Inspection on 21/06/07 for Beech Lawn Residential Home

This inspection was carried out on 21st June 2007.

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 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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Beech Lawn Residential Home Elton Park Hadleigh Road Ipswich Suffolk IP2 0DG Lead Inspector Debbie Kerr Unannounced Inspection 21st June 2007 09:15 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.V343908.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.V343908.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 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.V343908.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. 26th June 2006 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 – £450.00 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.V343908.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over nine hours on a weekday. This was a key inspection, which focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to and during the inspection. A number of records were inspected, relating to people using the service, staff, training, the duty roster, medication, health and safety and a range of policies and procedures. A tour of the home was made and time was spent talking with one person in the privacy of their room. A group of people living in the home were spoken with collectively whilst sitting in the conservatory. The registered manager was off duty on the day of the inspection, however the deputy manager was present and fully contributed to the inspection process. Time was spent talking to six staff about their experience of working in the home. What the service does well: Beech Lawn provides people with a well maintained, warm and comfortable home. Vases of fresh flowers, plants and pictures painted by some of the people living in the home are placed in communal areas, these additional touches helped to create a ‘homely’ environment. On entering the home there is a happy and relaxed atmosphere, people were seen engaged in friendly conversations over breakfast. Staff were observed to be caring and thoughtful, providing a high standard of care in a friendly and sensitive manner. Care plans 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. A member of staff has completed a National Vocational Qualification (NVQ) level 2, with additional units related to activities. Their flair and creativity provides people living in the home with a range of age appropriate, stimulating and interesting activities. 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. These have included information sessions about the condition, Bipolar and a correspondence course for dementia awareness through a local college. Beech Lawn Residential Home DS0000060475.V343908.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The home was approved in March 2007 by the Commission for Social Care Inspection (CSCI) to provide care to one person with a mental disorder. The inspector was informed that two people already residing at the home have developed dementia. The statement of purpose, service user guide and brochure need to be amended to reflect this change. They also need to demonstrate how the home is able to meet these people’s needs. The end of life wishes of the people using the service need to be discussed, agreed and recorded in the person’s care plan with regards to terminal illness, death and dying. Although this is a sensitive subject this information needs to be ascertained and agreed with the individual and /or their relatives to ensure that in these circumstances the individual and their relatives will be treated with dignity and respect and in accordance with their wishes. Beech Lawn Residential Home DS0000060475.V343908.R01.S.doc Version 5.2 Page 7 The policy for reporting allegations of abuse need to be amended to reflect the revised Adult Safeguarding Locality Committee, which replaces the Vulnerable Adult Protection Committee, operational procedures of June 2004. Consideration must be given to using temporary staff or agency to ensure the contracted staff employed at the home have the appropriate amount of time away from the work place. Additionally, before admitting more people into the service, each person already living at the home needs to be reassessed to ensure that there are sufficient care hours provided to meet their individual needs. Action must to be taken to address the issues raised by the fire service following their safety audit of the premises on the 25th May 2006, in particular relating to the administrators office on the second floor. Although a 30-minute fire door has been fitted, this was seen wedged open and there continues to be a significant health and safety risk to the administrator. Additionally a number of fire doors around the building were wedged open. The registered provider should ensure that there is provision of adequate welfare facilities for employees, for example a rest room and adequate toilet facilities that meet the Workplace (Health, Safety and Welfare) regulations 1992. A previous requirement was made for the home to be free of hazards, generally the home was neat and tidy, however wheelchairs were being stored in the corridors, although these were removed during the inspection, a suitable place must to be found to store equipment when