Inspection on 23/11/05 for Beech Lawn Residential Home

This inspection was carried out on 23rd November 2005.

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

The inspector 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 16/05/08

Beech Lawn Residential Home 21/06/07

Beech Lawn Residential Home 26/06/06

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 Limited Elton Park Hadleigh Road Ipswich Suffolk IP2 0DG Lead Inspector John Goodship Announced Inspection 23rd November 2005 10:00 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 Limited DS0000060475.V267645.R01.S.doc Version 5.0 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 Limited DS0000060475.V267645.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Beech Lawn Residential Home Limited Address Elton Park Hadleigh Road Ipswich Suffolk IP2 0DG 01473 251283 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 Old age, not falling within any other category registration, with number (26) of places Beech Lawn Residential Home Limited DS0000060475.V267645.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th November 2004 Brief Description of the Service: Beech Lawn is a registered care home for older people. It is registered for a maximum of 26 older people. The Home is owned by Guyton Care Homes Ltd which also owns a second Home in Ipswich. Beech Lawn is a large detached house situated in a private road on the outskirts of Ipswich. Accommodation is sited over two floors. The Home provides 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. Beech Lawn Residential Home Limited DS0000060475.V267645.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the second in this inspection year and was announced. It was also the second visit following the purchase of Guyton Care Homes Ltd by the new owner. The manager was present throughout. Records, care plans and files were examined. The inspector toured the building and spoke to six residents. Comment cards had been completed by 8 residents and 8 visitors. Topics raised, and a sample of comments, have been included in the body of the report. The inspection lasted from 0940hrs to 1645hrs. What the service does well: What has improved since the last inspection? What they could do better: The manager must not employ staff until they have been through the proper vetting procedures. Staff must be covered by a programme of regular supervision sessions, at least six times a year. The owner must comply with Regulation 26 and visit the home monthly, unannounced, producing a written report, a copy of which must be sent to the Commission. Beech Lawn Residential Home Limited DS0000060475.V267645.R01.S.doc Version 5.0 Page 6 The proposed designation of one carer as responsible for introducing more activities for residents will help to meet the comments of several residents. A plan for the refurbishment of the home still needs to be drawn up. It would improve the home if some or all of the rooms which are under 10 square metres could be enlarged. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Beech Lawn Residential Home Limited DS0000060475.V267645.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beech Lawn Residential Home Limited DS0000060475.V267645.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5. Prospective residents are given appropriate information to enable an informed choice to be made. The home also ensures that it can meet a person’s needs before an admission is agreed. EVIDENCE: The Statement of Purpose and the Residents Guide had been updated with the name of the new owner. A sample contract was included with the latter. The care plan of a resident who had only been in the home for two weeks included a full pre-admission assessment by the manager, as well as the social worker assessment. There had not yet been a review of the care plan as that would occur at the end of the trial period of four weeks. The home was planning to buy an electric hoist to replace the manual one. One resident was waiting to be assessed for a wheelchair by the Wheelchair Service. Beech Lawn Residential Home Limited DS0000060475.V267645.R01.S.doc Version 5.0 Page 9 Beech Lawn Residential Home Limited DS0000060475.V267645.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9. Residents are now better protected by the home’s drug administration procedures. However there is still some aspects which fail to meet the standards. Further protection will be ensured when the training of staff has been completed. Residents contribute to their care plans and to the reviews to ensure completeness and understanding of their needs. EVIDENCE: After the last inspection in July 2005, there were some outstanding requirements and recommendations following an earlier visit by the Commission’s pharmacy inspector, to ensure that the administration of medication was following approved and safe procedures. The home had responded to these within the stipulated timescale. This inspection was able to confirm that weekly audits of administration records were taking place; that hygienic practices were followed; that prescribed medication was administered and seen to be taken by the resident. One resident had signed their consent to self-medication, and one person kept their medication locked in their room but needed staff to administer it. A drug fridge was in place in the drug cupboard. Beech Lawn Residential Home Limited DS0000060475.V267645.R01.S.doc Version 5.0 Page 11 A resident confirmed that a chart was being kept to record each time they used their inhaler. Training for senior staff in the Safe Administration of Medication was continuing with Otley College. Five staff including the manager were finishing the programme, and another staff member was waiting to start. Care plans were reviewed each month by the key worker with the resident. This was confirmed by a resident who was also visited regularly by their social worker. Their care plan recorded a number of medical episodes recently, with the action taken. The resident also explained these to the inspector. The manager identified four residents whose mental health was causing concern. Two of these had been referred to the Community team for assessment. Staff were keeping a behavioural chart for one of them. None had been diagnosed with dementia. Beech Lawn Residential Home Limited DS0000060475.V267645.