Inspection on 16/05/08 for Beech Lawn Residential Home

This inspection was carried out on 16th May 2008.

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

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

Other inspections for this house

Beech Lawn Residential Home 21/06/07

Beech Lawn Residential Home 26/06/06

Beech Lawn Residential Home 23/11/05

Beech Lawn Residential Home 11/07/05

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 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Beech Lawn Residential Home Elton Park Hadleigh Road Ipswich Suffolk IP2 0DG Lead Inspector John Goodship Unannounced Inspection 16th May 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Beech Lawn Residential Home DS0000060475.V364522.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 Residential Home DS0000060475.V364522.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beech Lawn Residential Home Address Elton Park Hadleigh Road Ipswich Suffolk IP2 0DG 01473 251283 F/P 01473 251283 beechlawn@guytoncarehomes.net 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) Guyton Care Homes Ltd Miss Fay Ulah Veronica Millwood Care Home 26 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (1), Old age, not falling within any of places other category (26) Beech Lawn Residential Home DS0000060475.V364522.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One person over 65 years of age whose name was given to the Commission on 30 January 2007, who requires care by reason of mental disorder. 21st June 2007 Date of last inspection Brief Description of the Service: Beech Lawn is registered to provide care for a maximum of 26 older people and one person with a Mental Disorder, which excludes learning disability or dementia. Guyton Care Homes Ltd owns Beech Lawn, which is a large detached house situated in a private road on the outskirts of Ipswich. Accommodation is sited over two floors, providing one shared room and twenty-four single bedrooms, all with en-suite toilet facilities. There is a platform lift to the first floor. Communal facilities include two lounges and a spacious conservatory. Smoking is not permitted in the home. A statement of purpose, colour photographic brochure and a service user guide provides detailed information about the home, the services provided and access to local services. People living at the home are provided with a contract of the conditions of admission and terms of business. These reflect the fees charged by the home and how much each person is expected to pay per month. Fees range from £341.00 - £500.00 per week. People funded by Social Services have an Individual Placement contract, which reflects Social Services and/or the individual’s own contribution. These charges do not cover additional services such as the hairdresser, chiropodist and personal items such as toiletries, daily newspapers and any other items of a luxury or personal nature. Beech Lawn Residential Home DS0000060475.V364522.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection visit was unannounced and took place on a weekday. It lasted just over seven hours. It focused on the outcomes for residents, under each Outcome group. The manager was present for part of the visit, with the deputy manager assisting us when she was not available. This report includes evidence gathered during the visit together with information already held by the Commission. We inspected a number of records relating to people using the service, staff, training, the duty roster, medication, health and safety and a range of policies and procedures. We toured the home and time was spent talking with one person in the privacy of their room, as well as talking to residents seated in the lounge. Three visitors spoke to us about the home and the care of their family members. Prior to the visit, we sent the manager an Annual Quality Assurance Assessment (AQAA) form which asks for information and data to help us assess the quality of care. Unfortunately this was not returned to us in time to be used during the visit. We received it shortly afterwards, and have referred to information in it in this report. We also distributed survey questionnaires to a sample of residents, relatives, staff and health professionals. We received three back from residents, five from relatives/friends and one from a health professional. None were received back from staff. Relevant information and comments from these surveys has been included in this report. What the service does well: Residents are cared for by well-trained staff, whose care and concern is appreciated by residents and relatives. Comments from the surveys were: “ My sister receives every care and attention, she has a lovely en-suite room with a spacious bedroom and the lounge, conservatory, restaurant is superb.” “I visit at all different times of the day and all staff are excellent.” “Always a member of staff present if anything is required, and generally giving them re-assurance that they are not just left on their own.” Beech Lawn Residential Home DS0000060475.V364522.R01.S.doc Version 5.2 Page 6 Staff records confirmed they receive a range of training, which provides them with the skills and experience to meet the individual needs of the people using the service. Care plans, and comments from a health professional, confirmed that people are supported to access their general practitioner (GP) and other local health services relevant to them which specifically meet their individual mental health needs and general well being. This person also wrote: “From my own observations, residents are treated with dignity”. The home keeps families in touch with what is happening to their relative. A visitor told us: “I am phoned immediately if my sister is unwell.” Visitors are welcome and survey respondents were well aware of the manager who they would go to with any concerns. What has improved since the last inspection? What they could do better: Beech Lawn Residential Home DS0000060475.V364522.R01.S.doc Version 5.2 Page 