it is not in use. Where people choose to have freestanding electric radiators in their rooms, risk assessments must be completed to ensure measures are taken to protect the person’s safety. Assessments must also include the risks to people tripping and falling over trailing wires of portable appliances. The current practice of sluicing soiled garments in the sink before washing needs to change to comply with the Department of Health Guidance for Infection Control. The infection control policy will need to be amended to reflect the safe transportation and management of soiled linen. To promote peoples dignity and support them to manage their continence, bins with an easy to use lid need to be provided in toilets for people to place used continence products. Additional grab rails need to fitted around the home, especially in corridors to enable people to move freely and independently around the home. Fourteen falls were recorded in the incident and accident records between 1 - 21st June 2007. These falls were largely attributed to three people. The home needs to contact a falls co-ordinator to obtain advise for the future prevention of falls for people identified at risk. Staff supervision sessions should take place at least six times a year. Beech Lawn Residential Home DS0000060475.V343908.R01.S.doc Version 5.2 Page 8 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.V343908.R01.S.doc Version 5.2 Page 9 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.V343908.R01.S.doc Version 5.2 Page 10 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, Standard 6 is not applicable to this service. People who use the service experience good quality outcomes in this area. 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 in the majority of cases 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: The statement of purpose, service user guide and brochure needs to be amended to reflect that the home is registered to provide care to one person with a Mental Disorder. Consideration should to be given to how information about the service is provided to people with a sensory impairment. The inspector was informed that two people already residing in the home have developed dementia. The home needs to identify in the individuals care plans and in the information about the home how the service supports people with deteriorating and frail health needs. Beech Lawn Residential Home DS0000060475.V343908.R01.S.doc Version 5.2 Page 11 Prior to moving into the home each person has a pre - admission assessment completed. These provide detailed information about the individual’s health, social and personal care and determine if the home are able to meet the person’s individual needs. The deputy manager had undertaken an assessment of an individual returning from a stay in hospital to ensure the home could continue to meet their needs. Staff individually and collectively have the skills and experience to meet the specific needs of the people living in the home. Staff files and training records confirmed that staff have received recent training in Dementia Care and Bipolar Affective Disorder. Three people’s files were examined, two contained the necessary paperwork setting out the terms and conditions of residence, the method of payment and their current fee. These were signed and dated by the individual and /or their representative. For one individual funded by Social Services an Individual Placement Contract (IPC) was seen which confirmed the level of funding and the individual’s contribution. The home does not provide intermediate care; subsequently this standard is not applicable. Beech Lawn Residential Home DS0000060475.V343908.R01.S.doc Version 5.2 Page 12 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, People who use the service experience adequate quality outcomes in this area. Improvements made to the care plans and management of medication means that the health and personal care people receive is based on their individual needs, although they cannot be assured that at the time of serious illness, death or dying their wishes will be respected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A new care plan format is being introduced. Two of three care plans seen were much improved. Each contained a current photograph of the person together with their personal details including next of kin and other important contacts. The plans are well organised and provide detailed information covering all aspects of the individual’s health, personal and social care needs. Care plans are being reviewed on a monthly basis and clearly reflect peoples changing needs. A previous requirement was made for people’s nutritional needs to be monitored. Beech Lawn Residential Home DS0000060475.V343908.R01.S.doc Version 5.2 Page 13 Care plans contained charts confirming people were being weighed on a regular basis. Fluctuations in individuals weight are being monitored and where appropriate advice has been sought from a nutritionist. Observation throughout the inspection and the daily notes seen confirmed that the health and well being of people is being monitored. Regular visits were documented showing that people are supported to access their general practitioner (GP) and other local health services relevant to them. For people who are not well enough to leave the home arrangements are made