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15. Residents do not yet have enough variety of activities to meet their different needs, both inside and outside the home. The choice and quality of meals for residents have improved. EVIDENCE: Several residents had put on their Comment cards that there were not enough activities provided. Some repeated this during the visit. One resident regretted the loss of the exercise session which had been run by the wife of the previous owner. The manager agreed that she would try to obtain the equipment to start this activity again. She had also arranged a number of special Christmas musical events and a Christmas party. One of the staff was helping residents make Christmas cards on the day of the visit. A recent resident was tackling a jigsaw puzzle in the conservatory after lunch. In discussion with the inspector, the manager proposed to ask one of the care staff to take a lead role in identifying what residents wanted, planning these and encouraging residents to take part. It was recognised that residents had the right not to join in if they did not wish. Two residents told the inspector that they preferred their own company, as they always had. One resident was encouraged by the inspector to consider joining an outside interest group to continue something they had done while living at home. The home would help to arrange this if they wished. Several residents were accompanied to the nearby park. The private road was Beech Lawn Residential Home Limited DS0000060475.V267645.R01.S.doc Version 5.0 Page 13 in very poor condition for people with some mobility loss, and almost impossible for wheelchair users. The owner was trying to reach agreement with other householders to fill in the pot-holes to improve access. The manager said that the owner was thinking of buying a wheelchair access minibus to widen the choice of outings for residents. The home had recently started providing cooked breakfasts, and several residents came to the dining room for this. However, residents could choose to take breakfast in their own room. Residents who spoke to the inspector confirmed that they had this choice. Coincidentally the home was visited by the Environmental Health Officer the day after this inspection. All areas were found to be satisfactory except that the kitchen units were showing signs of wear and tear and would need refurbishing. Following a complaint earlier in the year, the home had responded positively to meet the wishes of a resident who was critical of the choice of food offered. The resident confirmed to the inspector that choice and quality had improved. Beech Lawn Residential Home Limited DS0000060475.V267645.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16. Residents can be sure that the home will respond to concerns and complaints in a prompt and positive way. EVIDENCE: The complaints record showed that seven complaints had been investigated by the home in the last twelve months. Response had been given to the complainants within the required time limits. Where the complaint was upheld, action was taken, and apologies given. The Commission also received a complaint about the care of a resident. It included matters relating to personal care, heating, quality of food, and staffing. 6 matters were not upheld, one was partly upheld, one was unresolved and one was upheld. The home had taken steps to prevent the re-occurrence of matters which were upheld, or partly upheld. Beech Lawn Residential Home Limited DS0000060475.V267645.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,24. Residents’ comfort will be improved with a proper re-furbishment plan. Their rooms are now warm and comfortable. EVIDENCE: The owner planned to convert the shared bedroom on the first floor into a single bed-sitting room. Work had already started. The home still has seven rooms measuring under 10 square metres, excluding the en-suites. Although these existed before the current national minimum standards were set and were therefore able to be registered, it would be good practice to have a plan to enlarge all or some of these over a reasonable period of time. Three bedrooms had been re-decorated, and one re-carpeted. The main lounge was in need of re-carpeting, and a decision was to be made shortly on this. The manager was still in the process of agreeing a longer term refurbishment plan with the owner as discussed when he took over. Beech Lawn Residential Home Limited DS0000060475.V267645.R01.S.doc Version 5.0 Page 16 Residents confirmed that the heating system had been improved, except for difficulties in one room at the end of a corridor, where an auxiliary heater was placed in the room. The home had now employed a maintenance man, and the manager had an on-going float for minor repairs and replacements. Beech Lawn Residential Home Limited DS0000060475.V267645.