7 Six requirements have been made as a result of this inspection. They are listed at the end of this report. There is a need to improve documentation for the information and protection of residents. The revised Statement of Purpose must now be issued, and a more readable version of the Service Users’ Guide should be written. The policy and procedures for the protection of vulnerable adults must be in line with the County policy. All staff information and training must follow this. All entries in care plan documents should be signed and dated to enable an audit trail to be followed. If residents are to be assured that the home is run in their best interests, there should be a more organised system for obtaining their views, and the views of relatives and health professionals. The home must show that residents are helped to exercise personal choice over how frequently they wish to bath or shower. There must be continuous review of the needs of residents and the impact on care hours. The dependency review should become a regularly updated management tool to assess staffing needs. The home should investigate the reasons why it has a 50 turnover of staff, and why it has difficulty recruiting. The home should find ways of supporting those residents who receive few, if any, visitors. This could be through employed staff, or using external organisations. As one person told us: “I do miss having someone to chat to”. Staff should not be required to take their breaks in the same rooms residents are using. This detracts from the homeliness of the environment. It is also difficult for staff to observe confidentiality in those circumstances. Equally staff should not have to take their breaks outside, unless it is their choice. 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 Residential Home DS0000060475.V364522.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beech Lawn Residential Home DS0000060475.V364522.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5. Standard 6 is not applicable to this home. Quality in this outcome area is good. People who use this service are provided with information they need to make an informed choice about the home. Once they have decided to move to Beech Lawn they will have their needs assessed and will be given a contract, which clearly tells them about the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We were told that the Statement of Purpose had been rewritten but was awaiting approval by the owner before being published. We were shown the final draft. This had been updated following the requirement from the last inspection to reflect that the home was registered to provide care to one person with a mental disorder. The Improvement Plan sent to us after the last inspection stated that this rewrite had been done by October 2007. It was not Beech Lawn Residential Home DS0000060475.V364522.R01.S.doc Version 5.2 Page 10 made clear to us why there had been this delay in issuing the revised Statement. The Service Users’ Guide had been updated and contained information about how the home was organised, and what services were available to residents for their everyday living. However it was a long, wordy document that was not user-friendly. The deputy manager told us that they were planning to produce a shorter version in a brochure format, whilst still covering the information required by the regulations. Although the Guide did not include the range of fees payable to the home, people living at the home were provided with a contract of the conditions of admission and terms of business. We saw that these reflected the fees charged by the home and how much each person was expected to pay per month. People funded by Social Services had an Individual Placement contract, which reflected Social Services and/or the individual’s own contribution. Prior to moving into the home each person had a pre - admission assessment completed. These provided detailed information about the individual’s health, social and personal care and determined if the home was able to meet the person’s individual needs. We examined the file for a recent admission, which showed that the person had been assessed two weeks before moving in. During that time, they had stayed in the home for a weekend trial period. Beech Lawn Residential Home DS0000060475.V364522.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11. Quality in this outcome area is good. Residents can expect staff to identify and review their care needs to ensure appropriate care is given. Their safety is protected by the home’s medication procedure and medication audits. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We examined three care plans in the new style format. Each contained a current photograph of the person together with their personal details including next of kin and other important contacts. The plans were well organised and provided detailed information covering all aspects of the individual’s health, personal and social care needs. We pointed out to the manager that there was no space on the proforma pages for signing and dating. She told us that this would be put right as soon as possible. Beech Lawn Residential Home DS0000060475.V364522.R01.S.doc Version 5.2 Page 12 The files were divided into headings which mirrored those in the pre-admission assessment. These included mobility, personal care, medication, sight and hearing, mental state, diet and social interests. Under each heading, on proforma, were statements about the service to be provided, and the objective to be achieved. For one resident, there was an objective to improve their independence by maintaining their current level of mobility. The manager told us that staff sometimes had to be reminded to encourage this person to walk with assistance and not to use a wheelchair unless they wished to. The previous inspection report had recommended that the home should seek advice from the health authority falls adviser. This had been done and we saw the records of the referral forms which the