for health professionals to visit them. Staff were observed treating people living in the home with respect and dignity. The interactions between the individuals and staff are friendly and appropriate. Staff call people by their preferred name and respond sensitively to their individual’ needs and preferences. The number of entries in the incident and accident records identified that between 1 - 21st June 2007 there have been fourteen incidents where people had slipped, tripped of fell. These incidents were largely attributed to three people. This was discussed with the deputy manager who was advised to contact a falls co-ordinator to obtain advice and /or training for the future prevention of falls where people are identified at risk. The senior on duty demonstrated the process of administering medication. The Monitored Dosage System (MDS) is used and each blister pack had a front sheet with the individual’s photograph for identification purposes. The process of receipt, administration and safekeeping of medication is well managed. The previous months MAR charts were inspected and were found to be correct with no missed signatures. Controlled drugs are locked separately within the medication cupboard. The controlled drugs register was seen, confirming that there is currently only one person taking controlled drugs. One other person had been prescribed controlled medication, but has stopped taking their Temazepam and using Fentonlyl patches. These were waiting to be collected by the pharmacy. The stock of medication was checked against the register and was found to be accurate. One person has a risk assessment in place, which determines that they are able to self-administer medication. They have been provided with a lockable cupboard in their room to store this. Previous MAR chart’s seen confirmed that the individual signs to accept receipt of their monthly medication and that the manager or senior member of staff completes an audit on a weekly basis to ensure that the individual is taking the correct medication. This is recognised as good practice, however on further inspection of the most recent MAR charts the weekly audits had not been taking place. Beech Lawn Residential Home DS0000060475.V343908.R01.S.doc Version 5.2 Page 14 Information needs to be ascertained, agreed and recorded in each person’s care plan to ensure that at the time of death or dying the individual is supported to manage degenerative and terminal illness through an established plan, which constantly monitors pain, distress and other symptoms. This will ensure that at the time of their death staff will treat them and their family in accordance with their wishes and spiritual beliefs with care, sensitivity and respect. Beech Lawn Residential Home DS0000060475.V343908.R01.S.doc Version 5.2 Page 15 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, People who use the service experience good quality outcomes in this area. People who use this service are able to make choices about their lifestyle and have access to recreational activities, which meet their individual preferences and expectations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An activities co-ordinator is responsible for arranging outings and in house entertainment. Their flair and creativity provides people with a range of age appropriate, stimulating and interesting activities. They discussed and agreed with the people living in the home, a programme of activities, which includes their interests and hobbies. The activity programme was seen displayed on the dining room door reminding people of the activities available to them and on which day. These include card making, flower arranging, painting, word searches, bowling, reading the local newspaper followed by discussion, board games, armchair exercises and arts and crafts. Board games include ‘Doreen’s Day Out’ which is similar to Monopoly; cards equivalent to ‘community chest’ and ‘chance’ are used to promote discussion. Beech Lawn Residential Home DS0000060475.V343908.R01.S.doc Version 5.2 Page 16 A Reminiscence game uses question cards, for example “Do you remember the first movie you went to see” also generating discussion amongst the people involved in the game. Entertainers are regularly booked to perform for the people living in the home. Trips are also arranged to local venues. Ten people were booked to go to see a Brass Band Concert being performed by the local church. Other trips out include the seaside, church services, theatre, pub lunches and shopping. For people whom choose not to take part in the group activities, staff time is made for one to one activities of people’s choice. One individual likes to play dominoes. Staff frequently supports people to walk to a well known supermarket, which is within easy distance of the home. The co-ordinator has purchased items to provide physical activity and appropriate exercise, such as armchair netball. This is a game using beanbags and a matt with different coloured shapes. People have to aim to score a hit in one of the shapes using the beanbags. ‘Squeeze’ balls are used to manipulate people’s hands and wrists. The co-ordinator also consulted with a physiotherapist to develop an armchair exercise programme. People were observed joining in a session, which was well thought out and encouraged all people to participate