Inspection on 11/07/05 for Beech Lawn Residential Home

This inspection was carried out on 11th July 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.

Other inspections for this house

Beech Lawn Residential Home 16/05/08

Beech Lawn Residential Home 21/06/07

Beech Lawn Residential Home 26/06/06

Beech Lawn Residential Home 23/11/05

Beech Lawn Residential Home 24/11/04

Beech Lawn Residential Home 26/07/04

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

CARE HOMES FOR OLDER PEOPLE Beech Lawn Residential Home Elton Park Hadleigh Road Ipswich IP2 0DG Lead Inspector John Goodship Unannounced 11 July 2005 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 Lawn Residential Home I54 - I04 S60475 Beech Lawn V237972 050711 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Beech Lawn Residential Home Address Elton Park Hadleigh Road Ipswich Suffolk IP2 0DG 01473 251283 01473 251283 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) Mr Ratnam Balaratnam Miss Fay Ulah Veronica Millwood Care Home 26 Category(ies) of OP Old Age (26) registration, with number of places Beech Lawn Residential Home I54 - I04 S60475 Beech Lawn V237972 050711 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 24/11/04 Brief Description of the Service: Beech Lawn is a registered care home for older people. The Home is registered for a maximum of 26 older people and was first registered in 1984. The Home is owned by Guyton Care Homes Ltd which also owns a second home, located in the Whitton Park area of Ipswich. Beech Lawn is a large detached house, standing in substantial grounds, situated in a private road on the outskirts of Ipswich. The town centre is easily accessible by car and bus and has a large variety of shops and facilities.Accommodation is sited over two floors. The Home provides one shared room and twenty-four single bedrooms, with all bedrooms having en-suite toilet facilities. There is platform lift access to the first floor. Communal facilities including a spacious conservatory are located on the ground floor. Beech Lawn Residential Home I54 - I04 S60475 Beech Lawn V237972 050711 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was the first inspection of this inspection year. The date was timed to follow the purchase of Guyton Care Homes by Mr and Mrs Balaratnam from the previous owners. Mr Balaratnam has been registered as the Responsible Individual by the Commission. The manager has remained the same. The Commission had received 3 complaints about the home this year, and this led to 2 visits from the Commission’s pharmacy inspector, as well as an additional visit by the lead inspector. Requirements and recommendations arising from those visits if not implemented are repeated here together with those arising from this inspection. On this visit, the inspector spoke to 4 residents in their rooms, as well as the new responsible individual and the manager. What the service does well: What has improved since the last inspection? What they could do better: The policies and procedures on the administration of medicines must improve, together with the further implementation of training for all staff responsible for administration. Parts of the home need to be re-furbished and furnishings replaced. The new owner has plans to do these.The planned change of staffing Beech Lawn Residential Home I54 - I04 S60475 Beech Lawn V237972 050711 Stage 4.doc Version 1.40 Page 6 to replace the work done directly by the previous owners must continue, in order to support the manager. 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 Lawn Residential Home I54 - I04 S60475 Beech Lawn V237972 050711 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Beech Lawn Residential Home I54 - I04 S60475 Beech Lawn V237972 050711 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these standards were inspected. EVIDENCE: Beech Lawn Residential Home I54 - I04 S60475 Beech Lawn V237972 050711 Stage 4.doc Version 1.40 Page 9 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) 8,9. Residents have their healthcare needs monitored and recorded, with prompt action as required. The home must meet all the requirements imposed in this report before its drug administration procedures ensure the safety of residents. EVIDENCE: A complaint about poor drug administration procedures was received by the Commission in March 2005. The Commission’s pharmacy inspector visited the home and found the complaint to be substantiated. 6 Requirements were laid on the home and 4 Recommendations. A follow-up visit was made in June 2005 to check progress on the issues raised in March. Record-keeping practice had improved but 2 further issues were raised concerning external medicines and reasons for non-administration. Medicine administration was satisfactory overall but a number of other issues were raised concerning divergences between stock levels and MAR chart entries. In all, 6 further requirements were imposed and one recommendation. Training of staff in drug administration had started by an outside academic body. A private chiropodist was at the home during the inspection. The manager said that it was becoming more and more difficult to get treatment from the NHS. Beech Lawn Residential Home I54 - I04 S60475 Beech Lawn V237972 050711 Stage 4.doc Version 1.40 Page 10 One resident said that they had had to change their GP on moving to the home as the practice would not visit. The manager said that named social workers were starting to visit annually to review residents, although one resident said they would like to see their social worker more frequently. The home had actioned the requirement of a previous