adviser received when they visited the home. Each person’s needs were discussed with staff and any preventative action taken, such as the installation of more grab rails in the corridors. A visitor told us that their friend had been having several falls at home but these had reduced since coming to live at Beech Lawn. The care plans included risk assessments, most of them completed by the deputy manager who had attended a course on Risk Assessment in 2007. The assessments identified the hazards for various activities and guidance for staff on reducing or eliminating them. Care plans contained charts confirming people were being weighed on a regular basis. Fluctuations in individuals weight were being monitored and where appropriate advice had been sought from a nutritionist. Plans included records of visits by the GP and district nurse as well as other health personnel. One resident had had a pressure sore for some time which required frequent visits by the district nurse. The record showed that no sooner had it healed than the resident scratched it causing it to break down. A district nurse told us that the home were quick to spot any health problems and referred these appropriately to the GP or district nurse. They also said that residents were taken to their rooms for medical treatments, although junior staff sometimes needed reminding of the need to protect residents’ privacy. We noted that the care plans were reviewed monthly with summaries of changes to care needs being highlighted for staff. These would be discussed with staff at handover times. The daily record would also note changes during each shift. We noted that some entries in this record were very short and sometimes gave a negative view of the resident. E.g. “No problems.” This gave the impression that the resident did not cause staff any problems. The daily record should provide a picture of each resident during the shift even if they did the same things they always did. This would be especially important for those residents choosing to stay in their rooms for all or most of the day. The staff maintained a Resident Care Check record in each bedroom which recorded when staff had been to see the person in their room during the day. It also recorded checks made by the night staff. Beech Lawn Residential Home DS0000060475.V364522.R01.S.doc Version 5.2 Page 13 One relative had asked if their family member could have more than one shower a week. The manager told us that each resident had one shower or bath a week unless for example they had soiled themselves. One resident was able to shower themselves every day. It was not clear from the records that residents were offered the choice of more frequent bathing. A sample check of the medication administration system was undertaken. We saw the giving out of medication, the checking of the records and the security of the medication which was on a medicine trolley. All was satisfactory. There were no gaps in signatures for medication, and the amounts in the blister packs tallied with the records of receipt and administration. We were told, and staff confirmed, that medication was only given out by senior staff or night staff, who had all been trained. The home was introducing the end of life documentation recommended by the Department of Health’s Gold Standard Framework. This was called an Advanced Care Plan. We saw some forms which had been completed. The deputy manager told us that they were considering adapting the forms to seek better information about residents’ wishes more relevant to a care home. Beech Lawn Residential Home DS0000060475.V364522.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is good. Residents can choose how they interact with other residents, and can maintain contact with their friends and relatives. They can be assured that their nutritional needs will be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was a member of staff responsible for the arranging of in house activities and entertainment and any trips outside the home. One resident told us that they enjoyed the activities and the trips out. However another said that “there are not enough activities to stimulate me.” The manager told us that people with the symptoms of dementia often declined the invitation to take part with other residents. The AQAA stated that in these cases, staff would sit with them and chat on a one-to-one basis. The staff we spoke to said this was what they would like to do but did not usually have the time. We saw one carer playing a ball game in the lounge with residents, and another helping a resident complete a jigsaw puzzle in the conservatory. Beech Lawn Residential Home DS0000060475.V364522.R01.S.doc Version 5.2 Page 15 There was a programme of that week’s activities on the noticeboard. They included exercises, ball games, bowling, bingo, painting and crafts. The manager told us that a record sheet was to be introduced to keep track of which residents took part in different activities. This would provide useful information for the monthly review of care needs. We noticed that two staff were taking their mid-morning break in the conservatory as there was no separate staff room in the home. This lessened the dignity and privacy of residents regarding the homeliness of the environment, and also prevented staff mentioning any resident by name so as not to breach confidentiality. During the morning, we noted a carer going into a resident’s room after knocking to offer them a cup of tea, and to tell them the choice of main course for lunch. That day it was fish and chips (it was a Friday) or ham salad. This person spent most of their day in their room. They told us they were well cared for and the staff were very good. They spent most of the day knitting. They had a few visitors but “I’ve outlived all my family.” People are provided with the option of having three cooked meals a day from a fixed four-week rolling menu. The cook was aware of the dietary needs of each of the people living in the home as well as issues