and enjoy the session. A Portfolio of photographs was seen conforming all of these activities have taken place. People are able to decide how they spend their time, they were observed sitting in lounge watching television, knitting, reading books and the newspaper or they spent time in their own room. One individual spoken with, who chose to stay in their room commented there was “nobody much to talk to”. They also commented that they “would like to go out more but there is not enough staff”. They spent their time watching television quizzes, they admitted that they had joined in flower arranging session, which they had enjoyed but on the whole felt quite lonely. Visitors are welcome at any time, entries in the visitors book confirmed that friends, relatives and family visit on a regular basis. To the rear of the house there is an attractive garden with seating for people to use in the nicer weather and to entertain their visitors. People are provided with the option of having three cooked meals a day from a fixed four-week rolling menu. Time was spent talking with the cook. The choice of meals available on the day of the inspection was either lamb casserole or cheese and onion quiche with seasonable vegetables. 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 provide a vegetarian option and purée food for people requiring a soft food diet. Beech Lawn Residential Home DS0000060475.V343908.R01.S.doc Version 5.2 Page 17 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. The food store seen confirmed that the home has a good range of quality food. These were being stored in accordance with food safety standards, however they could not produce evidence to confirm that they were recording fridge and freezer temperatures daily. They were advised to use the Better Food, Safer Business pack produced by the Food Standards Agency to record all temperatures. The lunchtime meal was observed. Tables in the dining room were nicely laid with tablecloths and vases of flowers. People have 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, however meals taken to rooms should be covered to keep them hot and prevent contamination. Staff were observed assisting people who find it difficult to eat their meal, however staff training is required to ensure that staff understand the importance of offering food at the pace of the individual to make them feel comfortable and unhurried. People spoken with were generally happy with the food. Beech Lawn Residential Home DS0000060475.V343908.R01.S.doc Version 5.2 Page 18 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, People who use the service experience adequate quality outcomes in this area. People using the service or their relatives cannot be assured that their complaints will always be responded too and until all staff working in the home receive training, people are not appropriately safeguarded from the risk of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The policies and procedures for dealing with complaints and safeguarding the people living in the home were seen. The complaints procedure has been amended on Beech Lawn headed notepaper to reflect the name and details of the Commission for Social Care Inspection (CSCI) instead of the former National Care Standards Commission (NCSC). This was displayed in the corridor. The complaints log confirmed there has been one complaint made since the last inspection in June 2006. The complaint was made about the response time for staff to answer the front door bell and the telephone. The complainants noted that this was not the first time they had experienced this when visiting their relative. There was no response recorded in the complaints log to suggest the concerns had been investigated and if the complainants were satisfied with the response. Beech Lawn Residential Home DS0000060475.V343908.R01.S.doc Version 5.2 Page 19 The procedure for reporting allegations of abuse refers staff to the Suffolk Vulnerable Adult Protection Committee (VAPC), informing them to refer all allegations of abuse to Social Services, Customer First Team. The deputy manager was also advised that the VAPC was disbanded in February this year and the Adult Safeguarding Board (ASB) created in its place. The homes policies relating to the protection of adults and whistle blowing will need to be amended to reflect this change. The Training programme confirmed that excluding the manager the home employs seventeen care staff, two cooks, three kitchen assistants and five domestics. Eleven care staff had attended a protection of vulnerable adults awareness training session in April 2007 and six staff attended this training in May 2006, however the catering, and domestic staff have not received this training. To safe guard people living in the home all people that work at Beech Lawn must attend training for the protection of vulnerable people. People living in the home and staff spoken with confirmed they would go directly to the manager if they were unhappy about something. Staff demonstrated a good understanding of what constituted as abusive practice and would have no problem reporting an incident or an individual if they had any concerns about their conduct. Beech Lawn Residential Home DS0000060475.V343908.R01.S.doc Version 5.2 Page 20 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, People who use the service experience adequate quality outcomes in this area. People can expect to live in a home that is nicely decorated, which is warm and comfortable, however to protect their welfare there continues to be issues around health and safety that need to be addressed. 