complaint to ensure that medical instructions on the sitting position of a resident were followed. A resident had recently been taken to Accident and Emergency following concern. This had not been reported to the Commission for Social Care Inspection as required by regulation. Beech Lawn Residential Home I54 - I04 S60475 Beech Lawn V237972 050711 Stage 4.doc Version 1.40 Page 11 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) 14,15. Residents are able to make choices about their daily lives, commensurate with their abilities. The catering facilities meet environmental health standards. Residents are provided with a sufficient nutritional diet, with evidence that individual preferences are met as far as possible. EVIDENCE: Care records and the daily record showed that all residents got up when they wished. Some were woken early for a cup of tea. One resident confirmed that they were a very early riser from choice – about 5am. Some residents were woken early to be given their medication. The Commission’s pharmacy inspector advised that prescriber advice should be sought (and documented) on moving to a later time than 6 a.m. A few residents preferred to go to bed late. Some of these were identified in their care plan on admission. The daily record contained numerous entries listing bedtimes for very late retirers, and those who sometimes chose to sleep in the recliner chair in their room. Residents spoken to during the inspection confirmed that they chose where to eat and spend their day. Some chose to stay in their room most of the day, as they did not like the company in the communal areas. Beech Lawn Residential Home I54 - I04 S60475 Beech Lawn V237972 050711 Stage 4.doc Version 1.40 Page 12 Breakfasts were normally served at 8.30a.m. 3 residents preferred to eat earlier than this. On previous visits, residents had commented that the food and the choice were usually good with plenty to eat. One resident disagreed strongly. The manager said that some different kinds of bread were being tried. She had also gone out to buy some items if residents specifically asked for them. An environmental health officer had inspected the kitchen in June 2005, and had made 5 requirements and one recommendation. By the time of the return visit in July, action had been taken on all matters. Beech Lawn Residential Home I54 - I04 S60475 Beech Lawn V237972 050711 Stage 4.doc Version 1.40 Page 13 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) 16,18. The home’s complaints procedure meets the required standard. The home has followed its procedure when it has received complaints. Staff are being trained to protect residents from abuse. EVIDENCE: A number of complaints were received by the Commission in March 2005. They related principally to poor standards of drug administration. These are covered under Standard 9 above. Other aspects of the complaint concerned a lack of cleanliness, lack of choice for residents when they went to bed and got up. staff workload and not following treatment procedures. 3 elements were not upheld, one was partly upheld and one was upheld. The Commission received a complaint in June 2005 about the care of a resident. It included matters relating to personal care, heating, quality of food, and staffing. 6 matters were not upheld, one was partly upheld, one was unresolved and one was upheld. The home had taken steps to prevent the re-occurrence of matters which were upheld, or partly upheld. 8 staff had completed in-house training on the protection of vulnerable adults, by viewing a training video and completing a questionnaire. There was an abuse action sheet for staff. It did not include the telephone number of Customer First who are now responsible for all referrals. Beech Lawn Residential Home I54 - I04 S60475 Beech Lawn V237972 050711 Stage 4.doc Version 1.40 Page 14 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) 19,21,23,24,25,26. Although the environment is safe for residents, some areas require refurbishment and repair. Until the hot water system is working acceptably, the home cannot ensure that hygiene and infection control standards are being met. EVIDENCE: No hot water was available in one downstairs bathroom, nor anywhere upstairs. It was suggested that the hot water had been run off by the baths given during the morning. This is not acceptable, as hot water must be available at all times for hygiene and infection control reasons. There were several minor maintenance matters noted, which the manager agreed to action. The temperature of one room was said by the resident to be always going up and down. This was caused by the draught coming through the French windows which were not sealed or properly double-glazed. The carpet tiles in the main lounge were worn and marked. The manager said that replacement flooring was planned. Beech Lawn Residential Home I54 - I04 S60475 Beech Lawn V237972 050711 Stage 4.doc Version 1.40 Page 15 During the inspection, the main washing machine was found to have broken down. After calling the contract servicers, the manager made temporary arrangements with the other home in the company to take some of the laundry. Individual rooms varied in the degree of personalisation, with some of the residents having items of their own furniture, and special recliner chairs. There was no shade on the ceiling light on the first floor landing. Beech Lawn Residential Home I54 - I04 S60475 Beech Lawn V237972 050711 Stage 4.doc Version 1.40 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. Residents are cared for by the appropriate numbers of staff on each shift. The home’s recruitment procedures cannot verify that proper