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29. The home has adjusted the staffing numbers to meet the needs of residents at a busy time. Staffing arrangements should be reviewed regularly to meet the changing needs of residents. The home’s recruitment procedures still cannot verify that proper safeguards are in place for the protection of residents. EVIDENCE: Several visitors commented that there were not always sufficient staff on duty. One resident said that they sometimes had to wait a long time for the call bell to be answered. However this resident said how nice it had been that morning when a carer had come in “and given me a cuddle.” Another resident said that staff had no time to stop and talk to residents, and “they only give me a dip bath not a nice soak.” The home had the minimum required staff on duty on each shift. Only one shift in the previous eight weeks had had to use an agency carer. There had been some changes to staff schedules earlier in the year to meet a criticism about the rushed workload around breakfast times. This should have given staff more time to talk and support residents. This was agreed by a senior carer. A review of workloads during the drug administration round in the evening would be beneficial. Beech Lawn Residential Home Limited DS0000060475.V267645.R01.S.doc Version 5.0 Page 18 Three staff files were inspected. One showed that the required procedures for checking the person’s application had not been followed. The person had started 4 weeks before the CRB certificate or the PovaFirst declaration had been received. Only one reference had been received, as a testimonial was not acceptable. There was also a gap in the employment record that had not been explained. There was no proof of the person’s identity nor a photograph. The manager said that she had been told by phone that another starter was clear on the Pova check, but the letter did not arrive until seven weeks later. The new cleaner had not been put through the CRB process. Beech Lawn Residential Home Limited DS0000060475.V267645.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,36,37,38. The manager of the home knows the residents well, and is responsive to their needs, and their concerns. A quality assurance plan is not in place to assure that residents’ best interests are safeguarded. The owner is not yet meeting Regulation 26 on monthly reporting, which would contribute to this safeguarding. The absence of a formal system of staff supervision reduces the effectiveness of the staff to meet residents’ needs. The improvement in the administration of medication has provided more protection for residents, but there is more compliance required in staff recruitment procedures before residents’ safety is assured. EVIDENCE: The manager had been in post since 1995, and held the NVQ Level 4 in Care and Management. The record of action taken to meet residents’ comments and complaints showed that she was responsive to their needs. Beech Lawn Residential Home Limited DS0000060475.V267645.R01.S.doc Version 5.0 Page 20 The manager had not yet started a formal supervision programme for staff. The owner had not yet undertaken the monthly unannounced visits with written reports to the Commission as required by Regulation 26. A maintenance man had been employed and the manager had an on-going small repairs and replacement budget. The home had a rudimentary Fire Risk Assessment statement but it was recommended that other information should be included. Beech Lawn Residential Home Limited DS0000060475.V267645.R01.S.doc Version 5.0 Page 21 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 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 X 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 2 X X X X 3 X X STAFFING Standard No Score 27 3 28 X 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X X 1 2 2 Beech Lawn Residential Home Limited DS0000060475.V267645.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement The registered person must that the quantity of medication signed as administered reconciles with the stock levels. The registered person must consult service users about the programme of activities arranged by the home, and provide facilities for activities in relation to recreation and fitness. The registered person must ensure that the premises are kept in a good state of repair, with an annual plan of maintenance and refurbishment. The registered person must immediately ensure that no person shall work at the home unless they have obtained the information and documents specified in this regulation. This requirement is repeated from the last inspection report. The registered person must undertake the monthly unannounced visits for the purposes listed in this regulation, and send copies of each report to the Commission’s local office. The registered person must begin a programme of formal DS0000060475.V267645.R01.S.doc Timescale for action 23/11/05 2 OP12 16(2) 31/12/05 3 OP19 23(2) 31/12/05 4 OP29 19(4) 23/11/05 5 OP33 26 23/11/05 6 OP36 18(2) 23/11/05 Beech Lawn Residential Home Limited Version 5.0 Page 23 supervision immediately. 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 Refer to Standard OP27 OP38 Good Practice Recommendations The registered person should review the workloads for the period in the evening when the two shifts are changing over, and the late evening drug round is in progress. The registered person should produce an enlarged Fire Risk Assessment to cover all aspects of fire prevention systems, fire detection, maintenance of equipment, fire training and fire drills, and any special risk assessments. Beech Lawn Residential Home Limited DS0000060475.V267645.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Beech Lawn Residential Home Limited DS0000060475.V267645.R01.S.doc Version 5.0 Page 25 - 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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