bureau check, these must be improved. Staff should be provided with contracts detailing their terms and conditions. Staff are respected and liked by the service users. Staff enjoy working at the home and present as a professional, organised group of people. EVIDENCE: Beech Lawn DS0000055098.V305077.R01.S.doc Version 5.2 Page 21 On the morning of the unannounced inspection, there were two qualified nurses; five care staff, one housekeeper, cook with assistant, laundress and maintenance staff on duty. Laundry staff are provided seven days a week, housekeeping staff work five days a week. There would be only one qualified nurse on at the weekends. On the afternoon shift, there is one nurse and four carers, whilst at night there is one nurse and two carers. Service users needs appeared to be met by the numbers and skill mix of staff, this is currently under review for the new extra beds. A staff rota is available within the home that demonstrated which staff are on duty at all times of the day. No staff are employed under the age of eighteen years of age and there is a qualified nurse on duty at all times. There are designated catering, housekeeping and laundry staff, although some undertake several roles. All staff are provided with a General Social Care Code of Practice. The Service Users informed the inspector that ‘the staff are super’, ‘respectful’ and ‘very good’. The comments about the staff were without exception, very positive. The home encourages and supports staff to undertake National Vocational Qualification (NVQ) training and the Registered Manager reported that staff are very keen to undertake NVQ courses. Seventeen staff out of twenty-five have completed their National Vocational Qualification level 2 or above. The Registered Manager supported by the home’s administration team operates a recruitment procedure, which includes application forms, interview information, CRBs, and two written references. At this inspection one staff file inspected did not have any evidence of an interview, no Criminal Records Bureau check or confirmation of registration had not been obtained. All registered nurses must have their number checked with the Nursing and Midwifery Council prior to commencing their employment. The inspector has been informed that all staff have been checked since the inspection. In the four staff files inspected three had no CRB and/or a POVA first check and one had a photocopy. The inspector and Manager discussed the importance of all staff have a Criminal Records Bureau check and that these are not transferable. Since the inspection the Registered Manager has confirmed that three CRBs have been sent for, the staff files have been updated and all staff who start their employment at Beechlawn will have an enhanced CRB obtained by the home or at least a POVA First until the full disclosure is obtained. The inspector was informed that no new staff have been provided with contracts detailing their terms and conditions of employment, as these are currently being reviewed. Beech Lawn DS0000055098.V305077.R01.S.doc Version 5.2 Page 22 All staff undertake an induction programme, which requires updating. Since the inspection a new checklist for registered and care staff has been compiled. All staff must complete an induction which complies with the Skills for Care requirements within the timescales. The inspector and Manager discussed the importance of the Manager having adequate managerial time to undertake the duties that are required. The registered manager has compiled training records for the staff. The qualified nurses are encouraged to pursue relevant external training courses and will return to do a training session for the rest of the team. The clinical room has training files as a resource for staff, with varied and informative material. Beech Lawn DS0000055098.V305077.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. This judgement has been made using available evidence including a visit to this service. There is clear leadership in this home and it is run in the best interests of the Service Users. The registered Manager must have adequate time to perform her managerial duties. The health and safety of service users must be safeguarded by staff receiving the training they require and environmental risks being assessed and minimised. EVIDENCE: The Registered Manager, Julie Weale is a Registered General Nurse with considerable general nursing experience and previous management experience. Mrs. Weale has been the Registered Manager for three and a half years, she has achieved her National Vocational Qualification Level 4 in management. The Registered Manager and Inspector discussed the need to Beech Lawn DS0000055098.V305077.R01.S.doc Version 5.2 Page 24 have adequate managerial/administration time to complete their role and to fulfil their duties. It was evident to the Inspector that there is clear leadership within the home. The Registered Manager ensures an open, positive and inclusive atmosphere. This was confirmed by the very positive comments from service users, visitors and staff. There are regular staff meetings where staff stated they are encouraged to contribute new ideas. Monthly visits are untaken by the Registered Provider who completes a report after inspecting the home and talking to staff and service