safeguards were in place, for the protection of residents. EVIDENCE: The Commission had received a comment that the staffing at night (2 carers) was not sufficient for the workload. The care plans of residents were inspected and the tasks of the late shift and the night shift discussed with the manager and senior carers. No evidence was found to substantiate this claim. The manager had made some alterations to the starting times of the kitchen staff to allow carers to attend to residents during the early morning. Recruitment documentation did not confirm that staff who had been taken on this year had received a POVAFirst clearance, as they had all started work before their full CRB certificate had been received. The previous owner believed the correct process had been followed but was unable to find the documents. It is essential that this is found and passed to the new owners as soon as possible. Beech Lawn Residential Home I54 - I04 S60475 Beech Lawn V237972 050711 Stage 4.doc Version 1.40 Page 17 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) 31,37,38. The manager’s role under the new owner should not detract from her good relationship with residents. Records were not all available or up-to-date, for the safety and protection of residents. EVIDENCE: The advent of new owners who will not have such a day-to-day involvement in the running of their homes will mean that the manager will take on a wider role, more in keeping with that expected of a registered manager. Discussion had started with the owner to review what support the manager needed to fulfil those tasks which the previous owners did themselves. Action to fill a new post was already underway. Residents said that the manager was always concerned for their needs and made many efforts to make them comfortable. One resident was very pleased that the manager had arranged for window boxes to be placed outside their room. . The home had not reported all incidents under Regulation 37 to the Commission. The matters listed under the Environment section and the Beech Lawn Residential Home I54 - I04 S60475 Beech Lawn V237972 050711 Stage 4.doc Version 1.40 Page 18 Staffing section, such as recruitment documentation and hot water availability, prevent the home from meeting Standards 37 and 38. Beech Lawn Residential Home I54 - I04 S60475 Beech Lawn V237972 050711 Stage 4.doc Version 1.40 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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 3 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 3 COMPLAINTS AND PROTECTION 2 x 2 x 3 3 2 2 STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x x x x x 2 2 Beech Lawn Residential Home I54 - I04 S60475 Beech Lawn V237972 050711 Stage 4.doc Version 1.40 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 9 Regulation !3(2), 17(1) Requirement The registered person must take steps to ensure full and accurate records for the administration or non-administration of prescribed medicines are completed in full at all times. The registered person must take steps to review current medicine administration procedures ensuring safe hygiene practices are followed at all times. The registered person must take steps to ensure safe procedures for the administration of medicines are followed at all times also ensuring medicines are administered in line with currently active prescribed instructions at all times. The registered person must take steps to ensure medicines held by service users self-managing their medicines are safely secured at all times. The storage of such medicines must form part of the risk assessment process. The registered person must take steps to ensure medicines requiring refrigeration are properly secured at all times. Timescale for action With immediate and ongoing effect. By 15th July 2005 2. 9 13(2), 13(4) 3. 9 13(2), 13(4) By 15th July 2005 4. 9 13(2), 13(4) By 15th July 2005 5. 9 13(2), 13(4) By 15th July 2005 Beech Lawn Residential Home I54 - I04 S60475 Beech Lawn V237972 050711 Stage 4.doc Version 1.40 Page 21 6. 9 13(2), 13(4), 14 7. 19 23(2) 8. 21 23(2) (j) 9. 29 19(4) 10. 37 37 The registered person must take steps to ensure the risks of service users self-administering medicines are assessed and reviewed as appropriate on a regular basis. The registered person must ensure that the home is kept in a good state of repair, as regards the heating and furnishings of all rooms. The registered person must ensure that there is a supply of hot water to all outlets at all times. The registered person must ensure that no person shall work at the home unless they have obtained the information and documents specified in this Regulation. The registered person must inform the Commission without delay of all deaths, illnesses and other events specified in this Regulation. By 15th July 2005 By 30th September 2005 By 30th September 2005 With immediate and ongoing effect. With immediate and ongoing effect. 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 9 Good Practice Recommendations It is recommended that arrangements are made for a review of inhaled medicines currently prescribed for a service user where there is no evidence that the medicines are currently administered. Beech Lawn Residential Home I54 - I04 S60475 Beech Lawn V237972 050711 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection 5th Floor St Vincent Street Cutler Street Ipswich IP1 1UQ 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 Lawn Residential Home I54 - I04 S60475 Beech Lawn V237972 050711 Stage 4.doc Version 1.40 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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