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 of a toilet and hand basin. Additionally people have the use of two lounges, a spacious conservatory and dinning room. Beech Lawn Residential Home DS0000060475.V343908.R01.S.doc Version 5.2 Page 21 Furnishings and lighting throughout the home are domestic in character and are sufficient for their purpose. At the rear of the house there is 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 is well maintained. The home has three assisted baths and a walk in shower. Bathrooms and toilets have grab rails and other equipment provided to promote people’s independence and safety. However, the grab rails in corridors need to be extended in places to enable people to move freely and independently around the home. People were seen holding on to doorframes and using the wall to steady themselves were the grab rails ended. Wheelchairs were being stored in the corridors, causing an obstruction, these were removed during the inspection, however a suitable place needs to be found to store equipment when it is not in use. The deputy informed the inspector that they have been asked to complete maintenance and decoration schedule for the owner of the home. The owner is currently seeking planning permission to extend the building to create additional bedrooms and to continue the refurbishment of the home. Generally the home was clean, bright and tidy. There has been a programme of redecoration to the dining room, lounges and corridors on the ground floor, however it was noted that rooms have been painted the same ‘off white/cream’ giving a sterile and bland appearance. The home has people who are elderly and mentally frail, which in some cases can create, impaired visual perception of their environment. Consideration should be given to having décor that has definition, which is recognisable, by individuals to identify areas and personal rooms and bathrooms by colour and identifiable objects. For example, distinguishable door handles, signage and different designs or coloured doors to personal rooms. 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. The laundry facilities are clean and tidy with appropriate equipment to launder clothing and bedding, however it was noted that soiled garments were being soaked and sluiced before being washed. This practice was discussed with the deputy manager; they were advised this does not comply with the Department of Health (DOH) guidelines for infection control. The inspector noticed that a used continence pad had been placed in the open top waste paper bin in one of the communal toilets. To promote peoples dignity and support them to manage their continence, bins with an easy to use lid need to be provided in toilets for people to place used continence products. Beech Lawn Residential Home DS0000060475.V343908.R01.S.doc Version 5.2 Page 22 Appropriate hand-washing facilities of liquid soap and paper towels are situated in all bathrooms and toilets where staff may be required to provide assistance with personal care. Staff also carry an antibacterial hand wash clipped to their uniform. A check of the water temperatures confirmed there is plenty of hot water, which was found to be close to the recommendation temperature of 43 degrees centigrade, however temperatures must be monitored to ensure they do not exceed this temperature. Beech Lawn Residential Home DS0000060475.V343908.R01.S.doc Version 5.2 Page 23 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, People who use the service experience adequate quality outcomes in this area. Staff in the home are trained and skilled, however staffing levels need reviewing to ensure there are adequate staff available to meet the needs of all people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Previous recommendations have been made to review staffing levels based on the needs of the people living in the home. Beech lawn is registered for 26 people, currently there are 23 people living in the home, with one person in hospital. Staffing levels in relation to the number of people requiring care were examined as part of the inspection. The duty roster reflected that each morning shift is covered by a senior and three care staff between 8am – 2.30pm. A senior supported by two carers between 2.30 - 9pm covers the afternoon shift. There is two waking night staff between the hours of 9pm – 8am. The combined hours of the staff in the waking day, allowing for half an hour per member of staff for breaks and hand over time, equals 42 care hours. These hours divided by the twenty-three people living in the home equates to 1.8 hours of care, per person, per waking day. Beech Lawn Residential Home DS0000060475.V343908.R01.S.doc Version 5.2 Page 24 Discussion with the staff team reflected that reduced staffing numbers due to people who have left employment and long-term sickness cover is causing problems. They confirmed that the home are in the process of trying to recruit more staff, however they are being asked to cover additional shifts, including their weekends off. One member of