relating to their health. They always provided a vegetarian option and purée food for people requiring a soft food diet. They confirmed they puréed the meat and different vegetables separately so that the individual could taste the individual flavours as well as identify the food by colour and texture. All meals are ‘home-cooked’ using mainly fresh ingredients. An inspection by the local council’s Environmental Health Officer in November 2007 had found that everything was being done in accordance with food hygiene standards. The officer noted that the system of “Safer Food, Better Business” was now being used to record all required information. The lunchtime meal was observed. Tables in the dining room were nicely laid with tablecloths and vases of flowers. People had a choice of where to eat, some had chosen to eat in their room. Meals were served quickly; these looked appetising and were nicely presented, Meals taken to rooms were covered and the plates were warmed. Several residents made comments about the meals: “The cooking is good; the meals are varied and tasty; I am really satisfied with the quality and choice of meals.” Beech Lawn Residential Home DS0000060475.V364522.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. Quality in this outcome area is good. Residents can be assured that their views will be listened to, taken seriously and acted upon. There is a proper policy, procedure and training programme in place to give residents confidence that they are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of this inspection, the Commission was undertaking a national information gathering exercise on the safeguarding of residents in care homes. This was done partly by a structured questionnaire. With the agreement of the manager, this was completed for the home and formed the basis of the assessment of Standard 18 above. The policies and procedures for dealing with complaints and safeguarding the people living in the home were seen. They were displayed in the corridor, together with a copy of the latest inspection report. The record of complaints had been revised on the recommendation of the last inspection. It now showed the action taken in response to the complaint. The form used however did not describe the original complaint. There was also a summary sheet at the front of the file. This showed that the home had received four complaints this year. One was about staffing levels, one about the lack of heating in a bedroom, one about meal times being rushed, and Beech Lawn Residential Home DS0000060475.V364522.R01.S.doc Version 5.2 Page 17 about how a carer had spoken to a resident. One resident told us that they had asked to see the owner to complain about the staffing numbers in February 2008. The owner had visited them in their room. They thought that the situation was better now after recruitment, and the owner had visited since to check how things were going. The resident told us they were satisfied with the response. Another resident told “I feel that I can talk to any of the staff if I am not happy”. The home had a policy on the protection of vulnerable adults and a whistleblowing policy for staff. Proper recruitment checks were made on applicants for staff positions before appointment. All staff had received training in this area during the last twelve months. This included all ancillary staff as well as care staff. The training used a distance-learning module that was assessed by an external tutor. The manager told us that she made sure that training was put into practice through supervision, both formal and informal. The staff we spoke to confirmed the training they had had, and were able to describe the different kinds of situations which could be defined as abuse. The manager had covered safeguarding during her NVQ3 and 4 programmes, but had not attended any session about the specific procedures in Suffolk. She admitted that she did not know enough about the local process for safeguarding referrals. We saw a reminder to staff on the noticeboard about abuse which did not correctly describe “what happens next” after an allegation had been made. Beech Lawn Residential Home DS0000060475.V364522.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,24,25,26. Quality in this outcome area is good. Residents can be assured that they live in a safe and well-maintained home, and that they will be encouraged to personalise their rooms as much as they wish. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Beech Lawn is a large detached house situated in a private road on the outskirts of Ipswich. Accommodation is sited over two floors, providing one shared room and twenty-four single bedrooms, all with en suite facilities comprising a toilet and hand basin. Additionally people have the use of two lounges, a spacious conservatory and dining room. Beech Lawn Residential Home DS0000060475.V364522.R01.S.doc Version 5.2 Page 19 Furnishings and lighting throughout the home were domestic in character and were sufficient for their purpose. At the rear of the house there was a large garden mostly laid to lawn with a patio area providing seating for use in the better weather. The garden and car parking to the front of the property was well maintained. Pot plants and new seating had been bought to enhance the area. The AQAA stated that families and residents had commented on how the seating area had been improved. Additional security lighting had been installed at the rear of the property to increase the safety of residents. The home had three assisted baths and two walk-in showers. One of the latter had recently been completed and was in use. However there was still unfinished tiling round the pipes. We noticed that during the morning the boiler room door near the office had been wedged open by a bucket of cleaning substances and a black bag of wet hand towels. These were removed as soon as they were pointed out to the manager. People’s rooms were nicely decorated and personalised reflecting their individual character. People