users, as required from the last inspection. This is forwarded to the Commission for Social Care Inspection and a copy is provided to the Registered Manager. The importance of informing the Commission for Social Care Inspection of anything under Regulation 37 was reiterated. This home is run to meet the needs of service users. Regular feedback is actively sought from service users and their relatives/representatives about the services provided to them. Annually a survey is conducted, the feedback is formalised into a report that is included in the Service user’s guide. The inspector and Manager discussed the importance of including stakeholders in this process, since the inspection a questionnaire has been compiled and is due to be circulated. Residents and relatives meetings are held. The meetings are listed on the notice board with minutes taken and distributed to all who attended the meeting. The Policies and Procedures are dated May 2004; this should be reviewed and updated. Service users are encouraged to control their own affairs where possible, but the home holds money on behalf of most of the service users. Accurate records are kept regarding all transactions and accounts are kept separately. The Registered Manager does not act as appointee for any of the service users. A spot check of a service users account tallied with the records. There is a safe for the safe keeping of Service Users valuables and all rooms are provided with a lockable space. There is evidence that staff have received fire, first aid, moving and handling training, this must be kept up to date. Staff should provided with health and safety and infection control training. The inspector was advised that all servicing of equipment takes place annually and legionella testing takes place monthly. Gas and call bell servicing took place in August 2006. Environmental risk assessments must be in place. The inspector has been advised since the inspection that the Home’s health and safety policies are being updated. Hot water temperatures must be regulated in the areas that are identified as a high risk. Beech Lawn DS0000055098.V305077.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 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 4 9 3 10 3 11 4 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 2 3 3 2 2 X 2 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 Lawn DS0000055098.V305077.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP25 Regulation 13 Requirement The programme of fitting hot water thermostats must be determined by the findings of risk-assessments that take into account the individual service user and the service users room. This requirement is carried over from the previous inspection. Previous timescale not met 01/11/05 Timescale for action 01/12/07 2. OP18 13(6) The Registered Manager shall be 01/06/07 making arrangements by training staff and other measures prevent Service Users being harmed or suffering abuse or being placed at risk of harm or abuse e.g. procedure, all registered nurses must have their registration checked with the Nursing and Midwifery Council. Previous timescales not met 01/04/06 3. OP22 23(2l) The Registered person shall 01/12/07 having regard to the number and needs of the service users ensure that suitable provision is made for storage for the purposes of the care home. DS0000055098.V305077.R01.S.doc Version 5.2 Page 27 Beech Lawn 4. OP24 12(4a)13( 4) 5. OP29 19(1)Sch. 2 6. OP30 18(1c) 7. OP38 13(4) The Registered Provider shall make arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of the Service Users e.g. door locks. Door keys should be provided unless the risk assessment suggests otherwise. Previous timescales not met 01/07/06 The registered person shall not employ a person to work at a care home unless- he has obtained the information and documents specified in paragraphs 1 to 7 of Schedule 2 e.g. Criminal Records Bureau check. The registered person shall ensure that the staff employed to work at the care home receive training appropriate to the work they are to perform e.g. induction. The registered person shall ensure that unnecessary risks to the health and safety of the service users are identified and so far as possible eliminated. 01/12/07 13/03/07 01/06/07 01/06/07 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. Refer to Standard OP7 Good Practice Recommendations It is recommended that the plan of care be drawn up with the Service User agreed and signed by the Service User and/or representative (if any). For a centralised list of activities with names of service users who have participated to be kept. DS0000055098.V305077.R01.S.doc Version 5.2 Page 28 2. OP12 Beech Lawn 3. 4. 5. 6. OP21 OP29 OP31 OP38 For the bathrooms to be homely and free from clutter. For staff to be provided with contracts detailing the terms and conditions of their employment. For the Registered Manager to have adequate managerial time to perform her duties and roles. For staff to be provided with health and safety and infection control training. Beech Lawn DS0000055098.V305077.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD 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 Lawn DS0000055098.V305077.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. 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