staff commented that they “can’t remember getting a full weekend off in ages”. The duty roster seen confirmed that staff are covering additional shifts on a regular basis. Staff commented that it is policy that the home does not use agency staff unless it is absolutely necessary. Staff spoke of feeling under pressure to cover the additional shifts and in some cases they have worked a waking night after their late shift. The rota reflects that the deputy and the manager are also working a minimum of three shifts a week. The statement of purpose and service user guide state that the manager is supernumerary to the care staff. Staff felt that they received good training and support from the management team, however they are feeling tired and felt that morale amongst the team is low. They attributed this to the additional shifts and the difference in the work to meet the changing needs and behaviours of people living and moving into the home. Consideration should be given to using temporary staff or agency to ensure the contracted staff employed at the home have the appropriate amount of time away from the work place. Additionally before admitting more people into the service, each person already living at the home should be reassessed to ensure that there are sufficient care hours provided to meet their individual needs. Observation of staff during the afternoon confirmed they were very stretched to meet people’s individual needs with the volume of work. A person fell requiring the assistance of two of the staff, at the same time the third member of staff reported to the senior an individual had an incontinence accident and required personal support, requiring two staff. A consultant arrived to discuss a person’s course of treatment and the lights in the home failed requiring investigation. An incident also occurred between two people living in the home, which needed staff intervention. All of these things took place leaving one person to assist people with their tea. The training programme confirmed that the home employs seventeen care staff, two cooks, three kitchen assistants and five domestics. Four staff have achieved their National Vocational Qualification (NVQ) Level 2 Awards in care. One person has completed level 3, another carer has enrolled to undertake level 3. The activities co-ordinator has completed additional units to obtain a NVQ for providing activities. The cooks have enrolled on NVQ Level 2 in catering. These figures reflect that Beech Lawn have not quite reached the National Minimum Standard (NMS) target of at least 50 of care staff to hold a recognised qualification. Beech Lawn Residential Home DS0000060475.V343908.R01.S.doc Version 5.2 Page 25 Records confirmed that staff are provided with training they need to gain the knowledge and skills to perform their work role and meet peoples needs. Most recent training has included Common Induction Standards, for new employees, which covers 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, dementia care, health and safety and administering medication. Additionally staff have been enrolled on correspondence courses with a local college, four people are doing dementia awareness and one has commenced the safe administration of medication. Staff files seen confirmed the home generally operates a good recruitment process. The deputy was unable to access the appropriate paper work including Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) for the three staff files checked. They were left an immediate requirement to forward these documents to the Commission for Social Care Inspection (CSCI) office. These documents were received on the 29th June confirming the appropriate checks had been taken up prior to employing staff to work in the home. Beech Lawn Residential Home DS0000060475.V343908.R01.S.doc Version 5.2 Page 26 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, 34, 35, 36, 37, 38, People who use the service experience adequate quality outcomes in this area. People living and working in the home cannot be assured that they will be protected by the arrangements in place for health and safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manger has been in post since 1995. They have a National Vocational Qualification (NVQ) level 4 in Care and Management. They were absent on the day of the inspection; therefore time was spent with the deputy manager and seniors on duty. The deputy manager has been in post for nine months and has a good understanding of the day-to-day running of the home and the needs of the people using the service. Beech Lawn Residential Home DS0000060475.V343908.R01.S.doc Version 5.2 Page 27 Prior to the inspection the home had been forwarded an Annual Quality Assurance Assessment (AQAA) form to complete. This is a new selfassessment 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 as requested, however the deputy confirmed that they were in the process of working through the document. They provided an example of their own quality assurance resident’s questionnaire, which asks for feedback on the quality of care and service they receive. The most recent survey is in the process of being completed. The deputy agreed to forward a copy of the results of the survey to the CSCI, these should also be made available to people connected to the service on request. As well as