had brought items of their own furniture and other personal possessions, such as photographs and ornaments. Several bedrooms had been refurbished with new furniture and matching accessories, enhancing the environment for the occupants. One resident told us “my room in particular is always very well cleaned”. There had been a problem with maintaining proper heating in the home in 2007. The last inspection report noted the number of free standing radiators in bedrooms. There was also a complaint on this matter in the complaint log. The manager told us that all freestanding radiators had been removed apart from two which belonged to the residents. We saw the risk assessments which had been completed for these. We noted that thermostatic valves had been fixed to most radiators to allow residents to control the level of heating in their room. In response to a requirement from the last inspection, grab rails had been installed in all the corridors enabling residents to move around the home more safely. Wheelchairs were being stored in the conservatory. Staff told us that this was the most convenient area for them to access the chairs when needed, and they did not believe they reduced the usable space as the conservatory was large and roomy. The laundry facilities were clean and tidy with appropriate equipment to launder clothing and bedding. The soaking and sluicing of soiled garments before washing had ceased. The dirty laundry was now put into red dissolvable bags using the sluice cycle on the washing machines. The cross-infection policy had been revised but was still awaiting approval from the owner. Beech Lawn Residential Home DS0000060475.V364522.R01.S.doc Version 5.2 Page 20 A check of the water temperatures confirmed there was plenty of hot water, which was found to be close to the recommendation temperature of 43 degrees centigrade. The temperatures were tested regularly by the maintenance man and we were shown the records of these checks. Beech Lawn Residential Home DS0000060475.V364522.R01.S.doc Version 5.2 Page 21 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. The home can demonstrate safe recruitment procedures, which protect residents. The number of staff rostered on duty is not always sufficient to support the needs of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had had a continuing problem in retaining and recruiting staff. This had been highlighted in the report of the inspection of June 2007. At the time of this inspection, the home had three vacancies to which it hoped to appoint shortly. In the meantime existing staff were being asked to cover the gaps in the rota. Agency staff had only been used for one shift since the beginning of 2008. The Commission received a concern from an ex-member of staff that on occasions there was only one carer and the manager on duty. The manager admitted that this had happened due to staff reporting sick on the day and a member of staff leaving suddenly. Eight out of sixteen care staff had left the home during the last twelve months. This was a high percentage which created difficulties for management and also unsettled residents, as the people who cared for them changed. Beech Lawn Residential Home DS0000060475.V364522.R01.S.doc Version 5.2 Page 22 A requirement at the last inspection was that the home must undertake a review of the staffing hours in conjunction with the individual assessments of people using the service. This was intended to ensure that there was sufficient staff available to meet the needs of all people living in the home. The home had done this in December 2007 although it was not clear what effect the analysis had had on staffing establishment. The staffing levels on each shift remained the same. The manager had written in the Improvement Plan required by the Commission that “extra staff will be available as necessary”. It was difficult to identify when this had been required or even where these extra staff would come from. No further dependency review had been carried out. The duty roster reflected that each morning shift was covered by a senior and three care staff between 8am – 2.30pm. A senior supported by two carers between 2.30 - 9pm covered the afternoon shift. There were two waking night staff between the hours of 9pm – 8am. A resident who had complained in February 2008 about the lack of staff told us that the situation was now better. We spoke to two members of staff, one who said the staffing levels were “OK if all the staff were in and were good”, and the other who said staffing levels were “all right”. Records confirmed that staff were provided with the training they needed to gain the knowledge and skills to perform their work role and meet peoples’ needs. Recent training had included Common Induction Standards, for a new employee, which covered principles of care, the role of and development of the worker, maintaining safety at work, effective communication, recognising and responding to abuse and neglect. Other training courses included first aid, food hygiene, fire safety, moving and handling, infection control, fire safety and administering medication. However we could find no clear training plan for the year showing which staff required training in the different topics. We examined the files for two staff members. These contained application forms, two references, identification documents, and records of the Protection of Vulnerable Adults check and their Criminal Records Bureau disclosure document. Training certificates were also filed there. Beech Lawn Residential Home DS0000060475.V364522.