obtaining feedback from the people using the service, the quality assurance and quality monitoring systems need take into account the views of family, friends and other professionals associated with the Beech Lawn to reflect how the home is meeting the aims and objectives set out in the statement of purpose. The deputy was not aware of the existence of a business plan. The responsible individual should have a business plan in place, which should include the details of the alterations to the home to increase occupancy levels. The inspector requested a copy of the plan to be sent to the CSCI to demonstrate the current and future financial viability of the home. Although the home does not manage people’s finances, for their convenience the manager does hold a small amount of personal cash for nine people. This is held separately for each person and a record of transactions of all monies spent and received are logged. The records and balance for four people were checked and were found to be accurate. Staff files confirmed that there is a lack of formal recorded supervision, however the deputy manager produced evidence that a structure for supervision was being implemented. Three staff had received supervision in May 2007, which had an agreed structure to discuss the aims, objectives and philosophy of the home, health and safety issues and personal development. Each member of staff should receive formal supervision at least six times a year. During the tour of the home a few issues relating to the safety and welfare of people living in the home were identified. Where people choose to have free standing electric radiators in their rooms, risk assessments must be completed to ensure measures are taken to protect the person’s safety. Additionally assessments must also include the risks to people tripping and falling over trailing wires of portable appliances. Beech Lawn Residential Home DS0000060475.V343908.R01.S.doc Version 5.2 Page 28 A number of fire doors around the building were wedged open, the deputy advised that they had ordered ‘Dor Guards’ to be fitted. Issues around the health and safety need to be addressed relating to the administrators office on the second floor. As previously identified in the key and random inspections undertaken last year, action must be taken to address the issues raised by the fire service following their safety audit of the premises on the 25th May 2006. Although a 30-minute fire door has been fitted to the office door, this was seen wedged open and there continues to be a safety risk to the administrator in the event of a fire. Additionally, staff spoken with are concerned about access to the second floor via the very narrow and steep staircase, there is a risk to people’s safety, especially if carrying files and documents up and down these stairs. The toilet facilities next to the administrator’s office are in poor condition. Staff do not have a separate staff room where they can take their brakes, they told the inspector they generally have a break outside, in all weathers. Both of these are issues that do not meet the Workplace (Health, Safety and Welfare) regulations 1992, which require the provision of adequate welfare facilities for employees. A number of policies and procedures were seen, including, restraint, the use of bedrails, promotion of continence and infection control. The infection control policy and procedures for dealing with soiled linen does not comply with the Department of Health (DOH) guidelines. The deputy manager was provided with information to access the DOH Infection Control Guidance for Care Homes booklet which gives clear information of the procedures the home should follow for the management of soiled or infected linen. Beech Lawn Residential Home DS0000060475.V343908.R01.S.doc Version 5.2 Page 29 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 2 3 2 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 3 3 2 X 3 3 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 2 3 2 2 2 Beech Lawn Residential Home DS0000060475.V343908.R01.S.doc Version 5.2 Page 30 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 OP1 Regulation 4 (c) Schedule 1 Requirement The statement of purpose, service user guide and brochure needs to be amended to reflect that the home is registered to provide care to one person with a Mental Disorder and people with dementia. This will inform current and prospective users of the service about the range of needs the home caters for. The dependency level of each person currently using the service needs to be reassessed. This will ensure that there are sufficient care hours provided to meet people’s individual needs. The end of life needs of people living in the home must be discussed with the individual, relatives and/or representatives to ensure that in these circumstances the individual and their relatives will be treated with dignity and respect and in accordance with their wishes. Timescale for action 17/08/07 2 OP3 18 (1)(a) 17/08/07 3 OP11 12(3) 17/08/07 Beech Lawn Residential Home DS0000060475.V343908.R01.S.doc Version 5.2 Page 31 4 OP18 13 (6) All staff including ancillary staff must attend training in for protection of vulnerable adults. This will safeguard people living in the home from the risk of abuse. Grab rails in corridors need to be extended. This will ensure the safety