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): 31,32,33,35,36,38. Quality in this outcome area is adequate. Residents cannot be assured that there is a system for obtaining their views on the running of the home to ensure it is run in their best interests. A process of staff supervision protects residents by monitoring and improving the skills of the staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has been in post since 1995. They have a National Vocational Qualification (NVQ) level 4 in Care and Management. They were absent for some of the inspection; therefore time was spent with the deputy manager and seniors on duty. The deputy manager had been in post for nearly Beech Lawn Residential Home DS0000060475.V364522.R01.S.doc Version 5.2 Page 24 two years and had a good understanding of the day-to-day running of the home and the needs of the people using the service. Prior to the inspection the home had been sent an Annual Quality Assurance Assessment (AQAA) form to complete. This is a self-assessment tool produced by the Commission for Social Care inspection (CSCI) that is being used for all regulated services. It is the home’s opportunity to assess their service and how well they think they are performing. This had not been completed and returned within the timescale requested. This was the second year that this had happened. It was received shortly after the inspection but was filled in with only brief comments under each heading. At the last inspection the home had been required to demonstrate how it took the views of all stakeholders into account to assess how well it met the aims and objectives set out in its Statement of Purpose. We were shown nine forms from a quality assurance survey. These were not dated so it could not be ascertained if any more were expected to be returned, or who it had been given out to. There was no evidence of any analysis of the forms or of any action taken on the comments. We asked for a copy of the report which would be prepared as a result of this survey and given to residents and relatives. Staff confirmed to us that regular staff meetings were held. We saw the minutes of the most recent one held in April 2008. Items covered included cross-infection control, protective clothing, promotion of continence, security and fluid intake. There was a suggestion that that there should be new condiment sets in the dining room and new jugs for the lounge. The manager had agreed but no action had yet been taken. Staff confirmed to us that they received regular supervision sessions. The current schedule was displayed in the office. There were six sessions still to be done from April 2008. Although the home did not manage people’s finances, for their convenience the manager did hold a small amount of personal cash for nine people. This was held separately for each person and a record of transactions of all monies spent and received were logged. The records and balance for two people were checked and were found to be accurate. For those residents who wished to keep their doors open at certain times, the home had fitted Dorguards which closed automatically on the sound of the fire alarm. One had also been fitted to the administrator’s office on the second floor. We were told that the staircase to this office which the fire officer had identified as a hazard would not be replaced until the extension planned for the home went ahead. No date for this was available. Beech Lawn Residential Home DS0000060475.V364522.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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 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 3 3 X 3 3 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 3 X 2 Beech Lawn Residential Home DS0000060475.V364522.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4(C) schedule 1 Requirement The revised statement of purpose must be agreed and issued, to inform current and prospective service users about the range of needs the home caters for. Service users must be offered a choice of how often they wish to bath or shower. The home’s policy on the protection of vulnerable adults and all information given to staff must reflect the current policy and procedures of the Suffolk Adult Safeguarding Board. At all times the home must be able to demonstrate that the number of staff on duty is sufficient and appropriate to the needs of the service users. The Commission must be sent the analysis of the latest quality assurance survey with a record of any action taken. Staff must be instructed to follow the home’s policy on the control of substances hazardous to health, and the fire safety policy, to ensure that all parts of the DS0000060475.V364522.R01.S.doc Timescale for action 30/06/08 2. 3. OP10 OP18 12(4)(a) 12(1) 30/06/08 30/06/08 4. OP27 18(1)(a) 30/06/08 5. OP33 24 31/07/08 6. OP38 13(4) 30/06/08 Beech Lawn Residential Home Version 5.2 Page 27 home to which service users have access are safe and free from hazards. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP1 OP7 OP10 OP18 Good Practice Recommendations The Service Users’ Guide should be produced in a clear and shorter format to be more easily read. All entries in care plan documents should be signed and dated, to enable them to be audited. The home should review the arrangements for where staff are allowed to take their breaks, to protect the confidentiality of residents and for the comfort of staff. The manager should attend updating training on the Suffolk Adult Safeguarding policy and procedures, to ensure that the home’s policy and training are in line with county policy. The tiling in the shower room should be completed to ensure greater hygiene and better cleaning. The reasons for the high turnover of staff should be analysed to try to reduce the unsettling changes of personnel for residents. The dependency survey should be updated on a regular basis to ensure that staff numbers on each shift are appropriate for the needs of residents. The home should investigate ways of supporting residents who get few visitors. The revised infection control policy should be approved and issued to staff. 5. 6. 7. 8. 9. OP26 OP27 OP27 OP27 OP37 Beech Lawn Residential Home DS0000060475.V364522.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Residential Home DS0000060475.V364522.R01.S.doc Version 5.2 Page 29 - 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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