of people using the service and enable people to move freely and independently around the home. 17/08/07 5 OP22 23 (2) (n) 17/08/07 6 OP22 23 (2) (l) Appropriate storage must be 17/08/07 found to store equipment when it is not in use, including wheelchairs. This will ensure the safety of people using the service and enable them to move freely and independently around the home, which is free from obstruction. The current practice of sluicing soiled garments in the sink before washing must be changed to comply with the Department of Health Guidance for Infection Control. This will reduce the risk of cross infection and ensure the safety of the people using the service. A review of staffing hours must be undertaken in conjunction with the individual assessments of people using the service. This will ensure there is sufficient staff available to meet the needs of all people living in the home. The quality assurance systems must take into account the views of family, friends and other professionals associated with the home. This will confirm how the home is meeting the aims and objectives set out in the statement of purpose. DS0000060475.V343908.R01.S.doc 7 OP26 13 (3) 17/08/07 8 OP27 18 (1)(a) 17/08/07 9 OP33 24 21/09/07 Beech Lawn Residential Home Version 5.2 Page 32 10 OP34 25 11 OP38 23(4) 12 OP38 13 (4) (a) (b) (c) The responsible individual should 17/08/07 have a business plan in place, which includes the details of the alterations to the home to increase occupancy levels. A copy of the plan must be forwarded to the CSCI to demonstrate the current and future financial viability of the home. Action must be taken to address 17/08/07 the issues as raised by the fire and rescue service in 25th May 2006, including action to make the administrator’s office on the second floor safe and where fire doors are being wedged open alternative measures are taken. This will ensure the safety of people living and working in the home. Where freestanding electric 17/08/07 radiators are in use in bedrooms, risk assessments must be completed. Additionally assessments must include the risks to people tripping and falling over trailing wires of portable appliances. This will ensure that measures are taken to protect people’s safety. 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 OP1 Good Practice Recommendations The service users guide and other information about the home should be available in a format suitable for the people with a visual and other sensory impairments. Beech Lawn Residential Home DS0000060475.V343908.R01.S.doc Version 5.2 Page 33 2. OP8 A falls co-ordinator should be contacted to obtain advice and /or training for the future prevention of falls. This will protect people identified at risk from further falls and injury. The manager or senior member of staff needs to ensure that a weekly medication audit is completed. This will ensure that the individual assessed as able to selfadminister their medication is taking the correct medication. A response to complaints should be recorded in the complaints log to reflect that concerns have been investigated and if the complainants were satisfied with the response. The Suffolk Vulnerable Adult Protection Committee (VAPC) was disbanded in February this year and the Adult Safeguarding Board (ASB) created in its place. The home’s policies relating to the protection of adults and whistle blowing will need to be amended to reflect this change. Consideration should be given to the decor of the home to ensure that there is definition, which is easily recognisable, by individuals who may have impaired visual perception of their environment. For example, distinguishable door handles, signage and different designs or coloured doors to personal rooms. A check of the water temperatures confirmed hot water was found to be close to the recommendation temperature of 43 degrees centigrade, however temperatures should be monitored on a regular basis to ensure they do not exceed this temperature. To promote people’s dignity and support them to manage their continence, bins with an easy to use lid need to be provided in toilets for people to place used continence products. Consideration should be given to using temporary staff or agency to ensure the contracted staff employed in the home has the appropriate amount of time away from the work place. Training figures reflect that Beech Lawn have not quite reached the National Minimum Standard (NMS) target of at least 50 of care staff to hold a recognised DS0000060475.V343908.R01.S.doc Version 5.2 Page 34 3. OP9 4. OP16 5. OP18 6. OP19 7. OP25 8. OP26 9. OP27 10. OP28 Beech Lawn Residential Home 11. 12. OP36 OP38 qualification. Staff supervision sessions should be undertaken at least six times a year. The infection control policy and procedures for dealing with soiled linen need to be amended to comply with the Department of Health (DOH) guidelines. The registered provider should ensure that there is provision of adequate welfare facilities for employees, for example a rest room and adequate toilet facilities that meet the Workplace (Health, Safety and Welfare) regulations 1992. 13. OP38 Beech Lawn Residential Home DS0000060475.V343908.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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. 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